坐骨神经痛病例中的循证预后评估
Evidence-based prognostication in a case of sciatica.
作者信息
Emary Peter C
机构信息
Master of Science (MSc) Candidate, MSc Advanced Professional Practice (Clinical Sciences), Anglo-European College of Chiropractic, 13-15 Parkwood Road, Bournemouth, Dorset, BH5 2DF, United Kingdom ; Private Practice, 201C Preston Parkway, Cambridge, ON, N3H 5E8, Canada E-mail:
出版信息
J Can Chiropr Assoc. 2015 Mar;59(1):24-9.
OBJECTIVE
To present an evidence-based case report on the prognosis of a patient with sciatica.
CASE
A 43-year-old man presented with right-sided buttock and lower extremity pain and numbness of 10 weeks' duration. Magnetic resonance imaging revealed a lumbosacral disc herniation. Straight leg raise testing provoked the patient's right sciatic pain, and neurologic examination revealed a diminished right Achilles tendon reflex and mild hypoesthesia along the patient's outer right foot.
OUTCOME
PubMed was searched and two cohort studies relevant to sciatic prognosis were found. These articles were critically appraised for their validity, importance, and applicability in making a prognostic estimate for this particular patient. Based on the appraised research evidence, and the confidence intervals calculated therein, the overall prognosis for sciatic pain recovery with conservative care was estimated as favourable for this patient, though sensory recovery (even with surgical care) was not.
SUMMARY
This case report illustrates how to use research literature in estimating the clinical prognosis for an individual patient, and how this can be useful towards clinical decision-making concerning treatment.
目的
提供一份关于坐骨神经痛患者预后的循证病例报告。
病例
一名43岁男性，出现右侧臀部及下肢疼痛和麻木10周。磁共振成像显示腰骶椎间盘突出。直腿抬高试验诱发患者右侧坐骨神经痛，神经学检查显示右侧跟腱反射减弱，右足外侧轻度感觉减退。
结果
检索了PubMed，发现两项与坐骨神经预后相关的队列研究。对这些文章的有效性、重要性和在对该特定患者进行预后评估中的适用性进行了严格评价。基于评价的研究证据及其计算的置信区间，估计该患者保守治疗坐骨神经痛恢复的总体预后良好，尽管感觉恢复（即使手术治疗）不佳。
总结
本病例报告说明了如何利用研究文献评估个体患者的临床预后，以及这对治疗的临床决策有何帮助。
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