髋关节影像学表现与腰痛患者疼痛和功能的相关性。
Association of Hip Radiograph Findings With Pain and Function in Patients Presenting With Low Back Pain.
机构信息
Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8233, St. Louis, MO 63110.
Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL.
出版信息
PM R. 2018 Jan;10(1):11-18. doi: 10.1016/j.pmrj.2017.06.003. Epub 2017 Jun 16.
BACKGROUND
Relationships between low back pain (LBP) and the hip in patient cohorts have been described primarily in patients with moderate to severe hip osteoarthritis (OA). Less is known about the links of LBP with hip radiographic findings of hip deformity and minimal OA.
OBJECTIVE
To describe the incidence of radiographic hip deformity or hip OA; to describe and compare spine- and hip-related pain and function in the subset of patients who were found to have radiographic hip deformity or hip OA; and to compare patients with evidence of radiographic hip deformity or hip OA to patients without hip radiographic findings.
DESIGN
Prospective cohort study with cross-sectional design.
SETTING
Tertiary university.
PATIENTS
A total of 63 patients (40 women, 23 men) with a mean age of 48.5 ± 14 years with LBP and a minimum of one positive provocative hip test.
METHODS
Hip radiographs were assessed by an independent examiner for hip OA and deformity.
MAIN OUTCOME MEASUREMENTS
Comparisons of hip and lumbar spine pain and function were completed for patients with radiographic findings of hip OA or deformity.
RESULTS
Moderate to severe hip OA was found in 12 of 60 patients (20.0%). At least one measurement of femoroacetabular impingement (FAI) was found in 14 of 60 patients (23.3%) to 33 of 45 patients (73.3%). At least one measurement of developmental hip dysplasia (DDH) was found in 7 of 60 patients (11.6%) to 11 of 63 patients (17.4%). Greater pain and reduced hip and lumbar spine function were found in the patients with moderate to severe hip OA. Patients with LBP and FAI were found to have significantly greater extremes of pain and reduced lumbar spine function.
CONCLUSION
Links between the hip and the spine affecting pain and function may be found in patients with LBP and hip deformity and before the onset of radiographic hip OA, and may be associated with hip deformity. Further investigation is needed to better understand these links and their potential impact on prognosis and treatment of LBP.
LEVEL OF EVIDENCE
II.
背景
在中重度髋关节炎（OA）患者队列中，腰背痛（LBP）与髋关节之间的关系主要描述为患者髋关节。然而，对于髋关节影像学发现髋关节畸形和轻微 OA 与 LBP 的联系知之甚少。
目的
描述放射影像学髋关节畸形或髋关节 OA 的发生率；描述和比较在发现放射影像学髋关节畸形或髋关节 OA 的患者亚组中脊柱和髋关节相关的疼痛和功能；并比较有放射影像学髋关节畸形或髋关节 OA 证据的患者与无髋关节放射影像学发现的患者。
设计
前瞻性队列研究，具有横断面设计。
地点
三级大学。
患者
共 63 例（40 名女性，23 名男性），平均年龄 48.5±14 岁，至少有一个阳性髋关节激发试验。
方法
由独立的检查者对髋关节进行放射影像学评估，用于髋关节 OA 和畸形的评估。
主要观察指标
对有髋关节 OA 或畸形放射影像学表现的患者进行髋关节和腰椎疼痛和功能的比较。
结果
在 60 例患者中，发现 12 例（20.0%）为中重度髋关节炎。在 60 例患者中，至少有 14 例（23.3%）有股骨髋臼撞击症（FAI），而 45 例患者中有 33 例（73.3%）有 FAI。在 60 例患者中，至少有 7 例（11.6%）有发育性髋关节发育不良（DDH），而 63 例患者中有 11 例（17.4%）有 DDH。在中重度髋关节炎患者中发现更严重的疼痛和髋关节和腰椎功能降低。有 LBP 和 FAI 的患者发现疼痛和腰椎功能明显更严重。
结论
在 LBP 和髋关节畸形患者中，可能发现影响疼痛和功能的髋关节和脊柱之间的联系，并且在放射影像学髋关节 OA 出现之前，这些联系可能与髋关节畸形有关。需要进一步研究以更好地了解这些联系及其对 LBP 预后和治疗的潜在影响。
证据等级
II 级。
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