Bernard T N, Kirkaldy-Willis W H
Clin Orthop Relat Res. 1987 Apr(217):266-80.
A retrospective review of 1293 cases of low back pain treated over a 12-year period revealed that sacroiliac joint syndrome and posterior joint syndromes were the most common referred-pain syndromes, whereas herniated nucleus pulposus and lateral spinal stenosis were the most common nerve root compression lesions. Referred pain syndromes occur nearly twice as often and frequently mimic the clinical presentation of nerve root compression syndromes. Combined lesions occurred in 33.5% of cases. Lateral spinal stenosis and herniated nucleus pulposus coexisted in 17.7%. In 30% of the cases of spondylolisthesis, the radiographic findings were incidental and the source of pain was the sacroiliac joint. Distinguishing radicular from referred pain, recognition of coexisting lesions, and correlation of diagnostic imaging with the overall clinical presentation facilities formulation of a rational plan of therapy. The above-outlined approach to managing low back pain evolved over a 12-year period. Designed to establish a specific diagnosis, it should yield excellent or good results in 84% of patients.
对1293例在12年期间接受治疗的腰痛患者进行的回顾性研究显示，骶髂关节综合征和后关节综合征是最常见的牵涉痛综合征，而椎间盘突出症和腰椎管狭窄症是最常见的神经根受压病变。牵涉痛综合征的发生率几乎是神经根受压综合征的两倍，且常常模仿神经根受压综合征的临床表现。33.5%的病例存在合并病变。腰椎管狭窄症和椎间盘突出症共存的情况占17.7%。在30%的腰椎滑脱病例中，影像学检查结果是偶然发现的，疼痛来源是骶髂关节。区分神经根性疼痛和牵涉痛、识别合并存在的病变以及将诊断性影像学检查结果与整体临床表现相关联，有助于制定合理的治疗方案。上述处理腰痛的方法是在12年期间逐步形成的。旨在确立明确诊断，该方法应能使84%的患者获得优或良的治疗效果。
