Harreby M, Neergaard K, Hesselsøe G, Kjer J
Department of Rheumatology, Centralsygehuset, Naestved, Denmark.
Spine (Phila Pa 1976). 1995 Nov 1;20(21):2298-302. doi: 10.1097/00007632-199511000-00007.
This report was based on a 25-year prospective cohort study and designed as a self-administered questionnaire with low back pain as the main topic.
To identify whether radiologic changes in the thoracic and lumbar spine and a history of low back pain in the adolescent period represent risk factors for low back pain in adults.
Six-hundred-forty 14-year-old school children were examined with x-rays of the thoracic and lumbar spine and registered by the school doctor regarding a history of low back pain.
All of the x-rays and the short journals from the school doctor's registration were reviewed. This primary information was the basis of the investigation 25 years later.
Eleven percent of the cohort had a history of low back pain in adolescence, and the results showed an 84% lifetime prevalence of low back pain in these subjects as adults and an increased frequency of low back pain the last month and week before they answered the questionnaire, compared with the rest of the cohort. These problems were associated with increased morbidity and decreased working capacity. Thirteen percent had radiologic abnormalities, mainly Scheuermann changes, in the thoracic and lumbar spine as adolescents, with no positive correlation to low back pain in this period. Unlike other reports, our results did not confirm a positive correlation between x-ray changes in the lower spine in adolescents and a higher prevalence of low back pain in adults. Stepwise logistic regression analyses showed that low back pain in the growth period and familial occurrence of back disease are important risk factors for low back pain later in life, with an observed probability of 88% if both factors are present.
This study suggests that low back pain in the growth period is "a real problem," with a trend toward aggravation as time passes. Thus, implementing preventive measures in schools may be very important.
本报告基于一项为期25年的前瞻性队列研究，设计为以腰痛为主要主题的自填式问卷。
确定青少年时期胸腰椎的放射学改变及腰痛病史是否为成人腰痛的危险因素。
对640名14岁学童进行了胸腰椎X线检查，并由校医记录其腰痛病史。
回顾了所有X线片和校医登记的简短记录。这些原始信息是25年后调查的基础。
该队列中有11%的人在青少年时期有腰痛病史，结果显示这些受试者成年后腰痛的终生患病率为84%，与队列中的其他人相比，在回答问卷前的最后一个月和一周内腰痛频率增加。这些问题与发病率增加和工作能力下降有关。13%的人在青少年时期胸腰椎有放射学异常，主要是休门氏改变，与这一时期的腰痛无正相关。与其他报告不同，我们的结果未证实青少年下脊柱X线改变与成人腰痛患病率较高之间存在正相关。逐步逻辑回归分析显示，生长期腰痛和家族性背部疾病是日后腰痛的重要危险因素，如果这两个因素都存在，观察到的概率为88%。
本研究表明，生长期腰痛是“一个实际问题”，且有随时间加重的趋势。因此，在学校实施预防措施可能非常重要。
