Weber M, Morgenthaler M
Orthopädische Abteilung der Chirurgischen Universitätsklinik Freiburg.
Z Orthop Ihre Grenzgeb. 1997 Sep-Oct;135(5):386-93. doi: 10.1055/s-2008-1039406.
Are there any radiological criterions which are able to indicate the profession related disease No. 2108?
The medical documents and x-rays of the whole spine of 390 back pain patients who applied for a profession related disease of the spine were evaluated. Those patients who fulfilled the professional claims for acknowledgement of the profession related disease were compared to those who didn't fulfill these conditions.
Concerning the segmental alterations of the cervical and the lumbal spine specific allocation frequencies were found. The dominance of L3/4 in the comparison group was conspicuous. Looking at the allocation frequencies of the cervical and lumbal disc alterations in view of affection heaviness it was obvious, that the predominating slight alterations mainly were located in the central parts of the cervical and the lumbal spine whereas bad alterations mainly were found in the lower parts. Regarding this matter test and comparison groups behaved the same way. Looking at the allocation frequencies concerning single respectively multiple alterations it was found that in the comparison group single respectively bisegmentale alterations could be recognized even in duplicate than in the test group in which the multiple alterations were dominant. The comparison of the cervical and the lumbal spine regarding chondrotic? spondylotic, slight and bad alterations in all mentioned features the next deeper located segment was affected particularly in the test group. Therefore a distal shift of the chondrotic alterations could be recognized. In case of the spondylotic affections it was the other way round: a cranial shift was conspicuous.
After doing heavy labour for years only a few isolated multiple affections of the lumbal spine are found. On the strength of this fact the proof of exclusively in the lumbal spine located alterations doesn't allow the acknowledgement of a profession related disease. However, a distal shift of osteochondrotic alterations respectively a cranial shift of spondylotic affections in the lumbal spine is suspicous for being job-related. L3/4 takes a very special place in the differential diagnosis of profession related disease of the spine. In the test group this part of the lumbal spine showed bad alterations much more frequent. The affection of L3/4 pleads against a considerable participation of mechanical influences and therefore against a profession related disease. Singular or bisegmental disc affections are out of question for being a profession related disease because these alterations are seen much more frequent in the comparison than in the test group.
是否存在能够指示职业相关疾病2108的放射学标准？
对390名申请脊柱职业相关疾病的背痛患者的医学文件和全脊柱X光片进行评估。将符合职业相关疾病认定职业要求的患者与不符合这些条件的患者进行比较。
发现了颈椎和腰椎节段性改变的特定分布频率。对照组中L3/4的优势明显。从颈椎和腰椎间盘改变的分布频率来看，考虑到病变严重程度，明显的是，主要的轻度改变主要位于颈椎和腰椎的中央部分，而严重改变主要出现在下部。在这方面，测试组和对照组表现相同。从单个或多个改变的分布频率来看，发现对照组中单个或双节段改变的发生率甚至是测试组的两倍，测试组中多个改变占主导。比较颈椎和腰椎在软骨性、骨性关节炎性、轻度和重度改变方面，在所有提到的特征中，测试组中位置更深的节段尤其受到影响。因此，可以识别出软骨性改变的远端移位。在骨性关节炎性病变的情况下则相反：明显的是近端移位。
多年从事重体力劳动后，仅发现少数孤立的腰椎多处病变。基于这一事实，仅位于腰椎的改变证据不足以认定职业相关疾病。然而，腰椎中骨软骨性改变的远端移位或骨性关节炎性病变的近端移位可疑与工作相关。L3/4在脊柱职业相关疾病的鉴别诊断中占有非常特殊的地位。在测试组中，腰椎的这一部分显示严重改变的频率更高。L3/4的受累不利于机械影响的显著参与，因此也不利于职业相关疾病。单个或双节段椎间盘病变毫无疑问是职业相关疾病，因为这些改变在对照组中比在测试组中更常见。
