腰背痛的评估

在全球范围内，腰痛（low back pain, LBP）导致残疾的情况多于其他任何病症。[1]Wu A, March L, Zheng X, et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Ann Transl Med. 2020 Mar;8(6):299. https://www.doi.org/10.21037/atm.2020.02.175 http://www.ncbi.nlm.nih.gov/pubmed/32355743?tool=bestpractice.com 时点患病率为 7.5%，终身患病率超过 80%。[1]Wu A, March L, Zheng X, et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Ann Transl Med. 2020 Mar;8(6):299. https://www.doi.org/10.21037/atm.2020.02.175 http://www.ncbi.nlm.nih.gov/pubmed/32355743?tool=bestpractice.com [2]Balagué F, Mannion AF, Pellisé F, et al. Non-specific low back pain. Lancet. 2012 Feb 4;379(9814):482-91. http://www.ncbi.nlm.nih.gov/pubmed/21982256?tool=bestpractice.com LBP 占急诊科就诊人次的 4%，为十大最常见主诉之一。[3]Edwards J, Hayden J, Asbridge M, et al. Prevalence of low back pain in emergency settings: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2017 Apr 4;18(1):143. https://www.doi.org/10.1186/s12891-017-1511-7 http://www.ncbi.nlm.nih.gov/pubmed/28376873?tool=bestpractice.com

患者初次就诊时的主要目的是评估患者的症状是否提示更加严重的潜在疾病。[4]Oliveira CB, Maher CG, Pinto RZ, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018 Nov;27(11):2791-2803. https://www.doi.org/10.1007/s00586-018-5673-2 http://www.ncbi.nlm.nih.gov/pubmed/29971708?tool=bestpractice.com 急性 LBP 患者的总体预后较好，大多数患者恢复后无后遗症。[5]Henschke N, Maher CG, Refshauge KM, et al. Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study. BMJ. 2008 Jul 7;337:a171. https://www.doi.org/10.1136/bmj.a171 http://www.ncbi.nlm.nih.gov/pubmed/18614473?tool=bestpractice.com [6]Williams CM, Maher CG, Latimer J, et al. Efficacy of paracetamol for acute low-back pain: a double-blind, randomised controlled trial. Lancet. 2014 Nov 1;384(9954):1586-96. https://www.doi.org/10.1016/S0140-6736(14)60805-9 http://www.ncbi.nlm.nih.gov/pubmed/25064594?tool=bestpractice.com 症状复发很常见，但大多数复发不会导致残疾。

有一小部分人群会因慢性 LBP（症状持续时间 >12 周）而无法正常活动。[7]Qaseem A, Wilt TJ, McLean RM, et al. Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017 Apr 4;166(7):514-530. https://www.doi.org/10.7326/M16-2367 http://www.ncbi.nlm.nih.gov/pubmed/28192789?tool=bestpractice.com 研究发现，若干因素会增加致残性 LBP 的发生风险。具体包括：不适应性疼痛应对行为、非器质性体征、功能障碍、一般健康状况差以及精神合并症。[8]Chou R, Shekelle P. Will this patient develop persistent disabling low back pain? JAMA. 2010 Apr 7;303(13):1295-302. http://www.ncbi.nlm.nih.gov/pubmed/20371789?tool=bestpractice.com 医生在询问和治疗患者的时候要考虑这些危险因素。