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]Hoy D, March L, Brooks P, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014 Jun;73(6):968-74. https://www.doi.org/10.1136/annrheumdis-2013-204428 http://www.ncbi.nlm.nih.gov/pubmed/24665116?tool=bestpractice.com 时点患病率为 9.4%，终身患病率超过 80%。[1]Hoy D, March L, Brooks P, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014 Jun;73(6):968-74. https://www.doi.org/10.1136/annrheumdis-2013-204428 http://www.ncbi.nlm.nih.gov/pubmed/24665116?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基础疾病。大多数急性 LBP 患者的总体预后较好，因为 90% 的患者恢复后无后遗症。[4]Spitzer WO, LeBlanc FE, Dupuis M, et al. Scientific approach to the assessment and management of activity-related spinal disorders: a monograph for clinicians. Report of the Quebec Task Force on Spinal Disorders. Spine. 1987 Sep;12(7 Suppl):S1-59. http://www.ncbi.nlm.nih.gov/pubmed/2961086?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腰痛（症状持续超过 6 个月）而丧失行为能力。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。[5]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。