腰背痛的评估

背痛极为常见，且尤其是腰痛（low back pain, LBP）在全球范围内造成的失能多于其他任何疾病。[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]Hartvigsen J, Hancock MJ, Kongsted A, et al. What low back pain is and why we need to pay attention. Lancet. 2018 Jun 9;391(10137):2356-67. http://www.ncbi.nlm.nih.gov/pubmed/29573870?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 [3]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。[4]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。[5]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 病史和体格检查有助于明确疼痛模式（例如，神经根性疼痛还是腰骶部疼痛），但极少能确定疼痛的准确解剖部位。[2]Hartvigsen J, Hancock MJ, Kongsted A, et al. What low back pain is and why we need to pay attention. Lancet. 2018 Jun 9;391(10137):2356-67. http://www.ncbi.nlm.nih.gov/pubmed/29573870?tool=bestpractice.com 病因可细分为机械性、全身性或牵涉性，其中机械性病因最常见。[6]Deyo RA, Weinstein JN. Low back pain. N Engl J Med. 2001 Feb 1;344(5):363-70. http://www.ncbi.nlm.nih.gov/pubmed/11172169?tool=bestpractice.com ​ 非专科就诊的多数腰痛患者，无论有无坐骨神经痛，无需常规进行实验室检查。[7]National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management. Dec 2020 [internet publication]. https://www.nice.org.uk/guidance/ng59 ​

一部分患者会出现慢性 LBP，定义为症状持续＞12 周。[8]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 使风险增加的因素包括不良的疼痛应对行为、非器质性体征、功能障碍、总体健康状况不佳、睡眠障碍和精神合并症。[9]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 [10]Beynon AM, Hebert JJ, Hodgetts CJ, et al. Chronic physical illnesses, mental health disorders, and psychological features as potential risk factors for back pain from childhood to young adulthood: a systematic review with meta-analysis. Eur Spine J. 2020 Mar;29(3):480-96. http://www.ncbi.nlm.nih.gov/pubmed/31907659?tool=bestpractice.com [11]Felício DC, Filho JE, de Oliveira TMD, et al. Risk factors for non-specific low back pain in older people: a systematic review with meta-analysis. Arch Orthop Trauma Surg. 2022 Dec;142(12):3633-42. http://www.ncbi.nlm.nih.gov/pubmed/34021388?tool=bestpractice.com [12]Amiri S, Behnezhad S. Sleep disturbances and back pain: systematic review and meta-analysis. Neuropsychiatr. 2020 Jun;34(2):74-84. http://www.ncbi.nlm.nih.gov/pubmed/32166629?tool=bestpractice.com ​ 临床医师在询问或治疗患者时应注意这些危险因素。