多发性硬化患者的腰背痛危险因素分析

Risk factors analysis for low back pain in patients with multiple sclerosis

目的 :通过调查多发性硬化患者的肌肉骨骼疾病及腰背痛,试图找到相关的危险因素。方法 :选择我院确诊为多发性硬化并且EDSS评分在4~7分的患者进行研究。收集记录患者的病史、疼痛、肌肉骨骼疾病、肌力和下肢痉挛状态。结果:190例患者被纳入研究对象,平均年龄(54.9±9.2)岁,男61例,女129例,病程(19.3±9.9)年,EDSS 4~7分。52例为复发缓解型,45例为原发进展型,93例为继发进展型。最常见的肌肉骨骼疾病表现为:膝关节骨关节炎(15例),爪状趾(13例),膝关节过伸(12例)。腰背痛患者共79例,在进展型患者中则更高(继发进展型:OR=2.958,P=0.007 9;原发进展型:OR=2.629,P=0.039 8)。EDSS量表中出现视觉功能障碍的患者,则出现腰背痛的概率越大(OR=1.411,P=0.012 4)),男性患者较女性患者腰背痛少(OR=0.306,P=0.001 4)。结论 :进展型及出现了视觉功能障碍的多发性硬化患者拥有更高的腰背痛风险。

Objective：To investigate musculoskeletal disorders and risk factors of low back pain in multiple sclerosis（MS）patients.Methods：In this study,patients in our hospital with confirmed MS with an expanded disabilitystatus scale（EDSS）score between 4 to 7 were selected.Data of MS history,pain,musculoskeletal disorders,muscle strength and spasticity in lower limbs were collected.Results：Among 190 patients,there were 61 males and 129 females,with an average age of（54.9±9.2）years old.The mean disease duration was（19.3 ±9.9） years,and the median EDSS score was 6.Forty-two patients were relapsingremitting type,45 patients were primary progressive type,and 93 patients were secondary progressive type.The most common musculoskeletal disorders were described as follows：knee osteoarthritis（15 cases）,claw toe（13 cases） and genu recurvatum（12 cases）.Seventy-nine patients with prevalence low back pain was higher than in patients with a progressive type（secondary：OR =2.958,P=0.007 9,primary（OR =2.629,P=0.039 8） and in patients who had a visual dysfunction at EDSS score（OR=1.411,P=0.012 4）.The prevalence was reduced in male patients（OR =0.306,P=0.001 4）.Conclusion：The progressive type of MS and visual dysfunction increased the risk of low back pain in these patients.