青年腰椎前凸角变化对下腰痛的影响及临床干预策略

Influence of lumbar lordosis angle change on low back pain in young people and clinical intervention strategy

目的探讨青年腰椎前凸角变化对下腰痛(low back pain,LBP)的影响,并分析实施临床干预的效果。方法选取2019年1月至10月于河南大学第一附属医院骨科门诊或病房接受诊治的青年LBP患者46例为LBP组,同期经河南大学第一附属医院体检健康青年30例为对照组。拍摄站立位腰椎侧位X线片,Cobb法测量总腰椎前凸角及节段前凸角,组间比较角度差异。对LBP组实施核心肌力训练,周期3个月,观测LBP症状缓解程度及腰椎前凸角变化。结果LBP组总腰椎前凸角为(46.7±9.5)°,对照组为(54.2±8.2)°,组间比较差异有统计学意义(t=-3.546,P=0.0007);LBP组总腰椎前凸角的丢失主要来自L4/5、L5S1节段前凸角减小(P<0.05)。核心肌力训练后,LBP组疼痛视觉模拟评分(VAS评分)较前显著降低,总前凸角、L4/5节段前凸角较前增加,差异有统计学意义(P<0.05)。结论腰椎前凸角的变化可能是引起青年LBP的主要原因。核心肌力训练有助于纠正腰椎前凸角变化、改善临床症状。

Objective To investigate the influence of lumbar lordosis angle change on low back pain in young people,and to analyze the effect of clinical intervention.Methods Forty-six young patients with low back pain(LBP)were included in the LBP group,and 30 healthy young people who underwent physical examination in the First Affiliated Hospital of Henan University were included in the control group.Lateral lumbar radiographs were taken in standing position.The total lumbar lordosis angle and segmental lordosis angle were measured by Cobb method,and the angle differences were compared between groups.Core muscle strength training was carried out in LBP group for 3 months,and the degree of relief of low back pain symptoms and changes of lumbar lordosis angle were observed.Results The total lumbar lordosis angle was(46.7±9.5)in the LBP group and(54.2±8.2)in the control group,and the difference was statistically significant(t=-3.546,P=0.0007).The loss of total lumbar lordosis angle in LBP group was mainly due to the decrease of L4/5 and L5S1 lordosis angle(P<0.05).After core muscle strength training,the visual analogue scale(VAS)score of pain in the LBP group was significantly lower than before,and the total lordosis angle and L4/5 lordosis angle were increased compared with before,and the differences were statistically significant(P<0.05).Conclusion The changes of lumbar lordosis angle may be the main cause of LBP in young people.Core muscle strength training is helpful to correct the changes of lumbar lordosis angle and improve clinical symptoms.