非特异性腰痛的对因治疗

Cause-specific treatment for nonspecific low back pain

非特异性腰痛是长期困扰临床医师的难题,目前存在着诊断混乱、疗效差的状况。为了明确病因以及做到对因治疗,我院进行了长期的基础和临床研究,并做了大量的文献调研,在此基础上总结出了几类非特异性腰痛的病因诊断及对因治疗措施。(1)脊神经后支综合征:因脊神经后支主干受机械刺激所致,治疗方法有液氮冷冻脊神经后支等。(2)腰椎间盘源性腰痛:由于腰椎间盘变性所致,可行腰椎间盘切除。(3)小关节综合征:小关节本身病变引发腰痛的情况很少,多数是由于小关节脱位刺激了旁边的脊神经后支所致。治疗方法同脊神经后支综合征。(4)腰椎不稳:由椎间连接松弛所致,可行腰椎融合。(5)棘上棘间韧带损伤:因棘间韧带损伤所致,疗法有封闭加小针刀松解术等。(6)内脏源性腰痛:是盆腔疾患的牵涉性痛,治疗原发病是关键。此几类非特异性腰痛的病因诊断及对因治疗措施供同行参考、商榷。

Nonspecific low back pain has long been a troublesome clinical entity in that the diagnoses are usually hard to define, and the effect of treatment unsure. We have been conducting long-term basic and clinical research in Zhujiang Hospital in an effort to find the exact mechanism for this disease and to explore its causal treatment. On the basis of literature review and treatment result evaluation, we recommend the following approaches for origin-specific diagnosis and treatments: (1) For spinal nerve dorsal ramus syndrome caused by mechanical stimulation on the stem part of the dorsal ramus, freezing the dorsal ramus with liquid-nitrogen may constitute the primary treatment. (2) In cases of low back pain originated from the lumbar disc due to degeneration of discs, treatment may be implemented through disc resection with or without arthrodesis. (3) Facet syndrome, a condition with low back pain that is seldom caused by pathological changes in the facet itself, but mostly by the pulling of the dorsal ramus due to the dislocation of the facet, should be attributed to the dorsal ramus syndrome. (4) Lumbar vertebra instability arising from loosened intervertebral conjunction calls for arthrodesis as the primary choice. (5) Interspinal ligaments injury can be most effectively treated by the combination of blocking and needle knife loosing. (6) Low back pain with underlying causes in the internal organs is often caused by diseases in the pelvic organs, and only these diseases are cured can the back pain be relieved. These origin-specific diagnosis and treatments we proposed here await further investigation and comments from our peers interested in this problem.