脑力劳动者与体力劳动者慢性非特异性腰痛的临床和影像特点比较  

A comparison of clinical and imaging characteristics of chronic nonspecific low back pain between manual workers and mental workers

作　　者：谢峰[1] 王立刚 边俊[1] 景成伟 陈维善[2] XIE Feng;WANG Ligang;BIAN Jun;JING Chengwei;CHEN Weishan(Shaoxing Hospital of Traditional Chinese Medicine,Shaoxing 312000,Zhejiang,China;The Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,Zhejiang,China)

机构地区：[1]绍兴市中医院,浙江绍兴312000 [2]浙江大学医学院附属第二医院,浙江杭州310009

出　　处：《中医正骨》2019年第4期22-25,共4页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的:比较脑力劳动者与体力劳动者慢性非特异性腰痛的临床和影像特点。方法:回顾性分析39例慢性非特异性腰痛患者的病例资料,其中脑力劳动者18例(脑力劳动组)、体力劳动者21例(体力劳动组)。男11例,女28例。年龄31～60岁,中位数48岁。比较2组患者治疗前的腰痛视觉模拟量表(visual analogue scale,VAS)评分、汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)评分以及口服美洛昔康片2周后的临床疗效,观察腰椎骨赘情况,测量并比较2组患者的脊柱全长X线片上骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS)、胸腰联合角(thoracolumbar junction,TLJ)、T_1脊柱骨盆倾斜角(T_1-spinopelvic inclination,T_1-SPi)、T_9脊柱骨盆倾斜角(T_9-spinopelvic inclination,T_9-SPi)、腰椎前凸角(lumbar lordosis,LL)、胸椎后凸角(thoracic kyphosis,TK)、矢状面轴向垂直距离(sagittal vertical axis,SVA)。结果:治疗前,2组患者的腰痛VAS评分比较,差异无统计学意义[(4.8±0.9)分,(4.4±0.9)分,t=1.579,P=0.123];脑力劳动组的HAMA评分高于体力劳动组[(13.0±5.1)分,(9.8±3.4)分,t=2.289,P=0.030]。口服美洛昔康片2周后,脑力劳动组有效13例、无效5例,体力劳动组有效18例、无效3例,2组患者的临床疗效比较差异无统计学意义(χ~2=1.082,P=0.298)。脑力劳动组5例有腰椎骨赘、体力劳动组18例有腰椎骨赘,脑力劳动组的腰椎骨赘发生率低于体力劳动组(χ~2=13.447,P=0.000)。2组患者PI、PT、SS、TLJ、T_1-SPi、LL、SVA比较,组间差异均无统计学意义[47.6°±11.3°,51.7°±8.5°,t=-1.303,P=0.201;15.3°±10.7°,17.7°±7.9°,t=-0.778,P=0.441;32.2°±6.8°,34.0°±8.5°,t=-0.722,P=0.475;6.8°±5.4°,10.3°±9.2°,t=-1.439,P=0.159;-2.0°±3.0°,-3.5°±3.7°,t=1.387,P=0.174;-34.1°±22.4°,-28.3°±42.5°,t=-0.538,P=0.595;(33.0±28.1)mm,(19.7±36.6)mm,t=1.265,P=0.214];脑力劳动组的T_9-SPi大于体力劳动组(-6.3°±4.0°,-10.2°±4.5Objective:To compare the clinical and imaging characteristics of chronic nonspecific low back pain(CNLBP)between mental workers and manual workers.Methods:The medical records of 39 patients with CNLBP(11 males and 28 females)between the ages of 31 and 60(Median=48 yrs)were analyzed retrospectively.The patients consisted of 18 mental workers(mental-work group)and 21 manual workers(manual-work group).The low back pain visual analogue scale(VAS)scores and Hamilton anxiety scale(HAMA)scores measured before the treatment and the clinical curative effects evaluated after 2-week oral application of meloxicam tablets were compared between the 2 groups.The lumbar vertebrae osteophytes were observed and pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),thoracolumbar junction(TLJ),T 1-spinopelvic inclination(T 1-SPi),T 9-spinopelvic inclination(T 9-SPi),lumbar lordosis(LL),thoracic kyphosis(TK) and sagittal vertical axis(SVA)on whole spine X-ray films were measured and compared between the 2 groups.Results:There was no statistical difference in low back pain VAS scores between the 2 groups before the treatment(4.8+/-0.9 vs 4.4+/-0.9 points,t=1.579,P=0.123).The HAMA scores were higher in mental-work group compared to manual-work group(13.0+/-5.1 vs 9.8+/-3.4 points, t=2.289,P =0.030).After 2-week oral application of meloxicam tablets,13 patients got a good therapeutic result and 5 patients got a poor therapeutic result in mental-work group,while 18 patients got a good therapeutic result and 3 patients got a poor therapeutic result in manual-work group.There was no statistical difference in clinical curative effects between the 2 groups(χ^2=1.082, P =0.298 ).The lumbar vertebrae osteophytes were found in mental-work group(5)and manual-work group(18).The incidence rates of lumbar vertebrae osteophytes were lower in mental-work group compared to manual-work group(χ 2=13.447,P =0.000).There was no statistical difference in PI,PT,SS,TLJ,T 1-SPi,LL and SVA between the 2 groups(47.6+/-11.3 vs 51.7+/-8.5 degrees, t=-1.303,P =0

关 键 词：腰痛 体力劳动者 脑力劳动者 

分 类 号：R681.5[医药卫生—骨科学]