115例20～30岁正常国人腰椎数据测量与其临床意义

115例20～30岁正常国人腰椎数据测量与其临床意义 115例20,30岁正常国人腰椎数据测量与其临床意义 暨南大学硕士学位论文 115 例 20~30岁正常国人腰椎数据测量与其临床意义 摘要 目的:为建立 20~30岁正常国人腰椎数据库提供理论依据和基础数据。 方法:选择南方地区 20~30岁健康正常人 115例男性 48例,女性 67例行腰椎正侧 位,过屈、过伸位 CR 片检查,采用国际通用的测量方法、国内通用的医用测量软件华海 MedRis测量出椎体上、中、下横径,椎体上、中、下矢状径,椎体前、中、后高度,椎 管矢状径,椎体间平移量,腰椎生理弯曲度,腰椎活动度,同时计算出椎间隙高度指数、 椎间曲度指数、椎间隙高度/椎体高度比值、椎间隙高度Hp/Ha比值。 结果:1. 椎间隙高度单位:mm:L1/L2~L5/S1前缘椎间隙高度范围男性为 12.09~ 17.51,女性为 10.30~15.83;中间椎间隙高度范围男性为 12.43~16.72,女性为 12.32~ 15.40;后缘椎间隙高度范围男性为 6.11~8.96,女性为 6.02~8.10。2.椎体高度单位:mm: L1~L5前缘椎体高度范围男性为 29.55~32.59,女性为 29.09~31.46;中间椎体高度范围 男性为 27.25~29.15,女性为 25.93~27.45;后缘椎体高度范围男性为 29.57~33.86,女性 为 28.38~31.90。3.椎体矢状径单位:mm:L1~L5上缘椎体矢状径长度范围男性为 39.25~42.22,女性为 34.73~38.08;椎体中间矢状径长度范围男性为 35.66~39.05,女性 为 32.16~35.74;下缘椎体矢状径长度范围男性为 40.02~42.63,女性为 35.60~38.20。4. 椎体横径单位:mm: L1~L5上缘椎体横径长度范围男性为 48.44~59.60,女性为 42.24~ 54.87;中间椎体横径长度范围男性为 43.78~55.42,女性为 38.66~52.33;下缘椎体横径 长度范围男性为 51.61~63.05,女性为 45.44~59.44。5.椎管矢状径Boijsen 法,单位:mm: L1~L5椎管矢状径范围男性为 19.23~24.93,女性为 18.29~23.91。6.腰椎生理弯曲度 Overlay 法,单位:? :L1/L2~L5/S1节段角度范围男性为 3.36~17.69,总曲度为 43.84; 女性节段角度范围为 3.86~17.92,总曲度为 49.45;总之,女性节段角度范围稍比男性大, 各节段角度男女间多数无显著差异P 0.05。7.中立位到过屈、伸位活动度Overlay法,单 位:? : L1/L2~L5/S1节段活动度过伸时男女均由上到下逐渐增大,男性活动度范围为 5.55~23.22,女性为 6.51~21.98;过屈时从上到下逐渐减少,男性活动度范围为 4.94~8.60, 女性为 4.63~8.03;总之,过伸时总节段活动度大于过屈时活动度,男女总节段活动度间 无明显差别P 0.05。8.中立位到过屈、伸位活动度夹角法,单位:? : 节段活动度范围 过伸位时男性为 12.48~17.62,女性为 12.54~18.61;过屈位时男性为 4.71~6.82,女性为 4.96~7.12;总之,节段活动度过伸位大于过屈位,男女间无明显差别P 0.05。9.腰椎屈 I暨南大学硕士学位论文 115 例 20~30岁正常国人腰椎数据测量与其临床意义 伸活动度L1/L2~L5/S1,单位:? :节段活动度范围Overlay法男性为 14.15~29.39,女 性为 14.54~26.61,男女活动度均从上到下逐渐增大;节段活动度范围椎间隙夹角法男性 为 17.19~23.94,女性为 17.5~25.71,男女活动度从上到下均逐渐增大;间隙夹角法测量 值较 Overlay法测量值大,男女活动度有差别P 0.05。10.椎体间平移量单位:mm:腰 椎间平移量范围男性为 2.18~4.16,女性为 1.85~3.45,男女均从上到下逐渐增加,男性 大于女性,统计比较无明显性别差异P 0.05。11.椎间隙高度、曲度指数:椎间隙高度指 数从上到下男女均逐渐增大,其范围男性为 0.33~0.48,女性为 0.31~0.45;椎间曲度指 数从上到下男女均逐渐增大,其范围男性为 0.21~0.31,女性为 0.16~0.29;两指数较为 恒定,男女各指数间多数差异不显著。12.椎间隙高度/椎体高度比值:前缘高度比值范围 男性为 0.41~0.57,女性为 0.36~0.48;中间高度比值范围男性为 0.46~0.60,女性为 0.46~ 0.58;后缘比值范围男性为 0.19~0.28,女性为 0.20~0.27;男女各比值较恒定,其中 L4/L5 、 L5/S1两节段的比值较大,男女比值间差异不显著P 0.05。13.椎间隙高度比值Hp/Ha: 该比值较为恒定,比值范围男性为 0.47~0.52,女性为 0.51~0.6,性别间无明显差异P 0.05。 结论:1.椎间隙高度:前缘高度由上到下逐渐增高,中间高度变化较大,后缘 高度 较小且较为恒定,这种变化规律是与腰椎生理弯曲及椎间盘形态相一致的,男女椎间高度 有明显差异。2.椎体高度:男女的椎体前缘高度均由上向下逐渐变高,中间高度变化较大 且较前、后缘高度相对较低,后缘高度 L2和 L3椎体较高,L4和 L5椎体反而降低,符合 生理曲度变化的规律,椎体大体呈中间凹陷的圆柱形。3. 椎体矢状径:男女椎体上矢径从 L1~L5 均逐渐增大,椎体中、下矢径从 L1~L4 逐渐增大,但 L5 又稍减小,总体上中矢 径较上、下矢径均小,呈腰部向内陷的梯形柱体。4. 椎体横径:男女椎体的上、中、下横 径均由 L1~L5 逐渐增大,而中横径皆小于相应上、下横径,因此腰椎体呈两端大、中间 凹的形态。男性各径均大于女性,各径性别间的差异明显P 0.01。5.椎管矢状径从上到 下逐渐变小,男性略大于女性,男女椎管矢状径性别差异不显著 P 0.05。6生理弯曲度 Overlay 法:男女节段角度从上到下均逐渐增大,其中 L4/L5、L5/S1 两节段角度较大, 男女除 L4/L5节段的角度有明显差异外P 0.01,其余节段均无明显差别,总 弯曲度,女 性大于男性。7.腰椎活动度过屈、过伸:过伸位时不论采用 Overlay 法还是椎间隙夹角法 活动度均由上到下逐渐增加,L1/L2、L2/L3活动度较小,L4/L5、L5/S1活动度较大;夹角 法男女活动度无明显差别P 0.05,而 Overlay 法男女活动度有差别。过屈位时的活动度 II暨南大学硕士学位论文 115 例 20~30岁正常国人腰椎数据测量与其临床意义 要比过伸时小,椎间隙夹角法男女活动度均由上到下增大,Overlay法则趋势相反,两种方 法的活动度男女间无明显差别P 0.05。8腰椎总活动度过屈+过伸:腰椎的活动度不论 Overlay法还是椎间隙夹角法男女均从上到下逐渐增加,男女部分节段活动度有显著差异。 9 椎体间平移量:男女椎体间平移量均由上到下逐渐增加,男女间无明显差别,过屈位平 移量较过伸位大。10.椎间隙高度指数、椎间曲度指数、椎间隙高度/椎体高度比和椎间隙 高度比Hp/Ha均较恒定,性别间大多数无明显差别。11.男女身高、体重与椎间隙高度、椎 体高度、椎体矢状径、椎体横径的部分数据均有一定的相关性,男性相关系 数R小于 0.5, 女性相关系数小于 0.6。12.地区间有明显的差异。 关键词:正常人、腰椎数据、测量、临床意义III暨南大学硕士学位论文 115 例 20~30岁正常国人腰椎数据测量与其临床意义 Abstract Objective: To provide theoretical basis and basic data for establishing the lumbar database of average Chinese aged 20~30Methods: 115 cases of average healthy people48 cases of male, 67cases of female living in the southern areas were chosen to be subject to the X-ray check of the AP & lateral view, over-flexion view and over-extension view of lumbar spine, the upper, middle and lower transverse diameters , the upper, middle and lower sagittal diameters, the anterior ,middle and posterior heights of the vertebral body, the sagittal diameter of the vertebral canal, the range of intervertebral translation, the lumbar physiological curvature, the lumbar range of Motion were measured using international general-use method and domestic general-use medical measurement software Huahai Medris; the index of the intervertebral space height, the index of the intervertebral curvature, the ratio of lumbar intervertebral height to vertebral body height, the ratio of posterior intervertebral height to anterior tervertebral height were calculated at the same timeResults: 1.Height of the Intervertebral Spaceunit:mm: L1/L2~L5/S1the height ranges of anterior intervertebral disc space were 12.09~17.51 for the male, 10.30~15.83 for the female; the height ranges of middle intervertebral disc space were 12.43~16.72 for the male, 12.32~15.40 for the female;the height ranges of posterior intervertebral disc space were 6.11~ 8.96 for the male, 6.02~8.10 for the female2. Height of the Vertebral Body unit:mm: L1~L5the height ranges of anterior intervetebral body were 29.55~32.59 for the male, 29.09~31.46 for the female;the height ranges of middle intervetebral body were 27.25~29.15 for the male, 25.93~27.45 for the female; the height ranges of posterior intervetebral body were 29.57~33.86 for the male, 28.38~31.90 for the female3. Sagittal Diameter of the Vertebral Bodyunit:mm:L1~L5 the length ranges of upper verterbral body were 39.25~ 42.2 for the male , 34.73~38.08 for the female; the length ranges of middle verterbral body were 35.66~39.05 for the male,32.16~35.74 for the female; the length ranges of lower verterbral body were 40.02~42.63 for the male, 35.60~38.20 for the female4. Transverse Diameter of the Vertebral Bodyunit:mm:L1~L5the transverse diameter ranges of the upper vertebralIV暨南大学硕士学位论文 115 例 20~30岁正常国人腰椎 数据测量与其临床意义 body were 48.44~59.60 for the male, 42.24~54.87 for the female; the transverse diameter ranges of middle vertebral body were 43.78~55.42 for the male, 38.66~52.33 for the female; the transverse diameter ranges of lower vertebral body were 51.61~63.05 for the male, 45.44~ 59.44 for the female5. Sagittal Diameter of the Vertebral CanalBoujsen method, unit:mm:L1~L5 the ranges of sagittal diameter of the vertebral canal were 19.23~24.93 for the male, 18.29~23.91 for the female6. Lumbar Physiological Curvature overlay method, unit: ? : L1/L2~L5/S1angle range of the segments was 3.36~17.69,the total degree of curvature was 43.84 for the male; the angle range of the segments was 3.86~17.92,the total degree of curvature was 49.45 for the female; In conclusion, the angle range of segments of male were wider than that of female, there was no distinct difference between the male’s and female’s for the angle of each segment P 0.057. Range of mothion from neutral position to over-flexion or over-extension positionoverlay method, unit:? :L1/L2~L 5/S1the ranges of motion within the close segments in the over-extension position showed gradual increase from up to down both for the male and female, the ranges of motion were 5.55~23.22 for the male,6.51~21.98 for the female; In the over-flexion position, the ranges of motion within the close segments showed gradual decrease form up to down, the ranges of motion were 4.94~8.60 for the male, 4.63~8.03 for the female; In conclusion, overall the ranges of motion of within the close segments in the over-extention position were wider than that in the over-flexion postion, there was no distinct difference between the overall segement motion range of male’s and female’s8. Range of mothion from neutral position to over-flexion or over-extension positionincluded angle method, unit:? : the motion ranges of the close segments in the over-extension position were 12.48~17.62 for the male , 12.54~18.61 for the female; In the over-flexion position, the motion ranges of the segments were 4.71~6.82 for the male, 4.96~ 7.12 for the female; In conclusion, overall motion ranges of the segments in the over-extention position were wider than that in the over-flexion postion, there was no distinct difference between the two genders9. Flexion and Extension Motion Range of Lumbar VertebraL1/L2~L5/S1,unit:? : the range of segments motion overlay method were 17.19~23.94 for the male,17.5~25.71 for the female, the ranges of segment motion showed gradual increase both for the male and for the female; the ranges of segment motion angleV暨南大学硕士学位论文 115 例 20~30岁正常国人腰椎 数据测量与其临床意义 method were17.19~23.94 for the male, 17.5~25.71for the female, the range of motion became gradual increase from up to down, the value derived from included angle method was higher than that from overlay method. There was difference between the two gendersP 0.05 10. Range of intervertebral translationunit:mm: the ranges of translation were 2.18~4.16 for the male, 1.85~3.45 for the female, the ranges showed gradual increase from up to down both for the male and female, male’s were bigger than the female’s, however, the difference of the translation ranges between the genders was not distinct11. Index of the Intervertebral Space Height, Index of the Intervertebral Curvature: the indices of the intervertebral space height showed gradual increase from up to down both for the male and female, the index ranges were 0.33~0.48 for the male, 0.31~0.45 for the female; the indices of the intervertebral curvature showed gradual increase from up to down, the index ranges were 0.21~0.31 for the male, 0.16~0.29 for the female, both of the indices were quite stable, the index differences between that of the male and female were not distinct12. Ratio of Lumbar Intervertebral Height to Vertebral Body Height: the ranges of anterior ratio were 0.41~0.57 for the male, 0.36~0.48 for the female; the ranges of middle ratio were 0.46~0.60 for the male, 0.46~0.58 for the female; the ranges of posterior ratio were 0.19~0.28 for the male,0.20~0.27 for the female; In conclusion, the indices were quite stable for both the male and the female, however, the ratios of segements L4/L5, L5/S1 were relatively high, the gender difference of the index was not distinctP 0.05. 13. Ratio of Posterior Intervertebral Height to anterior tervertebral heightHp/Ha: the ratio was quite stable, the ranges of ratio were 0.47~0.52 for the male, 0.51~0.6 for the female, there was no distinct difference of index between the two genders P 0.05Conclusions: 1. Height of the intervertebral space: the anterior heights became gradual increase from up to down, the height variation of the middle height was big, the posterior height was relatively low and stable; the variation rule was in accordance with the lumbar physiological curvature and the configuration of intervertebral disc, there was height difference between the genders. 2. Height of the vertebral body: the anterior intervertebral heights became gradual increase for both genders, the variation of the middle intervertebral height was quite big and the height was relatively lower than the anterior and posterior heights; for theVI暨南大学硕士学位论文 115 例 20~30岁正常 国人腰椎数据测量与其临床意义 posterior height, the vertebral body of L2 and L3 were relatively high, the vertebral of L4 and L5 were, on the contray, relatively low, which was in accordance with the variation rule of physiological curvature, generally, the vertebral body was columned sunk in the middle. 3Sagittal Diameter of the vertebral body: the upper sagittal diameters from L1 to L5 of the vertebral body became gradual increase for both genders; the middle and lower sagittal diameters from L1 to L4 of the vertebral body showed gradual increase, L5, however, was a little smaller, generally; the middle sagittal diameter was smaller than the upper sagittal diameter and lower sagittal diameters, showing a trapezia column sunk in the lumbar part. All of the diameters of male were bigger than that of female, the gender difference for each diameter was distinct4. Transverse Diameter of the vertebral body: the upper, middle and lower transverse diameters showed gradual increase from L1 to L5 for both genders, however, the middle traverse diameter was smaller than the upper and lower traverse diameters, therefore, the lumbar body was big at the two ends, sunk in the middle. All of the diameters of male were bigger than the female’s, the differences between the two genders were distinct P 0.01. 5. Sagittal diameters of the vertebral canal: It’sdate became gradual smaller from up to down, the data of male was a little higher than that of female, however, the difference between the genders was not distinct P 0.056. Physiological curvatureoverlay method: the segment angles of male and female became gradual increase from up to down, among them, the two segment angles of L4/L5 and L5/S1 were relatively big, except for distinct differences of the segment angle of L4/L5 between the male and female, the rest of the segments had no distinct difference. 7. Range of the motion of lumbar vertebraeover flexion , over extension: in the over extension position, the range of motion became gradual increase whether using overlay method or intervertebral included angle methods, the ranges of motion of L1/L2 and L2/L3 were relatively small, the ranges of motion of L4/L5, L5/S1 were relatively big; there was no distinct difference between the male and female while using the angle method. The range of motion in the over-flexion position was smaller than that in the over extension position, the ranges of motion became gradual increase from up to down while using intervertebral angle method, while using the overlay rule,the trends were on the contrary, the ranges of motion of the male and the female had no distince differenceP 0.05. 8.The overall range of motionover-flexion plus over-extension: the ranges of motion of the lumbar vertebrae became gradual increase whether using the overlayVII暨南大学硕士学位论文 115 例 20~30岁正常 国人腰椎数据测量与其临床意义 method or intervertebral included angle method, part of the motion ranges of segments had distinct difference between the male and female9. The ranges of intervertebral translation became gradual increase from up to down both for the male and for the female, for all of the segments, there was no distinct differences between the two genders, the range of translation was bigger in the over extension than that in the over-flexion postion. 10. Index of the intervertebral space height, index of the intervertebral curvature , the ratio of lumbar intervertebral height to vertebral body height and the ratio of posterior intervertebral height to anterior tervertebralheight were all quite stable, there was no distinct difference between the two genders11. The data of the stature, body weight both male and female had certain relativity with the part date of the intervertebral space height, vertebral body height, sagittal diameter of the vertebral body, traverse diameter of the vertebral body. The relativity index for the male was lower than 0.5, the relativity index for the female was lower than 0.6. 12. Distinct regional differences existed among all above datesKey words: healthy people, lumbar vertebrae data, measurement, clinic value VIII暨南大学硕士学位论文 115 例 20~30岁正常国人腰椎数据测量与其 临床意义 目录 摘 要I Abstract. IV 目 录VIII 前 言1 正 文7 1.研究的目的、现状和意义7 2.课 题 快递公司问题件快递公司问题件货款处理关于圆的周长面积重点题型关于解方程组的题及答案关于南海问题 思路. 8 3.指标的测量方法、意义 11 4.结果和统计 分析 定性数据统计分析pdf销售业绩分析模板建筑结构震害分析销售进度分析表京东商城竞争战略分析 16 5.讨论. 28 6.结论. 33 7.不足与展望. 35 参考文献. 36 附 图. 42 参加科研项目、学术会议 48 在学期间发表的学术论文 48 致 谢. 49IX暨南大学硕士学位论文 115 例 20~30岁正常国人腰椎数据测量与其临床意义 前 言 下腰痛Low back pain, LBP是指后背腰骶部的疼痛或不适感,可伴有或不伴有下肢的 [1] 放射痛 。它是一种症状,也可以说是一种综合征, 而不是疾病的名称。50%以上的下腰 [2] 痛初次发作4~8周内可以自愈, 但复发率高达85% 。下腰痛是一种常见的疾病, 大约 [3] 60%~80%的成人有患病史,在美国, 仅次于上呼吸道感染而居第2位 ,亚洲 国家如中国 因为体力劳动者较多, 发病率更高, 有统计显示在上海的3个职业群体中工人LBP超过1d [4] 的比例高过50% 。每年因为下腰痛花费大量的物力财力, 它是一种十分常见骨科病,发 病年龄趋于年轻化,也是患者就诊于骨科的最常见原因,尽管大多数的症状会在短期内消 失,但仍有部分会发展为慢性病变,严重影响患者的工作与生活。更严重的是,由于长期 受疾病困扰,慢性下腰痛患者的生活质量下降、劳动效率降低,导致离婚率、缺勤率上升, 同时酗酒、头痛及胃十二指肠溃疡的比率也明显增加,因此慢性下腰痛也日益成为严重的 [5] 社会经济问题 。由于下腰痛患者的疼痛症状、功能障碍程度与病变部位、病变严重程度 并不一致,影响因素较多,是一种较为常见而又复杂的问题,这给诊断、治疗、预后康复 [6] 评定带来一定的困难,目前对LBP的诊断仍不是很明确还存有争议 。因此对下腰痛的诊 治、发病机制和腰椎生物力学的研究显得尤为重要,前言部分就这几方面作出概述。 1.下腰痛的分类和发病机制 1.1 下腰痛的分类 很多因素可以引起下腰痛, 多数情况下是多种因素的联合作用,所以不同的学者把 下腰痛分为不同的类型。 1.1.1 非特异性下腰痛Nonspecific low back pain, NSLBP 在非特异性下腰痛患者中大部分原因不明, X线、CT等检查常无阳性发现,但往往 [7] 有外伤史, 如腰扭伤、棘间韧带劳损等。LBP门诊病人中约50%为非特异性LBP 。Peter [8] Kent 调查后发现澳大利亚的医生为了便于治疗, 常把NSLBP分为小关节型、椎间盘相关 型、不稳定型、骶髂关节型、体位型、非解剖型几个亚类。 1.1.2 按发病的缓急分为急性、亚急性、慢性下腰痛 多数文献在应用这种分类时并没有明确的限定时间, 一般认为发病时间2周为急性,1暨南大学硕士学位论文 115 例 20~30岁正常国人腰椎数据测量与其临床意义 [2] 6周为亚急性, 6周为慢性 。慢性LBP多由于急性LBP治疗方法不当、心理因素、躯体 [9] 化Somatization等因素使疼痛加重甚至转化所致 。 [9] 1.1.3 Richard A和Deyo 提出的分类在国外被多数人所接受,可以分为: 1.机械性的脊柱疾病, 如腰肌劳损70%,椎间盘突出4%,椎管狭窄3%,这一类共 占97%。 2.非机械性的脊柱疾病, 如肿瘤0.17% ,感染0.101% ,炎性关节炎0.13% , 这 一类共占约1%。3.内脏疾病占2%。 1.1.4 按照发病的生理系统分类 1.脊柱疾患, 包括脊柱的创伤和劳损如腰肌劳损,压缩性骨折、椎间盘突出、椎管狭 窄、脊柱肿瘤、炎症、感染、畸形。 2.神经疾患, 如中枢神经系统肿瘤、蛛网膜粘连、神经纤维瘤等。 3. 血管疾患, 多见腹主动脉瘤, 血栓闭塞性动脉炎产生的勒里施综合征Leriche’ssyndrome。 4.脏器性疾患, 如消化系统的胰腺痛、直肠痛, 泌尿系统的结石或脓肿, 妇科的炎症、 肿瘤以及后腹膜的肿瘤等都可产生下腰痛的症状。 5 精神社会因素, 多项研究显示, 心理恐惧使患者将无关的影像学表现与疼痛等症状联 [7] 系起来,加重了功能障碍 。 1.1.5 特殊类型的下腰痛 1.椎间盘源性疼痛 Discgenic pain disease曾被称为腰椎间盘紊乱。英国学者Park首先1979 [10] 年提出此概念, 接着Crock和Milette、McCarron RF 进一步从形态学方面提出除椎间盘 突出外椎间盘内部结构紊乱可导致LBP的概念, 使这种LBP病因才得到重视。目前接受的 定义是: 排除影像学检查神经根受压迫的慢性腰背痛, 那些由椎间盘本身所致的下腰痛 [11] [12] 即椎间盘源性下腰痛 ,据统计慢性下腰痛的病因中约40%应归为椎间盘源性 。 2.关节突源性疼痛 1911年Goldthwait提出椎间的小关节可能是腰部疼痛的原因, 并且最 [3] 近的研究显示, 大约8%~15%的LBP是由椎间小关节引起 ,具体的疼痛发生机理未完全 [13] 明了 。 [14] 3.肌性疼痛 刘永棠等 人通过尸体解剖和临床手术观察和诊断性治疗认为在L4/5、L5/S1 棘间韧带间存在滑囊, 正常情况下该滑囊有润滑、缓冲、防止棘间韧带撕裂伤的作用。2暨南大学硕士学位论文 115 例 20~30岁正常国人腰椎数据测量与其临床意义 该部位发生无菌性炎症后可引起LBP, 通常棘间韧带间封闭治疗效果显著。 [15] 1.1.6 下腰痛根据发生疼痛的病理因素不同,毕树雄 把下腰痛分为: 1.椎间盘源性疼痛 2.小关节疼痛 3.肌肉、韧带源性疼痛 4.牵涉痛 5.非器质性疼痛 1.2 下腰痛发病机制 1.2.1 脊柱作为一个具有支持和运动功能的整体,下腰痛是由于分布于这些结构上的游离 神经末梢受到外伤或炎症刺激,痛觉经传人纤维传至脊髓,再上行传至中枢产生的。常见 的涉及腰背部的牵涉痛主要由盆腔疾病引起,如女性痛经、妇科疾病、男性前列腺疾病以 及泌尿系统疾病。其它类型的下腰痛是因这些部位存有痛觉感受器,当这些组织发生损伤 或炎症时,可引起多种炎症介质释放,使神经末梢感受器致敏,出现持久兴奋,引起下腰 痛。另外,这些部位的损伤或炎症刺激还可通过痛觉感受器不断向脊髓发放疼痛信号,反 [16] 复刺激脊髓后角神经元,产生慢性下腰痛,此谓中枢性致敏作用 。有心理异常者,会出 现头痛、失眠、乏力及下腰痛现象。这种下腰痛是由于精神因素在肌肉、韧带等结构上引 [5] 起的躯体症状Somatization所致 。 [17] 1.2.2 下腰痛的危险因素很多,主要可分为以下三个方面 : 1.个人因素 1年龄:35~55岁是下腰痛的好发年龄,且目前有年轻化趋势。随年龄的增加,椎间 盘及小关节退变不可避免,同时腰背肌肌力下降、韧带劳损,严重影响了脊柱的稳定性, [18] 使其容易发生下腰痛 。 2健