中國(guó)非特異性腰背痛臨床診療指南

中國(guó)非特異性腰背痛臨床診療指南一、本文概述Overviewofthisarticle《中國(guó)非特異性腰背痛臨床診療指南》旨在為廣大醫(yī)療工作者提供一套科學(xué)、規(guī)范、實(shí)用的非特異性腰背痛診療流程和方法。非特異性腰背痛是一種常見(jiàn)的臨床癥狀，其疼痛原因復(fù)雜多樣，涉及生物力學(xué)、神經(jīng)生理、心理社會(huì)等多方面因素。因此，制定一份全面、系統(tǒng)的臨床診療指南對(duì)于提高診療效率、改善患者預(yù)后具有重要意義。TheChineseClinicalDiagnosisandTreatmentGuidelinesforNonspecificLowBackPainaimtoprovideascientific,standardized,andpracticalprocessandmethodforthediagnosisandtreatmentofnon-specificlowbackpainformedicalworkers.Nonspecificlowbackpainisacommonclinicalsymptom,anditscausesarecomplexanddiverse,involvingvariousfactorssuchasbiomechanics,neurophysiology,andpsychosocialfactors.Therefore,developingacomprehensiveandsystematicclinicaldiagnosisandtreatmentguidelineisofgreatsignificanceforimprovingdiagnosisandtreatmentefficiencyandimprovingpatientprognosis.本指南結(jié)合國(guó)內(nèi)外最新研究成果和臨床實(shí)踐經(jīng)驗(yàn)，對(duì)非特異性腰背痛的定義、流行病學(xué)、發(fā)病機(jī)制、臨床表現(xiàn)、診斷方法、治療策略及預(yù)防措施等方面進(jìn)行了詳細(xì)闡述。本指南還注重臨床實(shí)用性，為醫(yī)生提供了針對(duì)不同病情和患者的個(gè)性化診療建議，旨在幫助醫(yī)生快速準(zhǔn)確地診斷非特異性腰背痛，制定科學(xué)合理的治療方案，提高患者的生活質(zhì)量和健康水平。Thisguidecombinesthelatestresearchresultsandclinicalpracticeexperienceathomeandabroadtoprovideadetailedexplanationofthedefinition,epidemiology,pathogenesis,clinicalmanifestations,diagnosticmethods,treatmentstrategies,andpreventivemeasuresofnon-specificlowbackpain.Thisguidealsoemphasizesclinicalpracticalityandprovidespersonalizeddiagnosisandtreatmentrecommendationsfordifferentconditionsandpatients,aimingtohelpdoctorsquicklyandaccuratelydiagnosenon-specificlowbackpain,developscientificandreasonabletreatmentplans,andimprovethequalityoflifeandhealthlevelofpatients.本指南的編寫遵循科學(xué)、規(guī)范、實(shí)用的原則，力求為臨床醫(yī)生提供一套全面、系統(tǒng)的非特異性腰背痛診療參考。希望廣大醫(yī)療工作者能夠認(rèn)真閱讀、深入理解本指南內(nèi)容，并在實(shí)際工作中加以應(yīng)用，為患者提供更為優(yōu)質(zhì)、高效的醫(yī)療服務(wù)。Thecompilationofthisguidefollowstheprinciplesofscience,standardization,andpracticality,strivingtoprovideclinicaldoctorswithacomprehensiveandsystematicreferenceforthediagnosisandtreatmentofnon-specificlowbackpain.Ihopethatmedicalworkerscancarefullyreadanddeeplyunderstandthecontentofthisguide,andapplyitinpracticalworktoprovidepatientswithhigherqualityandefficientmedicalservices.二、診斷Diagnosis非特異性腰背痛的診斷主要依賴于患者的病史、體格檢查和必要的輔助檢查。診斷過(guò)程中需要排除其他可能導(dǎo)致腰背痛的特異性病因。Thediagnosisofnon-specificlowbackpainmainlydependsonthepatient'smedicalhistory,physicalexamination,andnecessaryauxiliaryexaminations.Duringthediagnosticprocess,itisnecessarytoexcludeotherspecificcausesthatmaycauselowerbackpain.詳細(xì)詢問(wèn)患者的疼痛起始時(shí)間、部位、性質(zhì)、持續(xù)時(shí)間、誘發(fā)和緩解因素，以及疼痛與活動(dòng)的關(guān)系等。同時(shí)，了解患者的工作性質(zhì)、生活習(xí)慣、既往病史和家族史，有助于判斷腰背痛的可能原因。Inquireindetailaboutthepatient'spainonsettime,location,nature,duration,triggeringandrelieffactors,aswellastherelationshipbetweenpainandactivity.Atthesametime,understandingthepatient'sworknature,lifestylehabits,pastmedicalhistory,andfamilyhistorycanhelpdeterminethepossiblecausesofbackpain.進(jìn)行全面的體格檢查，包括脊柱、肌肉、神經(jīng)系統(tǒng)等方面的檢查。特別要注意脊柱的生理彎曲、活動(dòng)度、壓痛和叩擊痛等。還要檢查雙下肢的感覺(jué)、運(yùn)動(dòng)和反射情況，以排除神經(jīng)系統(tǒng)疾病。Conductacomprehensivephysicalexamination,includingexaminationsofthespine,muscles,nervoussystem,andotherareas.Payspecialattentiontothephysiologicalcurvature,rangeofmotion,tenderness,andpercussionpainofthespine.Also,checkthesensation,movement,andreflexesofbothlowerlimbstoruleoutneurologicaldisorders.根據(jù)需要選擇合適的輔助檢查，如線平片、CT、MRI等影像學(xué)檢查，以及血常規(guī)、尿常規(guī)、生化檢查等實(shí)驗(yàn)室檢查。這些檢查有助于排除骨折、腫瘤、感染等特異性病因。Selectappropriateauxiliaryexaminationsasneeded,suchasX-ray,CT,MRIandotherimagingexaminations,aswellaslaboratorytestssuchasbloodroutine,urineroutine,andbiochemicaltests.Thesetestshelptoruleoutspecificcausessuchasfractures,tumors,andinfections.根據(jù)患者的病史、體格檢查和輔助檢查結(jié)果，綜合判斷是否為非特異性腰背痛。若懷疑有特異性病因，需進(jìn)一步深入檢查以明確診斷。Basedonthepatient'smedicalhistory,physicalexamination,andauxiliaryexaminationresults,comprehensivelydeterminewhetheritisnon-specificlowbackpain.Ifthereissuspicionofaspecificcause,furtherin-depthexaminationisneededtoclarifythediagnosis.非特異性腰背痛需與多種可能導(dǎo)致腰背痛的特異性病因進(jìn)行鑒別，如腰椎間盤突出癥、腰椎管狹窄癥、脊柱側(cè)彎、脊柱裂、脊柱腫瘤、脊柱感染等。通過(guò)詳細(xì)的病史采集、體格檢查和輔助檢查，可以逐步縮小診斷范圍，最終確定診斷。Nonspecificlowbackpainneedstobedifferentiatedfromvariousspecificcausesthatmaycauseit,suchaslumbardischerniation,lumbarspinalstenosis,scoliosis,spinabifida,spinaltumors,spinalinfections,etc.Throughdetailedmedicalhistorycollection,physicalexamination,andauxiliaryexaminations,thediagnosticscopecanbegraduallynarroweddownandthediagnosiscanbeultimatelydetermined.非特異性腰背痛的診斷標(biāo)準(zhǔn)主要包括：疼痛部位在腰部或背部，無(wú)明確的器質(zhì)性病變或特異性病因，疼痛持續(xù)時(shí)間超過(guò)3個(gè)月，且經(jīng)保守治療無(wú)效或反復(fù)發(fā)作。Thediagnosticcriteriafornon-specificlowbackpainmainlyinclude:painlocatedinthelowerbackorlowerback,noclearorganiclesionsorspecificcauses,painlastingformorethan3months,andineffectiveorrecurrentconservativetreatment.非特異性腰背痛的診斷是一個(gè)綜合的過(guò)程，需要結(jié)合患者的病史、體格檢查和輔助檢查結(jié)果進(jìn)行綜合分析。在排除特異性病因后，方可診斷為非特異性腰背痛。Thediagnosisofnon-specificlowbackpainisacomprehensiveprocessthatrequiresacomprehensiveanalysisbasedonthepatient'smedicalhistory,physicalexamination,andauxiliaryexaminationresults.Afterexcludingspecificcauses,non-specificlowbackpaincanbediagnosed.三、治療Treatment非特異性腰背痛的治療應(yīng)遵循個(gè)體化、綜合治療和預(yù)防為主的原則。治療的主要目標(biāo)是緩解疼痛、改善功能、提高生活質(zhì)量，并盡可能減少?gòu)?fù)發(fā)。Thetreatmentofnon-specificlowbackpainshouldfollowtheprinciplesofindividualization,comprehensivetreatment,andpreventionasthemainapproach.Themaingoaloftreatmentistoalleviatepain,improvefunction,improvequalityoflife,andminimizerecurrence.休息與活動(dòng)調(diào)整：急性疼痛期可適當(dāng)休息，避免加重疼痛的動(dòng)作或體位。隨著癥狀改善，應(yīng)逐漸增加活動(dòng)量，以增強(qiáng)腰背肌力量，預(yù)防復(fù)發(fā)。Restandactivityadjustment:Duringtheacutepainperiod,appropriaterestcanbetakentoavoidactionsorpositionsthatworsenthepain.Assymptomsimprove,theamountofactivityshouldbegraduallyincreasedtoenhancethestrengthofthelowerbackmusclesandpreventrecurrence.物理治療：包括熱敷、冷敷、按摩、牽引、針灸等，有助于緩解肌肉緊張、促進(jìn)血液循環(huán)、減輕疼痛。Physicaltherapy:includinghotcompress,coldcompress,massage,traction,acupunctureandmoxibustion,etc.,whichhelpsrelievemuscletension,promotebloodcirculation,andrelievepain.認(rèn)知行為療法：幫助患者調(diào)整心態(tài)，改變不良的生活習(xí)慣和工作姿勢(shì)，提高自我管理和自我控制能力。Cognitivebehavioraltherapy:helpspatientsadjusttheirmindset,changeunhealthylifestylehabitsandworkposture,andimprovetheirself-managementandself-controlabilities.對(duì)于疼痛劇烈、非藥物治療效果不佳的患者，可考慮局部注射糖皮質(zhì)激素或局麻藥，以緩解疼痛。但需注意，注射治療可能增加感染風(fēng)險(xiǎn)，且長(zhǎng)期多次注射可能導(dǎo)致軟組織損傷。Forpatientswithseverepainandpoornonpharmacologicaltreatmenteffects,localinjectionofglucocorticoidsorlocalanestheticscanbeconsideredtoalleviatepain.However,itshouldbenotedthatinjectiontherapymayincreasetheriskofinfection,andlong-termrepeatedinjectionsmayleadtosofttissuedamage.非特異性腰背痛患者通常無(wú)需手術(shù)治療。但對(duì)于少數(shù)經(jīng)嚴(yán)格保守治療無(wú)效、癥狀嚴(yán)重影響生活質(zhì)量的患者，可考慮手術(shù)治療。手術(shù)方式應(yīng)根據(jù)患者具體情況選擇，如腰椎融合術(shù)、椎間盤置換術(shù)等。Patientswithnon-specificlowbackpainusuallydonotrequiresurgicaltreatment.However,forasmallnumberofpatientswhohavefailedstrictconservativetreatmentandwhosesymptomsseriouslyaffecttheirqualityoflife,surgicaltreatmentmaybeconsidered.Thesurgicalmethodshouldbeselectedaccordingtothespecificsituationofthepatient,suchaslumbarfusionsurgery,intervertebraldiscreplacementsurgery,etc.非特異性腰背痛的治療應(yīng)綜合考慮患者的具體情況和需求，制定個(gè)性化的治療方案。應(yīng)重視預(yù)防工作，加強(qiáng)健康教育，提高公眾對(duì)腰背痛的認(rèn)識(shí)和自我防護(hù)能力。Thetreatmentofnon-specificlowbackpainshouldcomprehensivelyconsiderthespecificsituationandneedsofthepatient,anddeveloppersonalizedtreatmentplans.Weshouldattachgreatimportancetopreventionwork,strengthenhealtheducation,andenhancepublicawarenessandself-protectionabilitytowardslowerbackpain.四、預(yù)防與康復(fù)PreventionandRehabilitation保持正確的姿勢(shì)：在日常生活中，應(yīng)時(shí)刻保持正確的坐、站、行、臥姿勢(shì)，避免長(zhǎng)時(shí)間維持同一不良姿勢(shì)，以減輕腰椎的負(fù)擔(dān)。Maintainthecorrectposture:Indailylife,itisimportanttoalwaysmaintainthecorrectsitting,standing,walking,andlyingpositionstoavoidprolongedexposuretothesamepoorpostureandreducetheburdenonthelumbarspine.增強(qiáng)肌肉力量：通過(guò)進(jìn)行如平板支撐、橋式等核心肌肉鍛煉，可以增強(qiáng)腰背部肌肉的力量，提高腰椎的穩(wěn)定性。Enhancingmusclestrength:Byperformingcoremuscleexercisessuchasplanksupportandbridgeexercises,thestrengthofthelowerbackmusclescanbeenhanced,improvingthestabilityofthelumbarspine.控制體重：肥胖會(huì)增加腰椎的負(fù)擔(dān)，因此，保持合理的體重對(duì)于預(yù)防非特異性腰背痛具有重要意義。Weightcontrol:Obesityincreasestheburdenonthelumbarspine,therefore,maintainingareasonableweightisofgreatsignificanceforpreventingnon-specificlowerbackpain.避免過(guò)度勞累：在從事重體力勞動(dòng)或高強(qiáng)度運(yùn)動(dòng)時(shí)，應(yīng)注意勞逸結(jié)合，避免腰部過(guò)度勞累。Avoidexcessivefatigue:Whenengaginginheavyphysicallabororhigh-intensitysports,attentionshouldbepaidtoabalancebetweenworkandresttoavoidexcessivefatigueinthewaist.改善工作環(huán)境：對(duì)于需要長(zhǎng)時(shí)間坐著工作的人群，應(yīng)定期調(diào)整工作環(huán)境，如使用符合人體工程學(xué)的辦公椅和桌面，以減少腰部的壓力。Improvingtheworkingenvironment:Forpeoplewhoneedtositandworkforlongperiodsoftime,theworkingenvironmentshouldberegularlyadjusted,suchasusingergonomicofficechairsanddesks,toreducewaistpressure.物理治療：包括熱敷、冷敷、按摩、針灸等，可以有效緩解腰背部疼痛，促進(jìn)局部血液循環(huán)。Physicaltherapy:includinghotcompress,coldcompress,massage,acupunctureandmoxibustion,etc.,caneffectivelyrelievethepaininthelowerbackandpromotelocalbloodcirculation.康復(fù)訓(xùn)練：在專業(yè)康復(fù)師的指導(dǎo)下，進(jìn)行有針對(duì)性的康復(fù)訓(xùn)練，如拉伸訓(xùn)練、肌肉強(qiáng)化訓(xùn)練等，有助于恢復(fù)腰椎的正常功能。Rehabilitationtraining:Undertheguidanceofaprofessionalrehabilitationtherapist,targetedrehabilitationtrainingsuchasstretchingandmusclestrengtheningcanhelprestorenormallumbarfunction.藥物治療：在疼痛較為嚴(yán)重時(shí)，可以使用非處方藥物如非甾體抗炎藥進(jìn)行對(duì)癥治療，但應(yīng)注意藥物的使用劑量和時(shí)間。Drugtherapy:Whenthepainissevere,over-the-counterdrugssuchasnonsteroidalanti-inflammatorydrugscanbeusedforsymptomatictreatment,butattentionshouldbepaidtothedosageanddurationofdruguse.心理治療：針對(duì)部分因心理因素導(dǎo)致的非特異性腰背痛患者，可進(jìn)行心理咨詢和認(rèn)知行為治療，以緩解焦慮、抑郁等情緒。Psychologicaltherapy:Forsomenon-specificlowbackpainpatientscausedbypsychologicalfactors,psychologicalcounselingandcognitive-behavioraltherapycanbeprovidedtoalleviateanxiety,depression,andotheremotions.生活方式調(diào)整：鼓勵(lì)患者改變不良的生活習(xí)慣，如戒煙、限酒、合理飲食等，以促進(jìn)整體健康狀態(tài)的改善。Lifestyleadjustment:Encouragepatientstochangebadlifestylehabits,suchassmokingcessation,alcoholrestriction,andreasonablediet,topromoteoverallhealthimprovement.預(yù)防與康復(fù)是非特異性腰背痛管理中的重要環(huán)節(jié)。通過(guò)實(shí)施上述策略和措施，可以有效減輕患者的疼痛癥狀，提高生活質(zhì)量，并預(yù)防疾病的復(fù)發(fā)。醫(yī)護(hù)人員也應(yīng)對(duì)患者進(jìn)行個(gè)性化的指導(dǎo)，使其能夠積極參與到預(yù)防與康復(fù)的過(guò)程中。Preventionandrehabilitationareimportantlinksinthemanagementofnon-specificlowbackpain.Byimplementingtheabovestrategiesandmeasures,patientscaneffectivelyalleviatetheirpainsymptoms,improvetheirqualityoflife,andpreventdiseaserecurrence.Medicalstaffshouldalsoprovidepersonalizedguidancetopatients,enablingthemtoactivelyparticipateinthepreventionandrehabilitationprocess.五、總結(jié)與展望SummaryandOutlook隨著醫(yī)學(xué)科技的不斷發(fā)展與進(jìn)步，中國(guó)非特異性腰背痛的臨床診療水平也在持續(xù)提高。本指南的編寫，旨在規(guī)范非特異性腰背痛的診療流程，為臨床醫(yī)生提供一套科學(xué)、合理、實(shí)用的參考方案。通過(guò)明確非特異性腰背痛的定義、診斷流程、治療原則及預(yù)防措施，我們期望能夠減少誤診、誤治現(xiàn)象的發(fā)生，提高患者的治療效果和生活質(zhì)量。Withthecontinuousdevelopmentandprogressofmedicaltechnology,theclinicaldiagnosisandtreatmentlevelofnon-specificlowbackpaininChinaisalsocontinuouslyimproving.Thewritingofthisguideaimstostandardizethediagnosisandtreatmentprocessofnon-specificlowbackpain,andprovideascientific,reasonable,andpracticalreferenceplanforclinicaldoctors.Byclarifyingthedefinition,diagnosticprocess,treatmentprinciples,andpreventivemeasuresofnon-specificlowbackpain,wehopetoreducetheoccurrenceofmisdiagnosisandmistreatment,andimprovethetreatmenteffectivenessandqualityoflifeofpatients.總結(jié)過(guò)去的經(jīng)驗(yàn)，我們深刻認(rèn)識(shí)到非特異性腰背痛診療工作的重要性和復(fù)雜性。雖然目前已有一些有效的治療方法，但仍有待于進(jìn)一步的研究和探索。未來(lái)，我們需要在以下幾個(gè)方面加強(qiáng)工作：一是深入研究非特異性腰背痛的發(fā)病機(jī)制，為制定更加精準(zhǔn)的治療方案提供依據(jù)；二是加強(qiáng)跨學(xué)科合作，整合中西醫(yī)資源，形成綜合治療的合力；三是推廣健康教育，提高公眾對(duì)腰背痛的認(rèn)知和預(yù)防意識(shí)；四是建立完善的隨訪機(jī)制，長(zhǎng)期追蹤患者的康復(fù)情況，為進(jìn)一步優(yōu)化診療方案提供數(shù)據(jù)支持。Summarizingpastexperience,wedeeplyrecognizetheimportanceandcomplexityofnon-specificdiagnosisandtreatmentoflowbackpa