摘要
背景:下腰痛是骨科患者常见的临床表现,并且很大一部分患者同时伴有膝关节退变的表现。虽然现在已明确提出"腰-膝综合征"这一概念,但目前针对下腰痛病变所涉及到的腰椎小关节及膝关节退变的文献报道并不多见。目的:对于因小关节源性退变导致下腰痛同时伴发膝骨关节炎的相关文献进行总结及分析。方法:计算机检索1998年1月至2014年8月Pub Med数据库、中国期刊全文数据库的相关文章,英文检索词"low back pain,knee osteoarthritis,lumbar facet joint,total knee replacement,block treatment,non-fusion techniques,inflammatory factor,drug treatment";中文检索词"下腰痛,膝骨关节炎,腰椎小关节,膝关节置换,封闭治疗,非融合技术,炎症因子,药物治疗"。排除重复性研究及部分相关性较低的基础类文章。结果与结论:共计检索出157篇中英文文献,最终选择60篇文献进行综述。对于小关节源性下腰痛,目前认为继发性促进骨关节炎进展可能性大。在病理生理中,肿瘤坏死因子α、白细胞介素1β和基质金属蛋白酶等或许起着十分重要的作用。至于生物力学中,小关节倾斜角度的生物力学意义、倾斜角度与关节退行性变的关系是研究的重心。在临床治疗中,早期予以常规封闭治疗明确疼痛来源,轻症者行固定、功能锻炼延缓疾病进展,晚期则行手术治疗以恢复功能,缓解疼痛。
BACKGROUND：Low back pain is a normal syndrome in department of orthopedics. Moreover, most patients are consisted with knee joint degeneration. Through the conception of“knee-spine syndrome”has been proposed for a long time, the study which focused on low back pain and lumbar facet joints and degenerative knee is not quite easy to find. OBJECTIVE：To summarize and analyze articles involved in the low back pain syndrome of smal arthrogenous degeneration-induced lower back pain combined with knee osteoarthritis. METHODS：We retrieved PubMed database and China National Knowledge Infrastructure for related articles published from January 1998 to August 2014. The key words were low back pain, knee osteoarthritis, lumbar facet joint, total knee replacement, block treatment, non-fusion techniques, inflammatory factor, drug treatment. Repeated articles and some low connected researches were excluded. RESULTS AND CONCLUSION：A total of 157 articles were retrieved, and final y 60 articles were included. Present studies showed that smal arthrogenous lower back pain could promote osteoarthritis progress. In pathophysiology, tumor necrosis factor-αand interleukin-1β, along with matrix metal oproteinase might play a significant role. As for the biomechanics, the meaning of angle in facet joint, with the inclination angle affected to osteoarthritis is the centre of study. As for clinical treatment, conventional closed treatment in the early stage can identify the source of the pain. For the patients with mild disease, fixation and functional exercises can be used to delay disease progress. In advanced patients, surgical treatment could restore functions and lessen pain.
出处
《中国组织工程研究》
CAS
北大核心
2015年第7期1070-1076,共7页
Chinese Journal of Tissue Engineering Research
