急性期腰痛患者に対する安静・運動療法を基礎とした入院治療

Bed Rest and Exercise in Hospitalized Patients Treated for Acute Low Back Pain

　急性腰痛患者に対する安静・運動療法を基礎としたクリニカルパスの有用性を検討した．2003年1月～2004年4月までに入院した19～97（平均63）歳の男49例，女79例（計128例）を対象とした．診断は，新鮮圧迫骨折59例，腰椎椎間板ヘルニア26例，腰部脊柱管狭窄症12例，陳旧性圧迫骨折8例，変形性腰椎症6例，腰部打撲傷6例，急性腰痛症11例であった．治療方法，入院期間，転帰を調査した．全体の平均入院期間は38.9日で，83％が軽快し自宅退院した．疾患別に平均入院期間は異なっており，脊椎圧迫骨折患者では転院率が高かった．全体では薬物療法が72％に行われていたが，その多くは屯用の坐剤か外用薬であった．外固定が32％，物理療法が11％，ブロック注射が5％，手術が2％に行われた．腰椎椎間板ヘルニア・腰部脊柱管狭窄症において補助療法の使用頻度が高かった．クリニカルパスを疾患別ごとに修正し，圧迫骨折患者の介護保険制度下支援への移行を考慮する必要がある．

　We analyzed the outcome of hospitalization and a 35-day clinical pathway based on bed rest and exercise in 128 patients with acute lower back pain. Between January 2003 and April 2004, 59 patients with acute compression fractures, 26 with lumbar disc herniations, 12 with lumbar spinal canal stenosis, eight with old compression fractures, six with osteoarthrosis of the lumbar spine, six with contusions, and 11 with acute low back pain without organic failure were treated using the same clinical pathway. The average hospitalization period was 38.9 days. Although 83％ of the patients were discharged to their own home, many of the patients with compression fractures were transferred to other hospitals. Medication, external fixation, physiotherapy, block injection and surgery were needed in 72％, 32％, 11％, 5％ and 2％ patients, respectivery. Lumbar disc herniation and lumbar spinal canal stenosis required adjuvant therapy in relative high rates. We need modified clinical pathways for each diagnosis, especially in elderly patients with compression fractures.