急性腰痛を主訴に受診した外来患者の臨床診断と経過

Clinical Diagnosis and Course of Outpatients with a Chief Complaint of Acute Low Back Pain

　抄録：急性腰・下肢痛を主訴に，発症後1カ月以内に当科を受診した1,033患者の臨床診断とその経過を調査し，当科における急性腰痛患者の特徴，傾向，診断，治療上の問題点につき検討した．20歳から50歳代の労働年齢層の患者が全体の70％以上を占めていた．対象患者の90％以上は，発症後2週間以内に当科を受診しており，発症に関わる誘因が存在した症例は538例（52.1％）で，労作時の発症が多かった．90％以上の症例が，数回の対症療法にて初診後2週間程度の治療期間で症状改善が得られ，入院加療を要したのは60例（5.8％），手術治療を行ったのは29例（2.8％）と少なかった．急性腰痛を来す疾患は多岐にわたるが，MRIなど補助診断を有効に利用しながら病態を的確に見極め，早期に治療を開始すれば，多くが短期間の治療で良好な経過をたどると考えられた．

　We investigated the clinical diagnosis and outcomes of low back pain by reviewing the charts of 1,033 outpatients who presented at Eniwa Hospital between August 2001 and July 2002 with a complaint of sudden onset of acute low back and/or leg pain of less than one month duration. There were 420 females and 613 males, and their mean age was 42.4 years old (range：5 to 93 years), with more than 70％ of all patients being between 20 and 59 years old. The duration of the acute low back and/or leg pain before presentation was about 2 weeks in over 90％ of all cases. The cause was apparent at the time of the sudden onset of symptoms in 538 cases (52.1％)：291 (28.2％) were work-related, 116 (11.23％) were sports-related, and 72 (7.0％) were related to activities of daily living. Low back pain alone was the main symptom at the time of presentation, in 675 cases (65.3％), and 358 (34.7％) developed buttock pain and/or leg pain during the course of medical treatment. A neurological deficit was detected in only 80 cases (7.7％). We evaluated the magnetic resonance imaging (MRI) scans as a supplementary examination in 169 cases (16.4％). MRI was performed on the first visit in 90 cases, and on the second visit in 68 cases. The MRI, findings resulted in a change in the initial clinical diagnosis in 40 cases (23.7％). The symptoms in over 90％ of the cases treated conservatively improved within 2 weeks of the initial examination, and the symptoms persisted for more than one month in only 39 cases (3.8％). Hospital admission was necessary in 60 cases (5.8％), but spinal surgery because of failure of conservative treatment was performed in only 29 (2.8％) cases. The outcome of acute low back pain and leg pain was favorable when it was possible to accurately determine its etiology and perform treatment as early and appropriately as possible.