急性腰痛の臨床症状と画像所見の検討

Study of Clinical Manifestations and Imaging Findings in Acute Low Back Pain.

　抄録：1日以内で急激に発症した腰痛，殿部痛で，下肢の疼痛，神経症状を伴わない非特異的急性腰痛130例，男性77例，女性53例，平均年齢42.4歳を対象とし，発症様式から動作によるぎっくり腰，疲労などの誘因あり，なしの3群に分け，臨床所見と画像所見からその特徴を検討した．発症様式による差は認められなかった．急性腰痛の既往を有する割合が高く，疼痛は当初激烈であるが早期に緩解していた．X線所見では不安定性の頻度は低く，MRIでは軽度から中等度の椎間板変性を高率に認め，突出度はわずかであった．20歳代で非腰痛群と比較しても結果は同様であったことから，早期の段階での椎間板障害の存在が考えられ，椎間板のある程度の強度低下や機能障害に基づき，機械的刺激や疲労の蓄積で反復性に急性発作を生じるものと思われた．椎間板ヘルニア例に持続期間が長く，椎間板の器質的変化が進行すると疼痛は遷延化することが示された．

　We assessed the characteristics of non-specific acute low back pain with the rapid onset (within 1 day) of sever lumbago or buttock pain, but without pain or neurological symptoms of legs based on the clinical manifestations and imaging findings. The subjects consisted of 130 patients with acute low back pain, 77males and 53 females, average age 42.4 years. They were divided into three groups：patients with strained back by motion, patients with factors of fatigue etc., and patients without factors, and there were no differences between the results of clinical manifestations and imaging findings in the three groups. Most of the patients had a past history of acute low back pain. Although the pain was severe at first, remission occurred early. The frequency of instability on X ray images was low. MRI showed high rates of mild to moderate disc degeneration and little protrusion of the disc. Comparison with asymptomatic people in their twenties yielded the same results. Malfunction of the disc in the early stages appeared to be the factor that triggered the pain. Mechanical stress or accumulated fatigue based on a certain degree of loss of strength or functional disorder appeared to cause repeated acute attacks. In the cases of disc herniation, the duration of the pain was long. These results indicate that the pain becomes prolonged when the disc pathology progresses to organic change.