慢性骨筋膜间隔综合征致下腰痛临床探究.docVIP

慢性骨筋膜间隔综合征致下腰痛临床探究 　【摘要】 ［目的］探讨慢性骨筋膜间隔综合征所致下腰痛的发病机理。［方法］选取明确诊断为腰骶部慢性骨筋膜间隔综合征且未合并其他腰部疾病的患者30例，分别行腰腹肌肌力测定，竖脊肌内压测定，血常规，血沉，肌酸激酶（CK）及同工酶（CK-MM），乳酸脱氢酶（LDH）及同工酶（LDH5）测定，采用骨筋膜间隔切开减压手术治疗。术中切取竖脊肌标本用于组织病理学观察和透射电镜观察。［结果］各项酶学检验无异常；组织学光镜下观察到竖脊肌纤维部分溶解变性，肌纤维肥大，少量炎性细胞浸润；电镜下观察到肌纤维灶状溶解，核周线粒体聚集，胞内脂滴、溶酶体增多，肌卫星细胞增殖分化。［结论］腰骶部慢性骨筋膜间隔综合征是由于内在压力增加，筋膜间隔内组织代谢障碍，骨骼肌慢性受损，炎症因子释放，最终影响脊神经后支导致的下腰痛。 【关键词】 慢性骨筋膜间隔综合征； 下腰痛； 发病机理； 临床研究 Abstract：［Objective］To discuss pathogenesis of low back pain induced by chronic compartment syndrome.［Method］Thirty patients who had definite chronic lumboscaral compartment syndrome without other lumbal diseases were choosed respectively to test muscle force of lumbar and abdomen,intra-sacrospinal muscle pressure,blood routine,ESR,CK,CK-MM,LDH and LDHs.All patients received decompressive operation.Skeletal muscle specimens taken from sacrospinal muscle in each operation were possessed for histological and ultrastructuml observation.［Result］All of enzyme tests were normal.The author could observe the dissolved degeneration of part of sacrospinal muscle fibers,muscle fiber hypertrophy,and a small quantity of inflammatory cell infiltration with a light microscope.Focal solution of muscle fiber,the aggregation of mitochondria around the nucleus,the increase of lipid droplet and lysosome in cyte,and the proliferation and differentiation of muscle satellite cell could be observed with an electron microscope.［Conclusion］Pathogenesis of chronic lumboscaral compartment syndrome may be as followed.Intra-compartmental pressures increase,causing metabolism disturbance of the tissues under fascia compartment,damaging skeletal muscle chronically,then inflammatory factors are released,which stimulates posterior branch of spinal nerves,and finally induces low back pain. Key words:chronic compartment syndrome; low back pain; pathogenesis; clinical study 下腰痛（low back pain，LBP）是指后背的腰骶部的疼痛或不适感，可伴有或不伴有下肢的放散痛。约60％～80％的成人在一生中患有慢性下腰痛。在美国，下腰痛的发病率仅次于上呼吸道感染而居第2位〔1〕。目前已知导致下腰痛的原因有上百种之多，1981年Peck