Comparison of Lumbar Range of Motion in Patients Having Herniated Nucleus Pulposus with and without Nerve Root Compression

椎間盤後突患者有無併發神經根壓迫症狀時之腰椎活動度比較

王子娟(Wendy Tzyy-Jiuan Wang)

《物理治療》 25卷6期 (2000/11) Pp. 311-316

摘要

研究目的：比較正常人與椎間盤後突（herniated nucleus pulposus）患者之腰椎後伸（lumbar extension）與前彎（flexion）活動度。方法：受測者分為三組；第一組包括15位健康男性志願者，第二組包括15位男性下背痛病患，且有在核磁共振攝影術（magnetic resonance imaging）下確定的腰椎椎間盤後突合併神經根壓迫的診斷，第三組為15位男性椎間盤後突之下背痛患者，但無神經根壓迫的情形。腰椎活動度的測量工具是「背部關節活動測量儀」（BROM）。每組受測者執行腰前彎及腰後伸動作角度測量，取其平均值做為比較組別差異的依據。研究結果：發現在腰前彎角度方面，正常受測者較兩組椎間盤後突患者有更大活動度。腰後伸角度的比較結果則發現只有椎間盤後突合併神經根壓迫的患者有小於正常角度的情形。至於椎間盤後突但無神經根壓迫的患者，則在腰後伸活動度上與正常受測者沒有統計上的差異。結論：為椎間盤後突患者，不論神經根是否受壓迫，的確有腰前彎活動度減少的情形。而神經根有壓迫的患者腰後伸活動度小於正常範圍，可能原因為後伸動作造成椎間盤壓力的增加，可能同時增加椎間盤後突的程度，使得神經根壓迫情形更加惡化之故。若椎間盤後突程度不大，亦即並未造成神經根的壓迫，則腰後伸動作反而給予後突的椎間盤一個向前復位的力量，所以後伸活動度不會受到限制。這種臨床上的差異值得在評估下背痛病患時予以區分及注意。

關鍵字

腰椎 ； 關節活動度 ； 椎間盤突出

並列摘要

Background and Purpose: The purpose of this study was to compare the range of lumbar extension and flexion in normal subjects and patients having herniated nucleus pulposus (HNP) with or without nerve root compression. Methods. Three groups of subjects participated in this study. Group I consisted of 15 healthy male volunteers. Without previous history of low back disorders (LBD). Group II consisted of 15 male LBD patients who had the diagnosis of HNP with nerve root compression. Group III consisted of 15 male HNP patients without nerve root involvement. Patients in group II and III were all diagnosed by an orthopedic surgeon based on clinical examinations and results of magnetic resonance imaging (MRI). Lumbar ranges of flexion and extension were measured using the Back Range of Motion (BROM) instrument. Results: Normal subjects showed significantly greater flexion than both groups of patients. Range of extension was significantly greater in normal subjects comparing to patients with nerve root compression, but not different between normal subjects and patients without nerve root compression. Patients without nerve root compression demonstrated significantly greater range of extension than patients with nerve root compression. Conclusion: When bending either forward or backward, patients with LBD had less range because of pain or fear of producing pain. Patients with nerve root involvement exhibited less range of extension because they may have more uncontained type of disc herniation problem. When they tried to bend backwards, the pressure of posterior disc herniation tended to increase so that the extruded disc would irritate the compressed tissues and/or nerve roots more. On the contrary, patients without nerve root involvement had smaller disc protrusion, which could be more likely to be pushed anteriorly with extension movement. Clinically, this situation needs to be considered when evaluating and treating patients of disc herniation with or without nerve root irritation.

並列關鍵字

Lumbar spine ； Range of motion ； Herniated nucleus pulposus