香港大學李嘉誠醫學院矯型及創傷外科系列之一
麥建章醫生
香港大學李嘉誠醫學院
矯型及創傷外科學系臨床助理教授
研究指出有70-90%的成人會有腰骨痛的情況。坐骨神經痛和間歇性脊髓跛行雖不是太常見但與腰痛有著密切關係。雖比重不同,但創傷、退化、感染或腫瘤都可引起以上病症。
坐骨神經痛的特徵是疼痛或麻木從臀部或大腿後外側痛到小腿(最常見是小腿外或後側),反而腰痛有時不太明顯;同時腿痛部位反映受壓的節段和神經。由椎間盤突出而引起的麻痛是最常見的成因,於20歲至50歲較為普遍,一般是由於拉傷腰部或搬運重物而引起。如果是較輕微的疼痛、麻木或肌力減退,而沒有難以控制大小便的情況,便會以保守治療為主。
間歇性脊髓跛行的成因主要是腰椎退變,多於40歲或以上發病。椎管狹窄隨著退變而增加,導致供血到神經減退,可步行時間會減少,甚至有時只得幾分鐘。如果加上滑脫(即椎體移位),椎管的狹窄會更甚。
骨科脊柱醫生的角色是確認病症和尋找原因,排除感染和腫瘤的可能性後再給予最合適的治療,很多時候需進行磁力共振掃描以助診斷。療程以物理治療和藥物為主,若療效不理想就需要動手術 - 包括減除壓迫神經的椎間盤或改善滑脫,融合術及植入金屬則在脊柱有不穩定的情況下才需要。
腰椎病雖繁複,但只要及早求醫、掌握病理,就可對症下藥。
<刊載於《am730》,2015年7月13日>
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© 2025 Department of Orthopaedics and Traumatology, The University of Hong Kong. All rights reserved.