麻泽松,覃兴乐

慢性非特异性下腰痛（chronic nonspecific low back pain，CNSLBP）是临床常见的肌肉骨骼疾病。其功能受限不仅与疼痛及腰部活动减少有关，部分患者还可出现躯干、骨盆与下肢协调方式的改变。现阶段临床评估仍多依赖疼痛评分、功能障碍量表和腰椎活动度，这些指标能够反映症状及主观功能受限程度，但对患者实际运动表现的描述相对不足。随着步态分析及运动生物力学技术的应用，CNSLBP患者在步速、步频、步长、腰盆协调以及下肢负荷分配等方面的变化逐渐受到关注。已有研究提示，这些步态特征并不完全一致，患者之间存在较明显的个体差异，可能与疼痛状态、运动控制及代偿方式不同有关。本文结合近年相关研究，对CNSLBP患者的步态生物力学表现、功能评估方法及康复干预进展进行梳理，并对现有研究中人群异质性、评价方法差异及实验室测试与日常活动脱节等问题进行讨论，以期为临床功能评估和个体化康复提供参考。

慢性非特异性下腰痛；步态；生物力学；运动控制；功能评估；康复

[1] GBD 2021 LOW BACK PAIN COLLABORATORS.Global,regional,and national burden of low back pain,1990-2020,its attributable risk factors,and projections to 2050:a systematic analysis of the Global Burden of Disease Study 2021[J].Lancet Rheumatology,2023, 5(6):e316-e329. [2] MAHER C,UNDERWOOD M,BUCHBINDER R.Non-specific low back pain[J].Lancet,2017,389(10070):736-747. [3] KNEZEVIC N N,CANDIDO K D,VLAEYEN J W S,et al.Low back pain[J].Lancet,2021,398(10294):78-92. [4] 中国康复医学会脊柱脊髓专业委员会专家组.中国急/慢性非特异性腰背痛诊疗专家共识[J].中国脊柱脊髓杂志,2016,26(12):1134-1138. [5] GEORGE S Z,FRITZ J M,SILFIES S P,et al.Interventions for the management of acute and chronic low back pain:revision 2021[J]. Journal of Orthopaedic&Sports Physical Therapy,2021,51(11):CPG1-CPG60. [6] GARG A,PATHAK H,CHURYUKANOV M V,et al.Low back pain:critical assessment of various scales[J].European Spine Journal, 2020,29(3):503-518. [7] SHAFSHAK T S,ELNEMR R.The visual analogue scale versus numerical rating scale in measuring pain severity and predicting disability in low back pain[J].Journal of Clinical Rheumatology,2021,27(7):282-285. [8] 万丽,赵晴,陈军,等.疼痛评估量表应用的中国专家共识(2020版)[J].中华疼痛学杂志,2020,16(3):177-187. [9] DAL FARRA F,LOPOMO N F,FASCIA M,et al.How non-specific low back pain affects gait kinematics:a systematic review and meta- analysis[J].Frontiers in Pain Research,2025,6:1693068. [10] 陈晓兰,王琳,等.青年慢性非特异性腰痛患者步态:时空和动力学参数特征[J].中国组织工程研究,2019,23(4):556-561. [11] 刘红,侯美金,黄武杰,等.基于步态轮廓评分分析青年慢性非特异性腰痛患者的步态模式[J].中华物理医学与康复杂志,2020,42(3):232-238. [12] 黄武杰,刘红,李雅萍,等.疼痛缓解对慢性非特异性腰痛患者步态特征的影响[J].中国康复理论与实践,2021,27(2):197-202. [13] 罗卫,钟陶,高燕,等.慢性非特异性腰痛患者的三维步态功能分析[J].中国疗养医学,2023,32(3):273-276. [14] KOCH C,HÄNSEL F.Chronic non-specific low back pain and motor control during gait[J].Frontiers in Psychology,2018,9:2236. [15] SMITH J A,STABBERT H,BAGWELL J J,et al.Do people with low back pain walk differently?A systematic review and meta-analysis [J].Journal of Sport and Health Science,2022,11(4):450-465. [16] ALSUBAIE A M,MAZAHERI M,MARTINEZ-VALDES E,et al.Is movement variability altered in people with chronic non-specific low back pain?A systematic review[J].PLoS One,2023,18(6):e0287029. [17] TONG M H,MOUSAVI S J,KIERS H,et al.Is there a relationship between lumbar proprioception and low back pain?A systematic review with meta-analysis[J].Archives of Physical Medicine and Rehabilitation,2017,98(1):120-136.e2. [18] 陈炳霖,郭佳宝,李欣,等.青年慢性非特异性腰痛患者腰部本体感觉及其与肌力的相关性[J].中国康复医学杂志,2017,32(2):187-191. [19] VLAEYEN J W S,MAHER C G,WIECH K,et al.Low back pain[J].Nature Reviews Disease Primers,2018,4(1):52. [20] CARVALHO A R,BRIANI R V,BERTOR W R R,et al.Chronic low back pain and walking speed:effects on the spatiotemporal parameters and in gait variability[J].BrJP,2019,2(4):342-347. [21] BAGHERI R,EBRAHIMI TAKAMJANI I,POURAHMADI M R,et al.Trunk-pelvis kinematics variability during gait and its association with trunk muscle endurance in patients with chronic low back pain[J].Journal of Applied Biomechanics,2020,36(2):76-84. [22] SIMONET E,WINTELER B,FRANGI J,et al.Walking and running with non-specific chronic low back pain:what about the lumbar lordosis angle?[J].Journal of Biomechanics,2020,108:109883. [23] PIZOL G Z,MIYAMOTO G C,CABRAL C M N.Hip biomechanics in patients with low back pain,what do we know?A systematic review[J].BMC Musculoskeletal Disorders,2024,25(1):415. [24] SADLER S,SPINK M,CHUTER V.Gluteus medius muscle activity during gait in people with and without chronic nonspecific low back pain:a case control study[J].Gait&Posture,2021,83:15-19. [25] CEBALLOS-LAITA L,ESTÉBANEZ-DE-MIGUEL E,JIMÉNEZ-REJANO J J,et al.The effectiveness of hip interventions in patients with low-back pain:a systematic review and meta-analysis[J].Brazilian Journal of Physical Therapy,2023,27(2):100502. [26] 杨倩倩,孟宪中,颜雯婷,等.慢性非特异性腰痛患者足底压力特征分析和平衡研究[J].医用生物力学,2023,38(1). [27] 陈景洲,王惠娟,石真润,等.慢性非特异性腰痛患者躯干肌的等速力学特征和肌电信号研究[J].中国康复医学杂志,2021,36(1):51-56. [28] 岳寿伟.腰痛的康复评估与治疗[J].康复学报,2023,33(4):287-294. [29] 程继伟,王振林,刘伟,等.Oswestry功能障碍指数的改良及信度和效度检验[J].中国脊柱脊髓杂志,2017,27(3):235-241. [30] HOOPER T L,JAMES C R,BRISMÉE J M,et al.Dynamic balance as measured by the Y-Balance Test is reduced in individuals with low back pain:a cross-sectional comparative study[J].Physical Therapy in Sport,2016,22:29-34. [31] 刘晓龙,何梦晓,尹贻锟,等.核心稳定康复训练系统对慢性非特异性腰痛干预效果研究[J].中国全科医学,2023,26(9):1064-1071. [32] MCCLINTOCK F A,CALLAWAY A J,CLARK C J,et al.Validity and reliability of inertial measurement units used to measure motion of the lumbar spine:a systematic review of individuals with and without low back pain[J].Medical Engineering&Physics,2024,126:104146. [33] KENT P,HAINES T,O'SULLIVAN P,et al.Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic,disabling low back pain(RESTORE):a randomised,controlled,three-arm,parallel group,phase 3,clinical trial[J].Lancet,2023, 401(10391):1866-1877. [34] HAYDEN J A,ELLIS J,OGILVIE R,et al.Exercise therapy for chronic low back pain[J].Cochrane Database of Systematic Reviews, 2021,9(9):CD009790. [35] WORLD HEALTH ORGANIZATION.WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings[M].Geneva:World Health Organization,2023. [36] 王雪强,陈佩杰,矫玮,等.运动疗法治疗腰痛的专家共识[J].体育科学,2019,39(3):19-29. [37] 冯渊,何成奇,杨霖.运动疗法治疗慢性非特异性腰痛的临床研究进展[J].中华物理医学与康复杂志,2023,45(2):173-177. [38] 许思毛,张敬之,刘晓龙.核心稳定训练对慢性非特异性腰痛影响的Meta分析[J].河南师范大学学报(自然科学版),2022,50(2):150-156. [39] 张婵娟,李悦龙,张洲,等.运动控制训练改善慢性非特异性腰痛的fMRI研究[J].中国康复医学杂志,2022,37(3):303-310. [40] NÚÑEZ-CORTÉS R,SUSO-MARTÍL,SALAZAR-MÉNDEZ J,et al.How much walking is enough for chronic low back pain?A systematic review and dose-response meta-analysis[J].PM&R,2026. [41] 郑翔,张明兴,黄雅,等.生物反馈助力电刺激对慢性非特异性腰痛患者下肢步行功能的改善[J].中国组织工程研究,2025,29(3):547-553.

点击下载PDF