Lowbackpain Thai

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    September 17 ,2007September 17 ,2007 11

    LOW BACK PAINLOW BACK PAIN

    ( LBP )( LBP )

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    60-8060-80

    ! ! "#!$%"#!$%

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    22

    2.2. !)+,'!)+,' systemicsystemic +,*%-+,*%-

    (1)(1) !. . $+,$$!. . $+,$$ osteomyelitisosteomyelitis+,+,%!&$%!&$ epid!ra abscess epid!ra abscess(2)(2) % . % . "!ltiple myeloma "!ltiple myeloma %% %%)%%)(3)(3) #nflammatory disease#nflammatory disease .. $nkylosing spondylitis$nkylosing spondylitis($S)($S)+,"%!&$$$($%&,"$+,"%!&$$$($%&,"$(4)(4)+,$%*",(+,$%*",( %dissecting aortic ane!rism%dissecting aortic ane!rism+,+, %$%$ +,+,d!oden!md!oden!m!lcer!lcer(&)(&) "etabolic bone disease"etabolic bone disease .. 'steoporosis 'steoporosis 'steomalacia ('steomalacia (+,%!&+,%!&))()() - . ')%' +,$- . ')%' +,$

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    !$'(!$'(

    1.1. "!,!"!,! back m!scleback m!sclestrainstrainsprainsprain '(! %*$' /0!'(! %*$' /0!

    )*."1'(1&(%#!)*."1'(1&(%#!%!&$$%!&$$ (( !)!)f!nctional * str!ct!ral )f!nctional * str!ct!ral )

    2.2. %!&%!& ( Herniated +isc)( Herniated +isc) '*"!!'*"!!$2($$!" !2($$2($$!" !2($$!*$'+!(%$$'($!*$'+!(%$$'()%(!$ *#"&&!))%(!$ *#"&&!)

    an!l!s fibross!san!l!s fibross!s '*"'*"n!cle!s p!lpos!sn!cle!s p!lpos!s+ + -'!"$%!-'!"$%! posterior longit!nalposterior longit!nalligamentligament '*"!!$'(('*"!!$'((

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    !$'(!$'(

    33&!#$!&&!#$!& ((Pr!m"r#Pr!m"r#$e%e&er"t!'e t*e +p!&e )$e%e&er"t!'e t*e +p!&e )!'&& !'&&

    #$% (#)!#$#(!$#$% (#)!#$#(!$!! #$#!$$!!!* (#!! #$#!$$!!!* (#

    +!!( (+!!( ( O+tep*#teO+tep*#te $$ +pr+pr!&!!&! !&t +p".e!&t +p".e ".et !&t".et !&t", #$", #$ "&/+ !br++"&/+ !br++

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    September 17 ,200 7

    !$'(!$'(

    44 Sp!&"/ +te&+!+Sp!&"/ +te&+!+ !#(#)!,$!*!#(#)!,$!*+p!&"/ ."&"/+p!&"/ ."&"/ (",(#(",(#O+tep*#teO+tep*#te $$+pr+pr(-!&%! (!(-!&%! (! /!%"me&t/!%"me&t "(#$!&!"(#$!&! $#(#()$' $#(#()$'&! #$#) !&! #$#)!* #$"!( "(.%!#$* #$"!( "(.%!#$

    !!! "#!#'!!! "#!#'(( ./"$!."t!& )./"$!."t!& )

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    September 17 ,200 8

    !$'(!$'(

    &.&. +,%!&+,%!& (( 'steoporosis )'steoporosis ) *#"&&+!*#"&&+!2%#"&3$$!%)! *'(2%#"&3$$!%)! *'(,4+,!4 !$$,4+,!4 !$$

    ")10 !$ %$")10 !$ %$1"!2($! *"$)%(1"!2($! *"$)%(compression fract!recompression fract!re %!&$$ 1"(%!&%!&$$ 1"(%!&

    $$$%(!'$%')%'*"$$$%(!'$%')%'*"" $%!&),," $%!&),,."- $"$' '*"(%$,."- $"$' '*"(%$,

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    September 17 ,200

    // L b". p"!&L b". p"!&

    1.1. /$%$%) )2$/$%$%) )2$%+,%+,1.11.1 /$$5%!/$$5%!

    %%%%!$!$ %% $$ "--"-- " -" -!$(!(!$(!( ( ,ack pain )( ,ack pain )!$"!$" (( leg pain )leg pain )

    .!".!"((-!mbness )-!mbness )!.0 1"!!.0 1"! !!(0 1"!"$!!(0 1"!"$ $$$$,!,! is!al /ain Scaleis!al /ain Scale

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    1.21.2 /$%$/$%$$5%'('$5%'(' %% $+6%$+6% *."*."(.!.)!(.!.)!705705&(&( !"!"

    %$!)*!(%$!)*!(%$!$*,,$%$!$*,,$%$$5%$$5 0,/0,/+!'42%'+!'42%'%$+,$%$+,$ %% ,!$+&,!$+& +,+,

    $*)$*) %% +,%!&+,%!&""'(%)'(%)"" $!$! ((

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    1.31.3 ))1.3.11.3.1 gaitgait

    '!'!%%

    #!#!1.3.21.3.2 post!re post!re $($( ((listing)listing) $,$, (( kyphosis)kyphosis) $$ ( lordosis )( lordosis ) $,!$,! ( scoliosis )( scoliosis )

    1.3.31.3.3 l!mbofemoral rhythml!mbofemoral rhythm #!#!1.3.41.3.4 Straight leg raising test (S0)%Straight leg raising test (S0)%

    t .t .,, 0t .0t .

    5ross leg raising test % t .5ross leg raising test % t .,, 0t .0t .

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    1.3.&1.3.& /oint of tenderness/oint of tenderness ((............((............midline midline

    paraspino!s ..paraspino!s ..

    iliac crest iliac crest

    greater trochanter greater trochanter

    1.3.1.3. m!scle spasmm!scle spasm ((..............((............1.3.61.3.6 long tract signslong tract signs ((............ ((.......... ,abinski ,abinski

    clon!s clon!s

    hyperrefle7ia hyperrefle7ia

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    (1,3 ,$(1,3 ,$((

    #!$%#$#!$%#$ lower motor ne!ron lesionlower motor ne!ron lesion !"!"

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    Str"!%*t /e% r"!+!&% te+tStr"!%*t /e% r"!+!&% te+t

    4('& !!!#( 0 ,4('& !!!#( 0 ,'& +&.#()$'0'& +&.#()$'0!'&($!.(!#'& "$!'&($!.(!#'& "$

    #!%! ,*.%!!$!%! ,*.%!!$&!#0#$#'& ##!#0 #$#'& ##'&((#!'& #'&((#!'& #!0! + "+/!0! + "+/

    #)!"0! #5$(#)!"0! #5$(#!0!! # !$0#!0!! # !$0#.%!!%!$%!#( 1##.%!!%!$%!#( 1#!.!.

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    -"1-"1 Str"!%*t /e% r"!+!&%Str"!%*t /e% r"!+!&%te+tte+t

    ,!(+0+.,!(+0+.006$ #$'&6$ #$'&" ,!" ,!((&er'e rt !rr!t"t!&&er'e rt !rr!t"t!& $$*"m+t!&% m+./e +p"+m*"m+t!&% m+./e +p"+m !%!!%!

    "+0"+0 7070 6 6

    !(#(#!(#(# /mb"r/mb"r$$ +".r!/!". !&t+".r!/!". !&t

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    September 17 ,200 1

    22 I&'e+t!%"t!&I&'e+t!%"t!&

    B/$ te+t CBC , 9S ,B/$ .*em!+tr#B/$ te+t CBC , 9S ,B/$ .*em!+tr#

    :-r"# P/"!& L-S +p!&e AP, L"ter"/:-r"# P/"!& L-S +p!&e AP, L"ter"/

    L-S b/!;eL-S b/!;e

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    %1(#$%1(#$

    0#$ !1%!0#$ !1%! #!$%#$+!$%#$+& !"!"

    #!$%#!$% ,,

    +1+1 %11'%11' ",4--!",4--! ,,

    #!#!

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    September 17 ,200 22

    %1+-%1+-L-SL-S

    +p!&e AP ,L"ter"/+p!&e AP ,L"ter"/ #!#! 5050

    #()#() ,,

    /,&/,&!! ,, /,#)/,#),, ## ,,'&!'&!

    ,, #!#! 33 #$!#$! ,,

    !"!" !1%! #$ ,$!0 #(! 0!1%! #$ ,$!0 #(! 0

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    September 17 ,200 23

    %1+-%1+-L-SL-S

    +p!&e Ob/!;e '!e+p!&e Ob/!;e '!e C"+eC"+e Sp&$#//#+!+Sp&$#//#+!+ ""

    Sp&$#//!+t*e+!+Sp&$#//!+t*e+!+

    (-(- p/"!& L-S +p!&ep/"!& L-S +p!&e

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    September 17 ,200 24

    %1+-%1+-L-SL-S

    +p!&e 9te&+!& '!e+p!&e 9te&+!& '!e1.1. !$%' !!(0!$%' !!(0

    $$

    2.2. $(!$(! 0S spine0S spine !'%!&$!'%!&$$$ %!&$$%!&$$3.3. ,(%$#$!,(%$#$! 0 Spine0 Spine

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    33!(5!(5 (( ?!"%&+!+ )?!"%&+!+ )3131 0#"!0#"!(!$!p"t*!. b". p"!&)(!$!p"t*!. b". p"!&)

    (#)!#5! $#$% +#!(#)!#5! $#$% +#! 77 +$ +$#)!#$%#)!#$%

    3232 #(!#(!(( '!+.er%e&!. b". p"!& )'!+.er%e&!. b". p"!& ) #! #!#! #! ,,$!4$!4 ,, #!#! ,,

    #$#$3333#((#(( ( P+#.*%e&!. b".( P+#.*%e&!. b".

    p"!& )p"!& )

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    99 #$!#$!

    8989 ")$5$54"")$5$54" EFGEFG$!4%$!4%DFGDFG !!

    :9:9 (!'$%''(1'(1)(!'$%''(1'(1)!"!"

    D9D9 ("'(("'(

    E9E9 (%$% %"'(()(%$% %"'(()!'$%'!'$%'

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    %%

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    %' 1%' 1 LL

    B". P"!&B". P"!& (!'$%')"$$4$(!'$%')"$$4$

    )'$()2$)'$()2$ ("'(("'(

    JFK KLMN=JFK KLMN=$,$,

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    2.2. #"&'((!$$!." +!("#"&'((!$$!." +!(" $! (%-$! (%-

    ))% S0% S0*"#.$!) (!'$%'*"#.$!) (!'$%'$5$5%% 1",$5 *""$5$541",$5 *""$5$54 44 $!4$!4

    1"!(0*1"!(0* 2323 $!4*"$!4*" 0S spine $/ lateral0S spine $/ lateral1",!"$$5$54 *"1",!"$$5$54 *" 0S spine0S spine

    $/ lateral$/ lateral $ $ 'bli=!e'bli=!e *('("+,*('("+,$%!&$%!& pars interartic!larispars interartic!laris 1"#1"# 7ray7ray *"$5$54*"$5$54 44 $!4$!4!$5'!$5' 1212 $!41"!(0 !&*$!41"!(0 !&* 5hronic5hroniclow back painlow back pain

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    33 '&0'&0 ,, #$#$ ,, !1%!!1%!

    (( SL SL' 0"' 0"#!$%#$(#$#!$%#$(#$ ,, L-S +p!&e APL-S +p!&e AP@/"ter"/ , C: PA@/"ter"/ , C: PA "./"#5#$"./"#5#$",(#$!",(#$!

    44 '&0'&0 ,, #$#$ ,, !1%!1%! 88! 88(( SL SL' "' "#!$%#$ (#$#!$%#$ (#$ ,, L-S +p!&eL-S +p!&e

    AP @/"ter"/AP @/"ter"/

    +-+- L-S +p!&eL-S +p!&e "1&! "1&! 1#!!/#)!#!$%&!1#!!/#)!#!$%&!