| Low Back Pain(LBP)is the main cause of disability and limited labor capacity worldwide,and its incidence has been at a high level.A global assessment of the incidence of low back pain in adult men showed that the annual incidence of low back pain is about38%,and the vast majority of these are nonspecific low back pain caused by fatigue or injury to soft tissues such as muscles or ligaments.As a special group of Air Force pilots,the incidence of low back pain is significantly higher than that of the general population due to long-term exposure to special operating environments with high loads(+Gz),high angular acceleration,small space,and continuous mechanical vibration.Since 2018,with the upgrading of the Air Force’s aviation technical equipment and the promulgation and implementation of the Air Force’s new military training program,the intensity and difficulty of flight training faced by Air Force pilots have increased significantly compared with the past.Under this new situation,the epidemiological characteristics(incidence rate,pain impact,risk factors,and rehabilitation treatment status,etc.)of low back pain among pilots of different types of air force are still unclear.This study intends to take the front-line pilots of the Air Force as the research object.By collecting and integrating the existing epidemiological data of the low back pain of the Air Force pilots,the key parameters of the low back pain epidemiological investigation of the Air Force pilots are screened out.International standardized consensus on pain definition,pain degree and functional status score,development of epidemiological diagnostic criteria for low back pain in pilots,and preparation of a spinal health questionnaire suitable for Air Force pilots.Using this questionnaire,we conducted an epidemiological investigation in the front-line troops of the Air Force,and obtained the latest epidemiological characteristics of the incidence of low back pain in pilots of different types of aircraft.Studies on the disease spectrum of air force pilots show that lumbar degenerative disease has become the main cause of non-combat grounding and attrition of air force pilots in peacetime.The spinal sagittal functional curve plays an important role in the occurrence and development of lumbar degenerative diseases and related low back pain,and different spinal sagittal functional curves Roussouly classification,the long-term incidence of spinal degenerative diseases and characteristics are significantly different.The above results are the characteristics of the natural medical history of the general population.Air Force pilots are faced with special working environments,such as high load,high angular acceleration,severe postural changes,continuous vibration and so on.There is no answer to the relationship between Roussouly classification of sagittal functional curve of spine and the occurrence and development of low back pain.On the basis of previous in-depth investigation and study of the epidemiological characteristics of low back pain in pilots of different types of air force,the relationship between Roussouly classification of sagittal function curve of spine and pelvis and the incidence of low back pain in pilots was studied,which makes it possible for us to predict the risk of low back pain according to different spinal and pelvic function curves of pilots and formulate targeted intervention and rehabilitation measures for low back pain.At the same time,we study the Roussouly classification of the sagittal functional curve of the spine and pelvis of Air Force pilots,which is expected to provide a new reference index for the recruitment and selection of pilots.Methods:1.Taking advantage of the opportunity of our hospital’s annual inspection and investigation of the air force units in each war zone,we selected some front-line pilots of the air force by stratified cluster random sampling as the object of study.All the pilots who participated in this study completed the pilot Spine Health questionnaire.The questionnaire consists of demographic data,flight training,low back pain and lifestyle.Four members of the research group were divided into two groups,and the questionnaire statistics were carried out respectively.The questionnaire data were entered by Epidata 3.1software and the consistency was checked.SPSS 25.0 software was used for statistical analysis.2.A total of 192 graduating pilots from a flight academy of the Air Force were selected as the object of study.All the pilots who participated in the study completed the pilot Spinal Health questionnaire.The research group cooperated with the resident hospital to collect the full length(including pelvis)X-ray films of the standing spine of all the pilots involved in the study.The parameters of spinal sagittal functional curve,including PI,SS,PT,LL and APEX,were measured by Surgimap 2.3.2 software,and the spinal sagittal functional curve was classified by Roussouly.To analyze the correlation between the incidence of low back pain and Roussouly classification of sagittal functional curve of spine in pilots.Results:1.The average annual incidence of low back pain in pilots of three different types of aircraft is 66.4%.The annual incidence of low back pain in fighter,transport and helicopter pilots is 66.0%,73.4% and 56.6%,respectively.In order to reduce the recall deviation caused by too long memory time,we also investigated the three-month incidence of low back pain in pilots of different types.50.8%,58.1% and 43.4% of fighter pilots,transport pilots and helicopter pilots respectively experienced low back pain in the past three months.The average incidence of low back pain in three different types of air force pilots was 51.5% in 3 months.2.The frequency of low back pain in pilots was mainly occasional(at least once a month,but less than once a week),accounting for 59.7%.The timing of low back pain in pilots was mainly during or after flight training,accounting for 62.1%,which suggests that flight-related low back pain is dominant in the pathogenesis of low back pain in Air Force pilots.The pain degree of pilots’ low back pain was mainly moderate pain(VAS score of4-7 points),accounting for 48.9% of the total pilots,and the proportion of mild pain(VAS score of 1-3 points)was slightly lower(40.0%).The impact of low back pain on pilots is mainly the implementation of flight actions and the surrounding observation obstacles,and it is easy to cause the pilot’s attention to decrease.3.Based on the analysis of the risk factors of low back pain in pilots,it was found that the total flight time ≥ 2000 hours,inappropriate flight seat and sedentary(> 4 hours /day)were important risk factors for low back pain in pilots.Flight duration ≥ 2000 hours was the most important risk factor for low back pain(OR=5.191)in pilots,and the secondary risk factors were inappropriate flying seat(OR=2.126)and sedentary(> 4 hours/ day)(OR=1.650).Low back muscle exercise and relaxation after flight are the protective factors of low back pain in pilots(OR < 1).It can be considered that low back muscle exercise and relaxation after flight can relieve and prevent low back pain in pilots.In the past,there was no significant difference in age,body mass index and smoking between the low back pain group and the control group.4.The spinal sagittal functional curves of 192 pilots in a flight college of the Air Force were studied.It was found that there were 16 pilots of Roussouly Ⅰ,66 pilots of Roussouly Ⅱ,84 pilots of Roussouly Ⅲ and 26 pilots of Roussouly Ⅳ.In this study,the distribution of Roussouly typing of sagittal spinal function curve in air force pilots was significantly higher than that of normal Chinese sagittal Roussouly typing,while the proportion of Roussouly Ⅱ(34.4%)was significantly higher than that of type Ⅰ,type Ⅲand type Ⅳ.5.According to the study on the correlation between Roussouly classification of different sagittal functional curves of spine and the incidence of low back pain in pilots,it was found that the incidence of low back pain in pilots of type Roussouly Ⅱ was the highest,which was 72.7%.The incidence of low back pain in other pilots of type Ⅰ,typeⅢ and type Ⅳ was 50.0%,35.7% and 42.3%,respectively.There was a significant difference in the incidence of low back pain among the pilots of four sagittal Roussouly types(P < 0.001).On the basis of the Bonferroni test,multiple comparisons were made between the two groups.The results showed that the incidence of low back pain in pilots of type Roussouly Ⅱ was significantly higher than that of the other three types,and there was significant difference between the two types.There was no significant difference in the incidence of low back pain among the other three Roussouly types.The above results suggest that the risk of low back pain in pilots with Roussouly Ⅱ sagittal function curve is significantly higher than that in the other three types.Conclusion:This study revealed the latest epidemiological characteristics(incidence,risk factors and current status of rehabilitation treatment)of low back pain in pilots of different types of aircraft since the new equipment of the Air Force was installed and the new program was carried out.Among them,the incidence of low back pain in pilots was significantly higher than that reported before the implementation of the new outline,and the average annual incidence of low back pain in pilots of three types of aircraft(fighter,transport and helicopter)reached 66.4%.Our study on the risk factors of low back pain in air force pilots found that factors such as total flight time > 2000 hours and inappropriate flight seats were the core risk factors for low back pain.There was no difference in the distribution of previously reported factors such as age,body mass index and smoking between the low back pain group and the control group.Under the new situation,the incidence of low back pain in pilots is significantly increased,and it has a great impact on pilots’ flight training and daily life.In view of this situation,the development of early risk screening and targeted rehabilitation treatment for low back pain in pilots should become the key research content of our attention at the present stage.We introduced the sagittal functional curve Roussouly classification into the early risk screening and early warning of low back pain in pilots.It was found that the risk of low back pain in pilots with Roussouly Ⅱ sagittal function curve was significantly higher than that of the other three types.Our results are expected to provide a new reference for the risk prediction of low back pain in pilots and the selection of pilots. |
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