【精品】课件---间盘源性腰痛.ppt

间盘源性腰痛-复制疼痛好还是抑制疼痛好？ 刘宪义 北京大学第一医院 CASE REVIEW: X-RAYMRI: Results: DISSCUSSION: Induce the pain----Difficult!!! Inhibit the pain-----??? False Positive？ Case review: Sciatica-inefficacy Xu XX F/52 PTED Spinal canal decomprression and Disectomy(L4/5 L5/S1) Inhibting: lidocaine(Concentration of?1%) ---- administered intradiscally at responsible level ----observe the patients’ reactions. Research-Criterion : Provoking pain group( 6 patients ): 4 patients were positive. Average operation time :45 minutes. The remaining were administrated by “inhibiting pain”----pain released Inhibiting pain group( 6 patients ): All positive ---- pain disappear, Average operation time :25 minutes. Results: 腰痛6个月以上； 系统保守治疗无效； 神经系统检查正常； 直腿抬高试验阴性； 椎间盘造影有1-2个椎间盘异常，并有6/10原疼痛强度的诱发疼痛 （Derby R，et al：Neuromodulation，2000，3（2）：82） 间盘源性痛诊断标准 Severe pain Pain:before– during—after radiography False-positive Multi-disc pathological changes （at least two discs） No typical HIZ More effective efficient High reliability Accepted by?patients Yin XX M/31 DBP CASE REVIEW: All images are authorized by the patient! Inhibit the pain-----??? DBP----pain released! LDH,DLSS,VCF---- pain released??? * * DEFINITION： DBP（discogenic back pain ）：伴或不伴下肢放射痛的慢性腰痛，起自椎间盘本身，由椎间盘内部正常结构破坏和生化改变引起的腰痛或放射痛 椎间盘内破裂 （IDD Internal Disc Disrupation / Derangement） 纤维环放射状撕裂 Radial Tear of annulus 痛性纤维环撕裂 Painful Annulus Tear 痛性椎间盘病 　 Pain Dark Disc Disease 退变性椎间盘疾病（DDD Degenerative Disc Disease) 腰椎僵硬　 Lumbar Spondylosis 孤立性椎间盘吸收 Isolated Disc Resorption 节段不稳（Segmental Instability) Zdeblick classification: IDD?account for?39% of DBP Thomas A. Zdeblick, MD The Spine 4th edition 750 The concept of “internal disruptions” was proposed by Crock, in 1970 and 1986. Low back pain?may occurred without nerve root compression. IDD(Internal Disc Disrupation / Derangement) 0—Normal 1—Contrast agent?infiltrate to inn