腰椎间盘造影在椎间盘源性腰痛诊治中应用.docVIP

腰椎间盘造影在椎间盘源性腰痛诊治中应用 　 作者：郝定均 刘团江 吴起宁 周劲松 贺宝荣 【关键词】 腰椎间盘造影 摘 要：［目的］探讨椎间盘造影对椎间盘源性腰痛的诊断价值及椎间融合手术的疗效。［方法］2003年10月～2004年6月间对45例具有椎间盘源性腰痛症状的病人进行了椎间盘造影，共101个椎间盘，45例中依据椎间盘造影的结果行椎间360°融合手术18例，保守治疗27例。所有病例全部进行了MRI和CT检查。观察造影图像和MRI表现，记录诱发痛，随访手术组和保守组的疗效。［结果］45例中2l例出现了诱发痛(47％)，101个造影椎间盘中有21个椎间盘出现诱发痛(21％)；21例诱发痛阳性的病人中18例接受了360°融合手术，随访时间平均6个月(3~10个月)，术后1l例病人腰痛完全消失(11／18，优：61％)，4例疼痛基本消失(4／18，良：22％)，3例腰痛无变化(3／18，差：17%)；3例诱发痛阳性的病人和24例诱发痛阴性的病人行保守治疗，在同期随访中，1例腰痛完全消失(1／27,优：4％)，10例疼痛基本消失(10／27，良：37％)，16例疼痛没有变化甚至加重(16／27，差：59%)。［结论］腰椎间盘造影对椎间盘源性腰痛的诊断具有一定的敏感性，对确定为疼痛原因的椎间隙实施椎间360°融合手术可以消除病人的疼痛，近期效果比保守治疗好。 　　关键词：椎间盘源性腰痛； 腰椎间盘造影； 椎间融合术； 疗效 　　Application of lumbar discography in the diagnosis and treatment of the discogenic low back pain 　　Abstract：［Objective］To investigate the diagnositic value of lumbar discography in discogenic low back pain and the effect of intervertebral fusion surgery［Method］Fortyfive cases with 101 discs underwent discography,360 degree fusion manipulation were performed on 18 discography abnormal cases,27 cases were treated conservativelyDiscography,MRI and provocative pain were observed and all the cases were followed up［Result］Twentyone cases showed positive provocative pain(21/45,47%）and 21 discs of 101 were concordant discogrephy(21/101,21%)All cases were followed for an average of 6 months(3 months to 10 months),the satisfactory rate was 83%(15/18）in the surgery group and 41%(11/27）in the conservative group［Conclusion］It is concluded that the discography were moderate sensitive in the diagnosis of discogenic low back painFurthermore,the short term followup reveals that operative group has better pain relief result than conservative group 　　Key words：Discogenic low back pain; Discography; Intervertebral fusion surgery; Effectiveness 椎间盘源性腰痛是在对腰腿痛诊治过程中发现的一种新疾病，Crock于1970年提出，又称椎间盘内紊乱，是由一个或者多个椎间盘内部结构和代谢功能出现异常，如退变、终板损伤或释放出某些因子，刺激椎间盘内疼痛感受器所引起的腰痛。关于椎间盘源性腰痛的诊断除临床表现外，椎间盘造影被认为是唯一有效的方法；近来，因为心理因素对检查结果的影响及假阳性的出现，它的实用性受到质疑。作者对45例具有椎间盘源性腰痛症状的病人实施了椎间盘造影，并对诱发痛阳性的病人进行椎间融合手术，观察造影图像