腰椎间盘疼痛诊断及治疗.docVIP

腰椎间盘疼痛诊断及治疗 】目的：探讨椎间盘源性腰痛的诊断与治疗方法。 方法：回顾性分析2000年10月至2005年5月135例经椎间 盘造影（CT）检查诊断为椎间盘源性腰疼痛患者的影像资料。 男70例，女65例，年龄23?78岁，平均年龄46. 7岁，L3? 4 20例，L4?5 70例，L5S1 5例，L3?4与L4?5双间隙 10例，L4?5与L5S1双间隙10例。结果:所有患者随访6? 26个月，平均18个月，术后腰痛及下肢痛症状明显缓解， 均恢复正常生活和工作，VAS评分由术前平均72分，降至术 后18分，随访6个月时6. 5分。结论:椎间盘源性腰痛由于 临床和影像学表现不典型，常被误诊或漏诊，可结合腰椎MRI 及椎间盘造影进行诊断，腰椎前路椎间盘切除人工椎间盘置 换或椎间cage融合是治疗椎间盘源性腰痛的有效选择。 关键词】椎间盘腰痛诊断治疗结果 Fan ShouhuaPeng jiangxiu,Department of Orthopaedics, Jiangan People’ s Hospital, YiBing, SiChuan, 644200) [ObjectivelTo evaluate the diagnosis and treatment methods ofdiscogenic low back pain. Methods： Twenty-seven patients with chronic low back pain were diagnosed the discogenic low back pain with provocative discography from October 2000 to May 2005,and the radiological data of all cases were retrospectively analyzed. There were 70 males and 65 females with an average age of 46. 7 years (ranged 23~78 years) and the level of disc including L3~4 for 20 cases,L4~5 for 70 cases,L5S1 for 25 cases, both L3~4 and L4~5 for 10 cases, both L4^5 and L5S1 for 10 cases. Results： All cases were followed up for 18 months on the average (6^26 months), at the end of follow-up all the patients recovered normal social life and work without any symptoms. VAS decreased from 72 preoperatively to 18 postoperatively,and averaged 6. 5 at 6 months after operation. Conclusion with atypical symptom discogenic low back pain which is easily misdiagnosed should always be kept in mind when atypical back and leg pain is encountered. Discography provides good differential diagnosis. Surgical treatment including artifical disc replacement and ALIF provides satisfactory outcome. Key words 】Intervertebral disk Low back painDiagnosisTreatment outcome 腰椎间盘突出症是骨伤科的常见病，多见于青壮年，男 多于女，大多好发于腰4?5和腰5骶1之间，腰3?4之间 比较少见［1］，它是腰椎间盘发生退形性变之后，在外力 的作用下，纤维环破裂髓核突出刺激或压迫神经根、血管、 或脊髓等组织所引起腰腿痛为主要症状的病症。目前许多基 层医院骨科都选择了手术切除治疗，我院骨伤科自2000年 10月至2005年5月，共收治了 135例腰腿疼痛患者，采取 保守治疗，疗果满意，现总结如下，供骨科临床医生参考、 讨论。 1资料与方法 1. 1 一般资料：自20⑻年10月至2005年5月，共收治 135例腰椎间盘突出（膨出