椎间盘源性腰痛的临床特点与治疗

Clinical characteristics and treatment of discogenic low back pain

目的:探讨椎间盘源性腰痛的临床表现特点,为其诊断和治疗提供参考。方法:回顾性分析经手术治疗的21例椎间盘源性腰痛患者的术前临床表现、影像学资料及术后腰痛和功能改善程度。结果:椎间盘源性腰痛的主要临床表现为伴有功能障碍的严重腰痛,可伴随腹股沟、大腿前外侧痛或根性放射痛;病变椎间盘造影纤维环破裂明显,MRI上出现椎间盘纤维环后方高信号或终板信号改变者比率低;前路椎间盘切除、椎间融合术后疼痛VAS评分和Oswestry功能障碍指数改善率分别为(82.2±3.4)%和(74.0±5.7)%。结论:椎间盘源性腰痛患者的特异性体征和影像表现少,椎间盘造影是可靠诊断方法,前路椎间盘切除椎间融合疗效可靠。

Objective：To review the clinical characteristic of discogenic low back pain which guide to the diagnose and treatment.Method：Twenty-one patients with discogenic low back pain were peformed with anterior discectomy and intervertebral fusion.The clinical presentation and radiographic materials of these patients were studied retrospectively.The pain relief and functional improvement was assessed with visual analogue scale and Oswestry Disability Index.All patients were followed up for 8 months to 9 years（average 3.1 years）. Result：The clinical manifestations of discogenic low back pain is serious low back pain with significant dysfunction.The radiating pain and the referred pain in groin skins and low extremities were often presented without the nerve root compressed.The high-intensity-zone and the Modie change on the MRI can＇t be replaced for discography for their low sensitivity.Effective pain relief and functional improvement has been obtained by the intervertebral fusion and the improved rate is （82.2±3.4）% and （74.0±5.7）% respectively.Conclusion：The discography is the gold criterion for the diagnosis of the discogenic low back pain.The patient can be treated effectively by anterior discectomy and intervertebral fusion.