CT引导下椎间盘造影对椎间盘源性腰痛的诊断价值

The value of CT-guided discography in the diagnoses of discogenic low back pain

目的:评价CT引导下椎间盘造影对椎间盘源性腰痛的诊断价值。方法:对80例临床诊断为慢性腰痛患者行CT引导下椎间盘造影,CT扫描确定体表入针点、入针角度、深度,穿刺针尖到达椎间盘中心后,注入造影剂(欧乃派克),记录造影剂注入量,观察患者的疼痛反应,根据达拉斯CT椎间盘造影评价系统(Dallas Discogram Description,DDD)对造影椎间盘进行形态分级。对造影阳性病例的年龄、椎间盘形态分级、造影剂注入量作统计分析。结果:经椎间盘造影确诊为阳性患者53例,累及53个椎间盘,其中以41～50岁组阳性率最高(92%),按DDD分级统计3级、4级占阳性病例的77.36%。在所有病例MRI检查中,造影阳性的椎间盘MRI表现均为不同程度的退行性改变(黑间盘);所有病例中椎间盘后方的高信号区(HIZ)38例,其中35例椎间盘造影为阳性,占全部阳性椎间盘的66.04%。造影形态正常的椎间盘平均注入造影剂1.2±0.3ml;造影形态异常的椎间盘中诱发痛阳性者平均注入3.2±1.4ml,诱发痛阴性者平均注入3.4±1.8ml,二者间无明显差异。结论:CT引导下椎间盘造影定位准确,可清晰显示纤维环撕裂部位及程度,是诊断椎间盘源性腰痛的重要方法。

Objective：To evaluate the value of CT guided intervertebral discography in diagnosing discogenic low back pain.Method：80 patients diagnosed as chronic lumbar pain were cured by conservative methods more than 6 months and were not evidently alleviated.All patients underwent intervertebral discography by CT guide.The penetrated point and path were decided by the CT scan,when the needle reached the center of disc,injected the contrast agent（Ominipaque）,and then the dose was recorded,patient＇s response to the pain was observed,and asked if the pain was consistent with the past.According to the Dallas Discogram Description （DDD） to classify the intervertebral disc.Statistical analysis of positive cases was performed on the age group,disc shape classification,contrast agent dose.Result：There were 53 patients with the positive interverte- bral discography （66.25%）,involved 53 intervertebral discs,most of them were in the age of 41-50 years （92%）.In the total 102 abnormal intervertebral discs,53 were positive.According to the DDD,the 3,4 grade accounted for 77.36% in the total positive cases.In the MRI,the positive discs were dark which suggested the degenerative change,and none of the normal disc was positive in the discography.In 38 cases which had the HIZ（high intensity zone） in the posterior rim of the intervertebral disc,there were 35 intervertebral discs with the positive discography,which occupied 66.04% in all positive intervertebral discs.In normal intervertebral disc,the contrast agent injected of 1.2±0.3ml.And in the abnormal intervertebral disc,the dose induced the pain in the positive case averaged 3.2±1.4ml,and in the negative case averaged 3.4 ±1.8ml ,both had no statistics difference.Conclusion：The intervertebral discography by CT guide is the important method to diagnose the lumbar pain caused by the intervertebral disc,it can clearly show the rupture site and degree of the anulus fibrosus,and help locate the position precisely in the operation.