腰椎间盘造影在腰椎间盘源性腰痛诊治中的应用

Application of lumbar discography in the diagnosis and treatment of the discogenic lumbodynias

目的:探讨椎间盘造影对腰椎间盘源性腰痛的诊断价值及椎间融合手术的疗效,研究椎间盘造影对椎间融合节段范围选择的意义。方法:2004年1月至2006年2月对35例具有腰椎间盘源性腰痛症状的患者进行了椎间盘造影,共74个椎间盘。所有病例均行MR和CT检查,观察造影图像和MRI表现,记录诱发痛。35例患者中根据椎间盘造影的结果,行腰椎间融合术20例,并随访手术患者的疗效。结果:35例中20例患者22个椎间盘出现了诱发痛(57.1%),20例诱发痛阳性患者的22个节段均行腰椎间盘融合术,并全部随访,随访时间10个月～2年,平均15个月,按改良MacNab评定标准判断:优13例,良4例,可2例,差1例。15例诱发痛阴性的患者予保守治疗,在同期随访中,5例腰痛完全消失,7例疼痛基本消失,3例疼痛没有变化,甚至加重。6例患者腰椎融合节段相邻的9个椎间盘有MRI异常改变,但造影无诱发痛,即无症状椎间盘,未包括在融合范围之内,在同期的随访中,1例因相邻无症状退变间盘退变加重并产生严重症状而接受融合手术。结论:腰椎间盘造影对椎间盘源性腰痛的诊断和选择治疗方法等方面具有独特的价值,对确定为疼痛原因的椎间隙实施腰椎间融合术可以消除患者的疼痛。在选择融合节段时,仅融合有症状的退变椎间盘即可。

Objective：To explore the diagnostic value of lumbar disc imagery applied for patients with discogenic lumbodynias and the outcome of lumbar fusion and the significance of the imagery technique in choosing the joints and sections for fusion. Methods：The lumbar imagery technique was applied for 35 patients who suffered from discogenic lumbodynias, involv- ing 74 discs. All the cases got MRI and CT scanning. The results of the imagery and MR1 were observed and induced pains were recorded. According to the imagery results ,20 out of the 35 patients received lumbar fusion and were followed up. Resuits：Among 35 patients, the induced pains occurred at 22 discs in 20 patients （57.1%）. All the 22 segments in 20 patients with positive reaction were given lumbar fusion. The follow-up time was 10 months to 2 years with an average of 15 months. Based on the renewed MacNab standard,the results were excellent in 13 cases,good in 4 cases,fair in 2 cases,bad in 1 case. Fifteen patients with negative reaction were given conservative treatment and pains disappeared completely in 5 patients,disappeared nearly in 7 patients,no changes or became worse in 3 patients. Six patients including 9 lumbar discs neighboring the fusion segments who were found no changes in MRI scan and no induced pains in lumbar discography ,were not given fusion treatment. Meantime, 1 patient was given fusion treatment because his neighboring symptom-free discs getting more deteriora- tive resulted in the happen of serious symptoms. Conclusion： Lumbar imagery technique has its unique value in the diagnosis and selective treatment of lumbar-disc-related pains. Lumbar fusion of the intervertebral space causing pains can eliminate the suffering of patients. It is appropriate to select those deteriorating discs with symptoms in deciding the fusion segments.