腰椎间盘突出物及髓核炎性因子变化与症状性疼痛的关系

Correlation of lumbar intervertebral disc herniation and nucleus pulposus inflammatory factor to symptomatic pain

目的：关于腰椎间盘突出症患者出现腰腿痛症状时对其发生机制和影响因素的解释各说不一。实验拟验证腰椎间盘突出物矢状径大小及髓核炎性因子变化与症状性腰腿痛之间的相关性。方法：①对象：选择1999-10／2005-02江门市人民医院骨科手术治疗仅单个单隙L3-4、L4-5或L5～S1非中央型椎间盘突出，无椎管狭窄、椎体滑脱等椎管内骨及软组织病变病例共41例，男30例，女11例，年龄28～72岁，其中膨出型12例，突出型15例，游离型14例；同时取17例因腰椎爆裂型骨折手术减压中发现的受累椎间盘髓核组织作为正常对照。男10例，女7例，年龄19～73岁。②检测及评估：入院时由同一名非实验组医师对患者疼痛症状做问卷调查，采用视觉模拟评分法评价患者腰腿痛程度；采用突出物最大矢径与同层面椎管最大矢径之比即矢状径指数描述突出物的大小；检测椎间盘髓核组织炎性因子基质金属蛋白酶3、白细胞介素1的含量；并分别与腰椎间盘突出症腰腿痛程度进行相关分析。结果：两组患者全部进入结果分析。①腰椎间盘突出症患者突出物大小矢状径指数及基质金属蛋白酶3、白细胞介素1含量高于正常对照组（P〈0．05）。②脱出游离型患者突出物大小矢状径指数、基质金属蛋白酶3及白细胞介素1含量高于突出型、膨出型（P〈0.05）。③直线相关分析表明腰椎间盘突出症突出物基质金属蛋白酶3、白细胞介素1含量与腰椎间盘突出症腰腿痛视觉模拟评分显著相关（r=0.6786，0．6132），而突出物大小矢状径指数与腰腿痛视觉模拟评分无明显相关（厂：O．2804）。结论：①腰椎间盘突出患者有症状性腰腿痛表现时视觉模拟评分变化与突出物炎性因子基质金属蛋白酶3、白细胞介素1含量密切相关。②与腰椎间盘突出物大小的矢状径指数变化无明显相关。

AIM： Study results are various in the mechanism and influential factors of backleg pain in patients with lumber intervertebral disc protrusion. This study aimed to explore the correlation of sagittal index and changes in nucleus pulposus inflammatory factor to low back and leg pain. METHODS： The patients with single unilateral prolapse of lumbar intervertebral disc who were non-central type lumbar disc herniation （L3-4, L4-5 or L5-S1） and non-lumbar spondylolisthesis accompanied with spinal canal stenosis and intraspinal canal disease surgically treated with limited laminectomy from October 1999 to February 2005. The total number of subjects was 41 including 30 men and I l women and the patients ranged from 28 to 72 years old in age. Of them, 12 were the type of bulge, 15 were the type of protrusion and 14 were the type of free disc herniation of the lumbar spine. Another 17 involved intervertebral discs obtained in the decompression of lumbar bursting fractures were taken as a control group, in which were 10 males and 7 females aged 19-73 years. A questionnaire survey of painful symptoms to evaluate degree of low back and leg pain with visual analogue scale （VAS） was performed by the same non-experimental physician on admission. The ratio of the maximum sagittal diameter of protrusion and the sagittal diameter of the same level vertebral canal was sagittal index to describe degree of protrusion. The matrix metalloproteinase （MMP）-3 and intedeukin （IL）-1 contents were determined. Backleg pain degree of the protrusion was analyzed. RESULTS： All patients were included in the final results. The MMP-3 and IL-1 contents and the sagittal index of the protrusion in patients with lumbar intervertebral disc herniation were higher than in the control group （P 〈 0.05）. In comparison with the patients with lumbar intervertebral disc herniation and bulging, there were significant differences in MMP-3 and IL-1 contents and the sagittal index in patients with free intervertebral disc cartilage （P 〈 0.05）. MMP-3 and the IL-1 contents were in correlation with the VAS of lumbocrnral pain by correlation analysis （r = 0.678 6, 0.613 2）. There was no correlation between the sagittal index of the protrusion and the VAS of himbocrural pain （r=0.280 4）. CONCLUSION： The VAS of himbocrnral pain of lumbar intervertebral disc herniation is obviously correlated with the contents of MMP-3 and IL-1 of the protrusion. The VAS of lumbocrnral pain is not correlated with the sagittal index of the protrusion.