椎间盘源性腰痛的诊断与治疗

The diagnosis and treatment of intervertebrai disc low back pain

目的探讨椎间盘源性腰痛的诊断方法及最佳的治疗方案。方法回顾性分析132例经椎间盘造影检查诊断为椎间盘源性腰痛患者的临床资料。按随机数字表法随机分为三组：A组行经皮激光椎间盘气化减压术63例；B组行前路腹膜外椎间盘切除结合Cage植骨融合术21例；C组行后路椎间盘切除结合后外侧融合椎弓根螺钉固定术48例。术后观察各组患者视觉模拟法（VAS）评分及Oswestry功能障碍指数（0DI）评分的改善程度。结果腰椎MRI上病变椎间盘T2加权像低信号有重要意义。三组术后VAS评分降低值依次降低，A组（9．7±0．9）分，B组（7．4±1．2）分，C组（6．9±1．4）分，A组与B、C组比较差异有统计学意义（P〈0．05）。三组术后ODI评分降低值也依次降低，A组（19．4±1．4）分，B组（18．8±2．9）分，C组（16．5±2．1）分。A组与B、C组比较差异有统计学意义（P〈0．05）。结论椎间盘造影是目前诊断椎间盘源性腰痛的可靠方法；经皮激光椎间盘气化减压术与前路或后路椎间盘切除结合内固定术及融合术比较在改善患者疼痛与功能方面均有良好效果。

Objective To investigate the diagnosis method of intervertebral disc low back pain and the best treatment clinical efficacy. Methods The imaging data of 132 cases with intervertebral disc low back pain diagnosed by discography for disc imaging was retrospectively analyzed from October 2001 to October 2008. Randomly divided into three groups： group A of percutaneous laser disc decompression in 63 cases of gasification, group B extraperitoneal anterior disectomy, Cage fusion 21 cases, group C posterior fusion after disectomy arch root 48 cases of screw fixation. Observed in patients with postoperative visual analogue scale （VAS） and Oswestry disability index （ODI） score improvement. Results MRI of lumbar intervertebral disc on T2-weighted lesions as low signal was important. VAS after treatment in three groups followed by lower values to reduce, group A was （9.7 ± 0.9） points, group B was （7.4 ±1.2） points, group C was （6.9 ± 1.4） points. There were statistically significance between group A and group B, C （P〈 0.05）. ODI in order to reduce the value of reducing, group A was （19.4 ± 1.4） points, group B was （18.8 ± 2.9） points, group C was （16.5 ± 2.1 ） points. There were statistically significance between group A and group B, C （P 〈 0.05）. Conclusions Discography is a reliable method to diagnose intervertebral disc low back pain. Percutaneous laser disc decompression compared with posterior or anterior diseetomy and fusion combined with internal fixation has good results in improving pain and function of patients.