椎间盘造影压力及形态学变化对椎间盘源性腰痛的诊断意义

Pressure and morphologic analysis of discography in diagnosis of discogenic low back pain

目的观察椎间盘源性腰痛患者椎间盘造影阳性率及其造影压力和形态学的变化，研究椎间盘造影压力及形态学变化规律对诊断椎间盘源性腰痛的意义。方法选取2007年8月至2009年10月52例疑为椎间盘源性腰痛的患者，对其MRI显示明显退变的83个椎间盘及作为对照的52个相邻正常椎间盘进行“C”型臂X线透视引导下压力可控性椎间盘造影。造影过程中观测注射压力及椎间盘形态学变化。依据注射时诱发症状的压力情况分为四组：压力≤30psi、30〈压力50psi、50〈压力≤70psi及压力〉70psi。分析不同压力下椎间盘造影阳性率的差异，并根据Adams椎间盘造影形态分型对所造影阳性的椎间盘形态学表现与诱发压力的关系进行统计学分析。结果83个退变椎间盘中46个椎间盘造影阳性，对照组无造影阳性椎间盘。造影阳性退变椎间盘、造影阴性退变椎间盘和对照组椎间盘平均注射压力的差异有统计学意义（F=194．78，火0．001）。各压力组阳性率的比较，差异有统计学意义（X2=18．437，P〈0．001），而压力≤30psi组和30〈压力≤50psi组的差异无统计学意义。造影阳性椎间盘主要为AdamsⅢ、IV型，Ⅲ型和Ⅳ型椎间盘造影阳性时注射压力的差异有统计学意义（t=3．065，P〈0．001）。随椎间纤维环破裂程度的增加，造影压力呈下降趋势。结论压力控制下的椎间盘造影对诊断椎间盘源性腰痛有一定价值。造影阳性椎间盘往往表现为纤维环撕裂或不规则，诱发疼痛的压力与纤维环撕裂的程度具有一定相关性。

Objective To explore and evaluate the clinical significance of pressure-controlled discography in diagnosis of discogenic low back pain. Methods From July 2008 to October 2009, pressure- controlled discography under C-arm guidance was taken in 52 patients with suspected discogenic low back pain, including 83 degenerative discs and 52 ＂good＂ discs. Based on the pressure of discography inducing pain, the discs were divided into 4 groups： pressure ≤〈 30 psi, 30 psi〈pressure ≤ 50 psi, 50 psi〈pressure ≤70 psi, and pressure〉70 psi. By using SPSS 11.0 statistical software, the correlation of pressure of discography and morphologic representation was analyzed. Results Among 83 degenerative discs, positive discography was detected in 46 discs. During discography, the pressure of positive degenerative discs was （36.5±15.7） psi; the pressure of negative degenerative discs was （50.5±26.2） psi, and the normal discs＂ pressure was （98.6±3.7） psi. A significant difference could be found between the mentioned three groups. Among differ- ent pressure groups, the positive rate were analyzed by X2 test, and a significant difference was found as well. But no significant difference was found between the group of less than 30 psi and group of 30 to 50 psi. Ac- cording to Adams＂ morphological classification of discography, the pressure of disc varied from 30 to 50 psi in grade m, while less than 30 psi in grade Ⅳ. There was a significant difference of discography pressure between discography positive grade Ⅲ and grade Ⅳ. Conclusion The pressure-controlled discography is valuable for clinical diagnosis of discogenic low back pain. The morphological classification of discs could indicate the degree of the disruption of annular fibrosus.