椎间盘造影阴性在椎间盘源性腰痛诊断中的分析评价

Analysis of negative discography in patients with probable discogenic low back pain

[目的]通过对一组有典型椎间盘源性下腰痛症状和影像学表现但椎间盘造影阴性的患者进行前瞻性分析,观察椎间盘造影阴性是否能完全排除椎间盘源性下腰痛的诊断。[方法]2008年6月～2011年2月连续诊治的具有典型椎间盘源性疼痛症状和影像学表现(Dallas V型)但椎间盘造影阴性的一组患者共59例,其中男16例,女43例;年龄36～51岁,平均43.8岁;病史6个月～4年,平均1.8年。将59例患者随机分为两组,实验组(29例)于造影剂注射完后于椎间隙再给予注射利多卡因10 mg和地塞米松2.5 mg的混悬液,对照组(30例)则不注射药物并结束造影。两组患者于椎间盘造影术术前、术中、术后行VAS及ODI评分并观察结果。[结果]实验组术后2周内可见VAS评分下降,与对照组相比有统计学意义(P<0.01),术后第3周随访时两组间VAS评分无明显差别(P>0.05)。实验组中18例VAS评分下降的患者在术后第1、4、8周时进行VAS评分及ODI评分时均较术前明显改善(P<0.01),在第12周随访时总体上VAS评分及ODI评分与术前比较无明显差别(P>0.05),对照组患者VAS评分及ODI评分与术前比较均无明显差别(P>0.05)。[结论]本研究结果表明椎间盘造影阴性,但同时合并典型的症状和影像学表现时,并不能完全排除椎间盘源性疼痛的诊断。

[ Objective] Patients suffering from typical symptoms of discogenic low back pain with obvious disc pathological changes on MRI were observed to investigate whether negative discography resuh could absolutely exclude the diagnosis of disco- genic pain or not. [ MethodsI Fifty -nine isolated patients with negative discography （all patients showed Dallas V in discog- raphy） were enrolled in our study and randomly divided into two groups to receive either discography alone or discography plus intradiscal steroid and lidoeaine. Visual analog scale and Oswestry Disability Index were used to evaluate the changes of pain and function after discography. [ Results ] Twenty -nine patients were randomly distributed in experimental group, then underwent provocative discography plus intradiscal injection of lidocaine （10mg） and dexamethasone （2. 5mg） . Thirty of 59 patients were randomly distributed in the control group and received discography alone. Eighteen patients in the experimental group showed im- provement at the 1 to 8 week follow - up period than the control group （ P 〈 0. 01 ） by VAS and ODI scots, but no statistically significant improvement at the 12 week follow- up period （P 〉 0. 05 ） . In contrast, the mean VAS scores and ODI scores were not obviously changed in the control group （ P 〉 0. 05 ） . [ Conclusion ] The study indicated that negative discography in pa- tients with typical symptoms of discogenic low back pain can not absolutely exclude the diagnosis of discogenic pain. Patients of this kind may suffer from other diseases, but we can not ignore the existence of discogenic pain.