椎间盘源性腰痛的相关基础研究进展

Progress of Basic Research in Discogenic Low Back Pain

椎间盘源性下腰痛是在骨科是常见的疾病,它以发病时间早、发病率高、容易复发为特点,让患者的生存质量和劳动能力受到极大地影响。上个世纪,椎间盘退变被认为是盘源性下腰痛先决条件。近年来,国内外许多研究人员对病变椎间盘的前后的组织学变化、神经侵润、炎性介质、神经递质等给予了深入研究,逐步认识到在没有发现椎间盘突出的情况下发生于下腰痛,这可能是椎间盘内部的病变而引起的,即通常所说的盘源性下腰痛(discogentic low back pain)。虽然说椎间盘退变可以诱发下腰痛,但是椎间盘退变本身没有任何依据可以通过来临床干预,至少目前无有效的干预措施。但是,缓解疼痛症状则是研究和临床治疗的重点。研究发现,椎间盘内传递痛觉的神经纤维的存在是发生椎间盘源性下腰痛的首要条件,椎间盘内的破裂,以及神经的长入,在加上炎性介质及生物力学的原因,导致了盘源性下腰痛。但目前关于椎间盘内神经长入机制的研究较少,其机制较复杂,我们对近年来椎间盘内基础研究做一综述。

Diseogenic low back pain is a common disease in orthopedic, which is characterized for its early onset onset, high incidence, and easy recurrence. It has great impact on patient＇s quality of life and ability to work. Long past, the disc degeneration has been considered a prerequisite of disc disease to pain. In recent years, many scholars at home and abroad has conducted intensive study on changes of the intervertebral disc tissue, nerve invasion, inflammatory mediators and neurotransmitters around the disc degeneration and damage, and has gradually realized that it can also cause low back pain without disc herniation in the disc internal lesions, commonly, as discogenic low back pain. Though disc degeneration is one of the most fundamental causes of low back pain, disc degeneration itself is not a clinical intervention at present, effective interventions is still the focus of clinical treatment. The presence of nerve fibers is a prerequisite for discogenic low back pain occurs, it is less about the current research on nerve ingrowth mechanisms within the disc, its mechanism is very complicated too. In this article we reviewed basic research of lumbar disc discogenic in recent years.