三种诊断技术在椎间盘源性腰痛中应用的对比研究

Comparative study of three diagnostic techniques applied in discogenic low back pain

[目的]对比压力控制性椎间盘造影、椎间盘封闭与压力控制性椎间盘造影联合封闭对椎间盘源性腰痛的诊断价值。[方法]回顾分析2006年7月～2009年10月129例严重慢性下腰痛患者。分别采用压力控制性椎间盘造影(A组,43例)、椎间盘封闭(B组,41例)、压力控制性椎间盘造影联合封闭(C组,45例)诊断单节段椎间盘源性腰痛。所有患者均行经椎间孔椎体间融合联合椎弓根螺钉固定术治疗。采用Oswestry功能障碍指数(ODI)和视觉模拟评分(VAS)比较三组临床疗效。[结果]三组患者均顺利完成手术,无术后并发症发生。全部患者均获随访,A组随访时间平均3.6年,B组平均3.5年,C组平均3.6年。三组术前ODI及VAS评分比较,差异无统计学意义(P>0.05);术后1年和末次随访时均较术前明显改善(P<0.05)。术后1年和末次随访时,三组ODI及VAS改善率比较差异均有统计学意义(P<0.05),三组任意两者间ODI及VAS改善率比较差异均有统计学意义(P<0.05),疗效比较依次为:C组>B组>A组。[结论]压力控制性椎间盘造影、椎间盘封闭与压力控制性椎间盘造影联合封闭均为椎间盘源性腰痛的有效诊断方法。其中,压力控制性椎间盘造影联合封闭是椎间盘源性腰痛的最佳诊断标准。

[ Objective] To evaluate the diagnosis of discogenic low back pain （DLBP） with pressure -controlled discogra- phy, discoblock, pressure- controlled discography combined with discoblock. [ Methods] A retrospective analysis was made on 129 patients with severe chronic low back pain from July 2006 to October 2009. Single - level discogenic low back pain were diagnosed by the use of pressure - controlled discography （ group A , n = 43） , discoblock （ group B, n = 41 ）, pressure - controlled discography combined with discoblock （group C , n = 45 ） , respectively. All patients were treated by transforaminal lumbar interbody fusion （TLIF） combined with unilateral pedicle screws fixation （UPSF） . The clinical outcomes were com- pared within three groups according to Oswestry Disability Index （ODI） and Visual Analogue Score （VAS） . [ Results] The three groups were successfully underwent surgery, and no postoperative complications occurred. All patients were followed up, the patients were followed up 3.6 years on average in group A, 3.5 years on average in group B, 3.6 years on average in group C . There were no significant differences in ODI and VAS score within three groups before operation （ P 〉 0. 05 ） ; At 1 - year postoperatively and last follow - up, ODI and VAS score were significantly improved when compared with the preoperative scores in three groups （P 〈 0. 05 ） . Otherwise, there were significant differences in ODI and VAS score improvement rate within three groups （ P 〈 0. 05 ） . There were significant differences in ODI and VAS score improvement rate in any two groups within the three （P 〈0 05） , operative effect comparison as follows： group C 〉 group B 〉 group A. [ Conclusion] Pressure - controlled discography, discoblock and pressure - controlled discography combined with discobloek are effective diagnostie methods for dis- cogenic low back pain. Pressure - controlled discography combined with diseobloek is the best diagnostic method of the three.