伴HIZ的椎间盘源性腰痛的诊断与治疗体会

The diagnosis and treatment of discogenic low back pain with a high-intensity zone(HIZ)

目的探讨伴HIZ的椎间盘源性腰痛的诊断及采用后路椎间盘切除椎间融合术治疗的临床疗效。方法 33例符合椎间盘源性腰痛临床表现同时伴单节段HIZ的患者,经椎间盘造影28例明确诊断为椎间盘源性腰痛,均行后路椎间盘切除椎间植骨融合术治疗。术前及术后评估患者的腰部疼痛视觉模拟评分(Visual Analogue Scale,VAS)及Oswestry功能障碍指数(Oswestry Disability Index ODI)。结果在符合椎盘源性腰痛临床表现的患者中,HIZ预示着椎间盘造影的阳性率较高(84.8%)。末次随访时所有病人均恢复正常生活,腰痛较术前明显缓解,腰痛的VAS评分及ODI与术前比较差异有统计学意义。结论临床表现及HIZ可提供椎间盘源性腰痛的诊断参考,椎间盘造影是诊断椎间盘源性腰痛的可靠方法,后路椎间融合术治疗伴HIZ的椎间盘源性腰痛效果理想。

Objective To explore diagnostic method to discogenic low back pain with a high-intensity zone（ HIZ） and evaluate the effect of discectomy and posterior lumbar interbody fusion. Methods 33 patients with the clinical manifestation of discogenic low back pain and single level high-intensity zone underwent discography. 28 patients with positive discography were diagnosed as discogenic low back pain,and received surgery. There were 13 males and 15 females with an average age of 42.7 years（ ranging from 36 years to 55 years）. The treated level of disc located L4-5in 17 cases,L5-S1 in 11 cases. The preoperative and postoperative score of VAS（ Visual analogue scale） and ODI（ Oswestry disability index） were evaluated. Results The patients with the clinical manifestation of discogenic low back pain and high-intensity zone got the higher rate of positive discography（ 84.8%）. All the cases were followed up from 12 months to 36 months, at the end of follow-up all the patients recovered normal social life, there were significant improvement of VAS and ODI between preoperation and postoperation. Conclusion The clinical manifestation and HIZ provide the diagnostic reference, and the discography is the reliable diagnostic method of discogenic low back pain. Discectomy and posterior lumbar interbody fusion provide satisfactory outcome to discogenic low back pain with HIZ.