不典型腰椎间盘退变性腰腿痛诊断及治疗分析

Diagnostic and therapeutic analysis of atypically low back and leg pain caused by lumbar disc degeneration

目的探讨腰椎间盘退行变所致不典型腰腿痛的诊断及治疗方法。方法 2010-01-2014-09期间治疗腰椎间盘退变性腰腿痛397例患者,对其中52例不典型腰腿痛患者的诊断及治疗方法进行回顾性分析。结果经皮腰椎间盘穿刺造影91个间盘,63个间盘疼痛复制诱发试验阳性。经腰椎kambin三角全内镜下椎间盘内髓核切除微创手术13例,经腰椎间孔全内镜下椎管内直接切除突出间盘组织微创手术10例,PLIF或TLIF手术治疗25例,理疗及肌力锻炼4例。平均随访9.6个月,腰腿痛VAS评分治疗前与治疗后1周、1月及3月时间点比较有统计学意义(P<0.01)。治疗后3月疗效MacNab评定:优27例,良20例,可5例,优良率90.38%。结论椎间盘造影和疼痛复制诱发试验是确认腰椎间盘退变不典型腰腿痛责任椎间盘的有效方法,治疗上需依据具体情况选择不同治疗方案。

Objective To investigate the diagnosis and therapy of atypically low back and leg pain caused by lumbar disc degeneration. Methods From January 2010 to September 2014,52 cases with atypically back pain and leg pain caused by lumbar disc degeneration, who diagnosed and cured were reviewed. Results Discography in 91 lumbar discs,pain replication and induced test positive 63 discs. Percutaneous intradisc full endoscopic discectomy via lumbar kambin triangle in 13 eases,pereutaneous intracanal full endoscopic discectomy via lumbar transforaminal in 10 cases, lumbar interbody fusion in 25 cases,physical therapy and muscle strength exercise in 4 cases. The patients were followed up for average 9.6 months. The pre-therapy and post-therapy visual analogue scaie（VAS） was used to evaluate the back pain and the leg pain（P〈0.01）. According to Macnab criteria,the therapeutic outcome was excellent in 27 cases,good in 20 cases,fair in 5 cases,with the excellent and good rate of 90.38%. Conclusion Discography and pain replication and induced test were effective methods to confirm responsible disc resulted in atypically low back and leg pain caused by lumbar disc degeneration.