腹股沟疼痛与低位腰椎间盘突出关系的探讨

目的：探讨低位腰椎间盘突出症患腹股沟疼痛的临床特点和CT表现。方法：319例L4－5和L5－S1单节段腰椎间盘突出的患，其中34例有腹股沟疼痛，将其临床特点和CT表现与没有腹股沟疼痛的患进行比较。结果：腹股沟疼痛主要见于L4－5节段椎间盘突出，疼痛程度为I－Ⅲ级，有腹股沟疼痛的患腰痛症状的发生率减少。结论：L4－5节段椎间盘突出最可能发生腹股沟疼痛，窦椎神经可能是腹股沟疼痛的传入神经，部分患的腹股沟疼痛可能被腰痛、臀部同等症状掩盖。     

腰椎间盘突出症临床诊断与影像学诊断的相关性探讨

目的探讨临床确诊为腰椎间盘突出症患者的影像学改变与临床症状是否有一定相关性,以及对临床诊断和治疗的指导意义。方法以影像学技术CT扫描检查145例临床确诊为腰椎间盘突出症患者的腰椎(L3～4、L4～5、L5～S1),并根据影像学提示,将腰椎间盘突出分为<0.5cm和>0.5cm两组。分别以视觉模拟评分法(VAS)和腰及下肢压痛点的计数率检查评估疼痛的程度以及与上述影像学改变的相关性。结果145例患者影像学检查均有改变。其中未见明显突出仅提示退行性病变者9例,仅L4～5椎间盘突出56例;仅L5～S1椎间盘突出67例;L4～5,L5～S12节椎间盘同时突出(包括膨出)者11例;L3～4,L4～5,L5～S13节椎间盘突出(包括膨出)者2例。突出伴椎体滑脱14例;突出伴退行性病变89例。突出程度<0.5cm55例,>0.5cm81例。VAS评估椎间盘突出<0.5cm和>0.5cm两组的平均积分无明显差异(χ2=0.12,P>0.05);两组压痛点的计数与椎间盘突出的程度也不成正比(χ2=1.31,P>0.05)。结论临床诊断腰椎间盘突出症与影像学诊断的腰椎间盘突出不能完全等同。影像学检查的阳性结论只有与临床所见相吻合时,才有诊断价值。     

腰骶椎硬膜外腔封闭治疗腰椎间盘突出症

腰椎间盘突出症引起的急性腰腿痛临床上常用骶管硬膜外腔激素复合液治疗,并取得了较好 的疗效,现报告如下。1 资料与方法随机选出100例患者,男64例,女36例;年龄35～70岁,病程1周～25年,急性发作期24～72 h。所有患者都有下腰痛,腰部僵硬,不能自主活动和单侧下肢放射性疼痛、麻木。均被CT 确诊为腰骶椎间盘突出,部位L3～4 42例,L4～5 31例,L4～S1 20例,L5～S1 7例。所有 患者ASA分级Ⅰ～Ⅱ级。患肢直腿抬高试验< 60°。方法腰段硬膜外腔注射(A组)50例,男38例,女12例。根据疼痛部位选择相应上一节或下一 节硬膜外腔穿刺点…     

骨盆牵引与调制中频电治疗腰椎间盘突出症

腰椎间盘突出症患者 2 2 0例 ,男 14 6例 ,女 74例 ;年龄 2 6～ 6 5岁 ;病程 2d～ 30年 ;均有腰痛症状 ,伴有下肢疼痛或麻木 16 0例 ,感觉减退 6 2例 ;CT或MRI检查提示L3～ 4椎间盘突出 12例 ,L4～ 596例 ,L5～S1112例 ,多节段突出 2 3例。 2 2 0例患者按就诊先后顺序随机分为中频和超短波组各 110例。中频组采用调制中频电治疗 ,方形电板 4cm× 6cm分别置于患处两侧 ,选用仪器内置 1号处方 ,剂量以患者耐受为宜 ;然后进行仰卧位腰椎骨盆牵引 ,牵引力从体重的 1/4开始逐渐增大 ,以不超过体重为宜。超短波组采用超短波治疗 ,波长7 37m ,…     

骶管封闭治疗86例腰椎间盘突出症

我科从1990年至今，对于由腰椎间盘突出引起的腰腿痛患者86例，采用骶管封闭治疗均取得满意疗效。现报告如下：1临床资料本组86例，其中男性68例，女性16例。年龄最大65岁，最小17岁。病程7天～12年。腰痛伴双下肢疼痛4例，单纯双下肢疼痛3例，腰痛伴单下肢疼痛51例，单纯单下肢疼痛28例。直腿抬高试验阳性，椎间盘突出部分L3～L4、L4～L5、L5～L1，许多患者多个椎间盘突出同时存在。     

腰椎间盘突出症临床诊断与形像学诊断的相关性探讨

目的 探讨临床确诊为腰椎间盘突出症患者的景仰学改变与临床症状是否有一定相关性，以及对临床诊断和治疗的指导意义。方法 以影像学技术CT扫描检查145例临床确诊为腰椎间盘突出症患者的腰椎（L3-4、L4-5、L5-S1），并根据影像学提示，将腰椎间盘突出分为&;lt;0.5cm和&;gt;0.5cm两组。分别以视觉模型评分法（VAS）和腰及下肢压痛点的计数率检查评估疼痛的程度以及与上述景仰学改变的相关性。结果 145例患者影像学检查均有改变。其中未见明显突出仅提示退行性病变者9例，仅L4-5椎间盘突出56例；仅L5-S1椎间盘突出67例；L4-5，L5-S1 2节椎间盘同时突出（包括膨出）者11例；L3-4，L4-5，L5-S1 3节椎间盘突出（包括膨出）者2例。突出伴椎体滑脱14例；突出伴退行性病变89例。突出程度&;lt;0.5cm 55例，&;gt;0.5cm81例。VAS评估椎间盘突出&;lt;0.5cm和&;gt;0.5cm两组的平均积分无明显差异（x^2=0.12,P&;gt;0.05）；两组压痛点的计数与椎间盘突出的程度也不成正比（x^2=1.31,P&;gt;0.05）。结论 昨夜诊断腰椎间盘突出症与影像学诊断的腰椎间盘突出不能完全等同。影像学检查的阳性一结论只有与临床所见相吻合时，才有诊断价值。     

腰骶椎间盘突出症的CT表现(附206例报告)

目的探讨腰骶椎间盘突出症的CT表现。方法选择腰骶间盘突出症206例,男134例,妇女72例,年龄20~72岁,平均41.1岁,病程2个月~30年。全部患者均有坐骨神经痛表现,直腿抬高试验阳性,部分患者有反复发作下腰痛史。全部病例均采用西门子双层螺旋CT全身扫描机进行轴位扫描,层厚为3 mm,层距为3 mm并观察扫描结果。结果本组206例中单发段突出的156例,双节段突出的50例,腰3~4椎间盘突出的8例,第4~5腰椎间盘突出94例,第5骶椎~第1骶椎椎间盘突出54例,第4~5腰椎第5骶椎~第1骶椎同时突出50例。结论腰骶椎间盘突出的类型和程度与病人的临床症状和体症有密切关系。     

椎间盘突出临近退变节段是否导致腰痛

背景：椎间盘突出症患者腰痛原因很难判断,一直以来,认为突出的椎间盘是椎间盘突出症患者腰痛及腿痛重要原因,椎间盘突出临近退变节段是否导致腰痛需进一步研究证实。目的：通过椎间盘造影判断突出临近退变节段是否是椎间盘突出症患者腰痛原因,并报告经椎间盘镜摘除椎间盘后残留腰痛在临近退变疼痛椎间盘经亚甲蓝注射治疗的效果。方法：20例同时具有腰痛和腿痛椎间盘突出症患者行椎间盘造影检查,这些患者腰椎MRI表现为有1个突出椎间盘外至少合并1个或1个以上的临近退变的椎间盘,全部患者均经椎间盘镜摘除椎间盘切除突出的椎间盘,5例临近退变椎间盘造影阳性患者在椎间盘镜切除后经椎间盘内注射亚甲蓝治疗。腰痛、腿痛采用目测类比评分评定。结果与结论：20例患者总共64个椎间盘行椎间盘造影,共11个椎间盘造影阳性,其中6个位于椎间盘突出临近退变节段,5个位于引起神经根性痛的椎间盘突出节段。全部病例腿痛行椎间盘镜切除突出椎间盘后明显缓解,腰痛有部分缓解,6例临近椎间盘造影阳性患者经椎间盘镜摘除椎间盘后腰痛明显,影响日常生活,其中5例行临近疼痛椎间盘亚甲蓝注射后腰痛缓解,1例患者拒绝亚甲蓝注射治疗仍有明显腰痛。结果显示椎间盘突出症患者腰痛可能来源于突出临近退变节段。     

椎间盘突出临近退变节段是否导致腰痛

背景:椎间盘突出症患者腰痛原因很难判断,一直以来,认为突出的椎间盘是椎间盘突出症患者腰痛及腿痛重要原因,椎间盘突出临近退变节段是否导致腰痛需进一步研究证实.目的:通过椎间盘造影判断突出临近退变节段是否是椎间盘突出症患者腰痛原因,并报告经椎间盘镜摘除椎间盘后残留腰痛在临近退变疼痛椎间盘经亚甲蓝注射治疗的效果.方法:20例同时具有腰痛和腿痛椎间盘突出症患者行椎间盘造影检查,这些患者腰椎MRI表现为有1个突出椎间盘外至少合并1个或1个以上的临近退变的椎间盘,全部患者均经椎间盘镜摘除椎间盘切除突出的椎间盘,5例临近退变椎间盘造影阳性患者在椎间盘镜切除后经椎间盘内注射亚甲蓝治疗.腰痛、腿痛采用目测类比评分评定.结果与结论:20例患者总共64个椎间盘行椎间盘造影,共11个椎间盘造影阳性,其中6个位于椎间盘突出临近退变节段,5个位于引起神经根性痛的椎间盘突出节段.全部病例腿痛行椎间盘镜切除突出椎间盘后明显缓解,腰痛有部分缓解,6例临近椎间盘造影阳性患者经椎间盘镜摘除椎间盘后腰痛明显,影响日常生活,其中5例行临近疼痛椎间盘亚甲蓝注射后腰痛缓解,1例患者拒绝亚甲蓝注射治疗仍有明显腰痛.结果显示椎间盘突出症患者腰痛可能来源于突出临近退变节段.     

关节突关节不对称与腰椎间盘突出位置的关系

目的:评估关节突关节不对称与腰椎间盘突出的关系。方法:96例单节段腰椎间盘突出患者,用CT测量关节突关节形态,与没有椎间盘突出的自身临近节段对照,比较两者之间的相关性。同时观察腰椎间盘突出位置与关节突关节方向的关系。结果:椎间盘突出在L4/5节段是56个(58.33%),在L5/S1节段是40个(41.66%)。59例突向左侧(61.46%),37例突出右侧(38.54%)。L4/5椎间盘突出节段存在关节不对称的为8/56,对照节段存在关节不对称的为2/40(P>0.05),L5/S1椎间盘突出节段存在关节不对称的为12/40,对照节段为4/56(P>0.05)。关节突关节不对称与腰椎间盘突出总体存在相关性(P<0.01)。关节突关节不对称与腰椎间盘突出在L5/S1节段存在相关(P<0.05),而在L4/5节段无相关(P>0.05)。腰椎间盘突出在哪一侧与关节突关节角度形态无关(P>0.05)。结论:关节突关节不对称与腰椎间盘突出存在相关,但突出的位置与关节角度无关。     

Schmerzen und Funktionsstörungen des Iliosakralgelenks bei Bandscheibenvorfällen der unteren Lendenwirbelsäule

Back and leg pain in patients with lumbar disc herniation can be caused by various mechanisms. In addition to nerve root compression, functional alterations in the sacroiliac joint, facet joint or the iliolumbar and sacrotuberal ligaments can produce "pseudoradicular" lower back syndrome. The following study attempts to show whether or not pain and functional alterations in the sacroiliac joint (SIJ) correlate with herniations revealed by computed tomography (CT). The study also attempts to determine the correlation between pain and functional changes of the SIJ and the size and level of the disc herniation. Fifty patients with monosegmental disc herniations revealed by CT who showed no signs of bone or soft tissue alterations were included in this study. The average duration of the patients' complaints of leg or back pain was 5.7 years. Ninety-six percent of these patients had received conservative treatment before admission to our hospital. All patients were compared to a control group consisting of 16 healthy subjects of comparable age. All patients underwent a comprehensive functional, neurologic and radiologic examination. The CTs were analyzed by a standardized three-dimensional method. All of the 50 patients had sciatica complaints and a disc herniation revealed by CT. In two cases hemiation of the L3-4 disc was demonstrated, in 14 cases L4-5 disc herniation and in 34 cases a L5-S1 disc herniation. In contrast to the control group of 15 healthy subjects, the patients showed a significant number of functional disorders upon examination. In 84% of all patients, movement of the SIJ was restricted. Painful palpation of the symphysis was demonstrated in 46% of all cases. Thirty-five percent of patients with herniation of L4-5 disc demonstrated SIJ tenderness as opposed to 65% of the patients with herniation of the L5-S1 disc. This SIJ tenderness did not correlate with motion of the SIJ. In addition, SIJ motion and frequency of sensory dysfunction showed no correlation with the size of the disc herniation. Paralysis and loss of reflexes showed a positive correlation with the increasing size of the disc herniation. SIJ tenderness decreased as the size of the herniation increased. Dysfunction of the ipsilateral SIJ is explained by increased muscular tone caused by irritation of the n. sinuvertebralis and its lumbar coupling. Frequency of SIJ tenderness is significantly higher in patients with herniations between L5 and S1. Since the SIJ is innervated by the r. dorsalis of the sacral roots, the increased tenderness can be explained by the change in neurovegetative innervation of the SIJ. Due to the high correlation between lumbar disc herniation and SIJ dysfunction, disc herniation should be considered as a possible cause of sacroiliac-joint syndrome.     

Verlauf nicht operierter lumbaler Bandscheibenvorfälle

In Western industrial countries, low back pain is one of the most frequent causes of illness. Between the 4th and 5th decades of life approximately 80% of adults complain of low back pain, lasting for fairly long periods. About 10% of this population must undergo disc surgery once during life. Several authors have discribed good results for lumbar disc surgery in 55%-86% of their cases. Few control data are available, however, on patients with radiologically proven herniation of the disc regression, who were treated conservatively. Their observations indicate that regression of herniation of a lumbar disc is possible using conservative therapy exclusively. A study was therefore carried out on 43 patients with lumbar disc abnormalities, as demonstrated by spinal computed tomography (CT). Initially, 38 of them showed a herniation and 5 protrusion of the disc plus further neurological deficits and radicular pain syndromes. The subjects were followed up for over 20 months (mean) and monitored by CT in order to check the possibility that the CT findings, neurological deficits, and pain would regress a lengthy period of therapy. The results were the following: Initially, all patients complained of severe low back pain and sciatica, leading to subsequent treatment. At the time of follow-up, 15 of them still reported remittent or chronic low back pain, 9 remittent, and 16 chronic sciatic pain but of much less intensity. Before treatment, 40 patients had neurological deficits, whereas at the time of follow-up, only 24 patients still had deficits. In 2 patients the symptoms had not changed and in 2 others slight deterioration was observed. CT control examinations showed clear regression in the extent of disc herniation in 15 patients, in 18 a moderate decrease, and in 9 cases the CT findings had not changed. A favorable tendency towards regression was observed in disc herniations at the level of L5-S1 and in cases showing sequestration of the disc. Herniations of the disc at higher levels between L4-5 and L3-4 or a lateral herniation, reaching the intervertebral foramen, showed on unfavorable prognosis.     

经皮激光椎间盘减压术（PLDD）联合神经根阻滞治疗腰椎间盘突出症的临床研究

目的探讨经皮激光椎间盘减压术（PLDD）联合神经根阻滞治疗腰椎间盘突出症的机制和临床疗效。方法2004年2月至2007年7月采用PLDD联合神经根阻滞治疗腰椎闾盘突出症病人84例。单间盘突出50例，≥2个间盘突出34例。L3/4节段突出19个，L4/5节段65个，L5/S1节段32个，共116个椎间盘。术后定期随访。结果术前JOA评分平均为（18±6），术后3个月随访JOA评分平均为（26±3），有显著性差异（P〈0．05）。84例病人中62例为优，19例为良，3例为可，优良率为96．4％。术前VAS评分平均为（7．8±1．4），术后一周VAS评分平均为（2．6±1．7），术后3个月VAS评分为（2．1±1．2）有显著性差异（P〈0．05）。结论PLDD联合神经根阻滞治疗腰椎间盘突出症临床疗效满意，可成为一种优化的微创手术推广。     

极外侧型腰椎间盘突出症磁共振分级与下腰痛评分的相关性

目的 探讨磁共振（MRI）分级与下腰痛评分的相关性及其在诊断极外侧型腰椎间盘突出症（ Far lateral lumbar disc herniation , FLLDH）中的价值。方法 回顾性分析2009年8月至2014年4月收治的经手术确诊的35例FLLDH患者的MRI表现,并选择同时期其他类型的腰椎间盘突出症（LDH）包括中央型、侧后型共35例作为对照组,根据其突出间盘大小及与神经根受累情况进行MRI分级,并分析MRI分级与各自下腰痛评分[采用日本骨科学会（JOA ）腰痛评分]的相关性。MRI分级评分越高表示突出间盘越大及神经根受累情况越严重;下腰痛评分越低表示功能障碍越明显。结果（1）MRI下,FLLDH与其他类型LDH分布节段差异有统计学意义（P〈 0.05） , FLLDH多见于L3-L4 , L4-L5节段,而L5-S1,无FLLDH分布。（ 2） FLLDH的MRI分级高于其他类型LDH（t=5.714,P〈0.01）,下腰痛评分低于其他类型LDH（t=4.406 ,P 〈0.01）,两组间差异均有统计学意义。（ 3 ） FLLDH的MRI分级与下腰痛评分呈负相关关系（r=-0.754 , P 〈0.05）。结论MRI的FLLDH分级评分与神经根受压引起的下腰痛虽然有一定的相关性,但在临床应用中还应注意其他影响因素。     

针灸治疗腰椎间盘突出症的临床效果及远期神经肌电图变化情况

目的探讨针灸治疗腰椎间盘突出症的临床效果及远期神经肌电图变化情况。方法选择我院2015年1月至2017年1月收诊的120例腰椎间盘突出症患者为研究对象,按照随机数字表法将其分为对照组和观察组,各60例。对照组采取常规治疗(腰椎牵引),观察组在腰椎牵引的基础上实施针灸治疗。比较两组的治疗效果。结果观察组的近期治疗总有效率高于对照组(P<0.05)。治疗后,两组患者的CRP、IL-6水平及腰椎疼痛评分均较治疗前降低,且观察组低于对照组(P<0.05)。治疗后,两组的腰椎功能评分、腰椎活动度及生活质量评分均较治疗前升高,且观察组高于对照组(P<0.05)。随访3年时,两组的胫神经F波潜伏期及腓神经F波潜伏期均较治疗前缩短,胫神经F波传导速度及腓神经F波传导速度均较治疗前升高,且观察组优于对照组(P<0.05)。结论采用针灸治疗腰椎间盘突出症患者可获得良好的近、远期效果,且能降低腰椎疼痛度及炎性因子水平,改善患者的腰椎功能及生活质量。     

双平板DSA引导下经皮穿刺臭氧消融术治疗腰椎间盘突出症的临床疗效观察（附37例报告）

目的：观察双平板DSA及其类CT功能在经皮穿刺臭氧消融术治疗腰椎间盘突出症中的应用及临床疗效。方法回顾性分析37例腰腿疼痛或麻木患者,平均年龄（49.38±13.05）岁,共44个病变椎间盘,经CT或MRI证实为腰椎间盘突出症,在双平板DSA设备透视引导下行经皮穿刺臭氧消融术,术中每个椎间盘内注射臭氧4～25 mL（平均13.82±3.62 mL）,盘外神经根周围注射臭氧0～15 mL（平均7.73±2.87 mL）,并于盘内外注射曲安奈德水针共5 mL。观察术前及术后1周、1个月、3个月、6个月、1年腰腿疼痛变化情况,同时观察术中术后并发症发生情况。结果37例患者中,34例于臭氧消融术后腰腿疼痛VAS评分明显下降,并且疼痛缓解时间大于1年,改良Macnab疗效评定总有效率91.89%;3例疼痛缓解不明显,其中1例出现椎间盘感染。结论双平板DSA引导下经皮穿刺臭氧消融术治疗腰椎间盘突出症,创伤小,并发症少,止痛效果确切。     

Schmerzen und Funktionsstörungen der Lendenwirbelsäule bei lumbalen Bandscheibenvorfällen

In this study we attempted to explore the correlation between lumbar disc herniation and functional disorders of the lumbar spine. Fifty patients with lumbar disc herniation proven by computed tomography underwent a comprehensive functional, neurological and radiological examination. All patients were compared to a control group consisting of 16 healthy subjects of comparable age. Only patients without signs of bone or soft tissue alterations or pregnancy at the time of examination were included into the study. Herniations of the L4-5 disc showed a dysfunction in the same segment in 64% of the cases. There was also a correlation between this segmental dysfunction and pain in the sacrotuberal and iliolumbar ligaments. All patients with segmental dysfunction felt pain in the dorsal ligaments. If there was no segmental dysfunction pain in the dorsal ligaments was encountered just as often as in the control group. Herniations of the L5-S1 disc had a dysfunction in the same segment in only 12% of the cases, but in 35% there was dysfunction of the L4-5 motion segment. In this group pain in the dorsal ligaments did not correlate with segmental movements. Frequency of ligamental pain in L4-5 herniations was equal to that in L5-S1 herniations. With increasing size of the disc herniation, the frequency of segmental dysfunction, paralysis and loss of reflexes also increased, but the pain in the dorsal ligament decreased.Segmental dysfunction is explained by increased muscular tone being provoked by irritation of the sinuvertebral nerve. The differences between L4-5 and L5-S1 movements are probably due to the different functional anatomy of these segments. Ligamental pain may be explained by the fact that these ligaments have the same insertion and the muscles have increased in tone.     

中老年腰椎间盘突出症的CT诊断(附56例报告)

目的：分析中老年腰椎间盘突出症的CT表现，评价CT对腰椎间盘突出症的诊断价值及限度。材料与方法：收集经手术证实的中老年腰椎间盘突出症56例，对它们的CT征象进行回顾性分析。结果：CT诊断中老年腰椎间盘突出症的符合率为85．7％；CT分型：中心后型，后外侧型，椎间孔内或外型；主要CT表现有：(1)腰椎间盘后缘局限性后突软组织密度块影，边缘光滑，硬膜囊受压、变形；(2)游离碎块形成；(3)神经根受压、水肿或湮没；(4)突出髓核部分钙化或骨化；此外，CT还能清楚显示椎管及侧隐窝狭窄、黄韧带肥厚、小关节病变以及椎间盘真空征等合并征象。结论：CT是诊断中老年腰椎间盘突出症的首选检查方法，大部分病例经CT检查可作出正确诊断。     

20岁以下青少年腰椎间盘突出症影像学分析

目的探讨青少年腰椎间盘突出症的病因、临床及影像学表现特点。方法回顾性分析16例青少年腰椎间盘突出症的临床和影像学表现。结果L4-5，L5-S1是椎间盘突出的好发部位。16例青少年腰椎间盘突出症的主要CT、MR表现为：①中央型腰椎间盘突出2例，占12．50％；②周围型腰椎间盘突出14例，占87．50％。结论本病的发生与外伤和腰骶部发育异常有关。X线平片对青少年椎间盘突出诊断价值不如CT和MR，CT和MR检查准确性高，且为无创性检查，是诊断青少年腰椎椎间盘突出较为理想的检查方法。     

Spontaneous regression of a large sequestered lumbar disc herniation: a case report and literature review

Lumbar disc herniation is a common disorder in adults that is accompanied by lower back and radicular pain. A 32-year-old man visited our clinic with 1-week history of persistent lower back pain and weakness in his right big toe. Magnetic resonance imaging (MRI) of his lumbar spine revealed herniated discs at L3/L4, L5/S1 and L4/L5, where a right-sided intraspinal mass lesion deep to the L4 vertebral body was causing compression of the nerve root. The patient underwent conservative treatment and reported no symptoms referrable to his back or leg 4 months later. Follow-up MRI showed no herniation of the nucleus pulposus at the L4/L5 level or lesion deep to the vertebral body of L4, whereas no changes had occurred to the status of the herniated L3/L4 and L5/S1 discs. The present case and a literature review show that a sequestered lumbar disc herniation can regress within a relatively short timeframe without surgery. The authors emphasise the utility of conservative therapy for patients who do not have a definitive surgical indication.