腰椎间盘源性疼痛机理的临床研究

目的 :分析腰椎间盘突出症病人的临床症状、体征与椎间盘和神经根大体病理形态改变的关系 ,临床症状、体征和椎间盘突出类型与髓核中炎症介质 (磷脂酶A2 )水平的关系以及临床症状、体征和椎间盘突出类型与脑脊液 (以下简称CSF)中神经肽类递质变化的关系。从临床角度探讨腰椎间盘突出症疼痛机理。材料与方法 :分析161例腰椎间盘突出病人的髓核突出类型及神经根病理形态改变与腰腿痛程度的关系 ;分析 2 0例腰椎间盘髓核组织中磷脂酶A2 活性水平与神经根性疼痛程度的关系 ;3 1例腰椎间盘突出症病人脑脊液中P物质和降钙素基因相关肽含量与神经根性疼痛程度进行比较。结果 :①腰椎间盘的膨出、突出、脱出和脱出游离各组之间无疼痛程度的统计学显著差异。而神经根呈急性炎症反应的病人中重度疼痛高达 80 % (P <0 .0 1)。②腰椎间盘突出症病人椎间盘髓核中磷脂酶A2 活性显著高于自身血液中和健康人椎间盘髓核中磷脂酶A2 活性水平 ,腰椎间盘突出症病人的腰腿痛程度与其髓核中磷脂酶A2 活性明显相关。③腰痛病人脑脊液中P物质和降钙素基因相关肽水平高于正常对照组 ,并与疼痛等级有关。结论 :①腰椎间盘突出物的病理形态和对神经根的机械压迫与其引起的临床疼痛症状和神经根体征无明确关系 ,而神经根性疼痛与局部

Clinical Analysis on Mechanism of Radiculopathy due to Lumbar Disc Herniation

Objective:To analyze the mechanism of the radicular pain caused by lumbar disc herniation in a clinical point of view. Comparative analysis were made on the correlation of the clinical symptoms with the pathomorphological types of herniated discs, activity changes of phospholipase A 2 in nucleus, the changes of SP and CGRP in CSF. Methods:One hundred and sixty-one patients with lumbar disc herniation were included in the study. The correlation of the pathomorphologic types of herniated disc and nerve root with the severity of the radicular pain was analyzed statistically. The phospholipase A 2 activity was assayed in 20 nucleus samples obtained at surgery for disc herniation. The correlation of phospholipase A 2 activity with the severity of the radicular pain was analyzed. The CSF levels of SP and CGRP in 31 patients with disc herniation were assayed by RIA method and the correlation of the CSF levels of SP and CGRP with the severity of the radicular pain was also analyzed. Results:1. No significant difference was found between the pathomorphological changes of disc and the severity of pain. However, 80% of the patients with acute inflammation of the nerve root suffered from severe pain ( P <0.01). 2.The level of PLA 2 activity in herniated nucleus was much higher than that in blood and normal disc. The level of PLA 2 activity significantly correlated to the severity of radicular pain. 3. The level of SP and CGRP in the CSF of patients with back pain was much higher than that in normal control. The level of SP and CGRP in the CSF significantly correlated to the severity of radicular pain ( P <0.001). Conclusion:1. The severity of radicular pain does not correlate to the pathomorphological changes of the herniated disc but correlate to the inflammation of the root. 2. The increased level of PLA2 activity in herniated nucleus plays an important role in the pathogenesis of radicular pain of lumbar disc herniation. 3. This study has proven the hypothesis that more SP and CGRP would be released into CSF after the mechanical stimuli to spinal nerve root. The increased release of SP and CGRP in CSF was well correlated to the pain severity and the sensitivity of nerve root to mechanical stimuli.