腰椎间盘造影在椎间盘源性腰痛诊治中的应用

目的应用椎间盘造影对椎间盘源性腰痛进行诊断并评价椎间融合手术的疗效。方法2003年10月—2004年6月间对45例具有椎间盘源性腰痛症状的患者进行了椎间盘造影,共101个椎间盘。所有病例全部进行了MRI和CT检查。观察造影图像和MRI表现,记录诱发痛、手术和保守治疗的疗效。结果45例患者中21例出现了诱发痛（47％）,101个造影椎间盘中有21个椎间盘出现诱发痛（21％）;21例诱发痛阳性患者中18例接受了360。融合手术,随访时间平均16个月（15～23个月）,术后11例患者腰痛完全消失（11／18,优：61％）,4例疼痛基本消失（4／18,良：22％）,3例腰痛无变化（3／18,差：17％）;3例诱发痛阳性患者和24例诱发痛阴性患者行保守治疗,在同期随访中,1例腰痛完全消失（1／27,优：4％）,10例疼痛基本消失（10／27,良：37％）,16例疼痛无变化甚至加重（16／27,差：59％）。结论腰椎间盘造影对椎间盘源性腰痛的诊断具有一定的敏感性,但不是一个特异性诊断方法;对确定为疼痛原因的椎间隙实施椎间360。融合手术可以消除患者的疼痛,中期效果好。

The application of lumbar discography in the diagnosis and treatment of the discogenic low back pain

Objective To investigate the diagnostic value of lumbar discography in discogenic low back pain and the effects of intervertebral fusion surgery.Methods Forty-five cases with 101 discs underwent discography, 360 degree fusion manipulation were performed on 18 discography abnormal cases, 27 cases were treated conservatively .Discography, MRI and provocative pain were observed and all the cases were followed up.Results Twenty-one cases showed positive provocative pain (21/45,47%), and 21 discs of 101 were concordant discography( 21/101,21%). All cases were followed up for an average 16 months (15 to 23 months), the satisfactory rate was 83% (15/18) in the surgery group and 41%(11/27) in the conservative group.Conclusions It is concluded that the discography is moderately sensitive in the diagnosis of discogenic low back pain. Furthermore, the short term follow-up reveals that operative group has better pain relief than conservative group.