摘要
目的:探讨腰椎间盘突出类型导致疼痛的程度,并分析其原因。方法:选取2002年1月至2008年12月手术治疗腰椎间盘突出症265例(其中男162例,女103例,年龄21～78,平均46.3岁),均行单间盘手术(L4,5128例、L5S1137例)。每例患者在术前进行Oswestry功能障碍指数问卷(ODI),术中根据改良Carragee系统将突出间盘分为5组(根据髓核突出的程度-纤维环破裂的程度分为Ⅰ组脱出-小破裂、Ⅱ组脱出-大破裂、Ⅲ组碎片-完整、Ⅳ组变性-完整、Ⅴ组钙化-退变),对各组术前ODI评分进行统计学处理,分析不同突出类型与其疼痛程度的相关性。结果:纤维环破裂的Ⅰ组和Ⅱ组突出间盘术前疼痛严重,与纤维环完整的Ⅲ、Ⅳ、Ⅴ组突出间盘相比有统计学意义,而纤维环破裂缺损大的Ⅱ组与相对纤维环破裂缺损小的Ⅰ组相比,更为疼痛,有统计学意义。结论:突出的间盘如果伴有纤维环破裂,髓核就可以进入椎管,导致神经根性疼痛加重;髓核及其释放的物质有机会通过化学因素而导致神经根性疼痛加重。
Objective：To evaluate the preoperative pain degree of lumbar intervertebral disc herniation and analyzed its reason.Methods：From January 2002 to December 2008,265 patients with lumbar intervertebral disc herniation were operated by single segment,of which site in L4,5 was 128 cases and in L5S1 was 137 cases.There were 162 males and 103 female,ranging in age from 21 to 78 years,with an average of 46.3 years.Oswestry index of all patients was observed before operation.The patients were divided into five groups based on Carragee system（according to degree of nucleus pulposus herniation and degree of fibrous ring cleavage to group,prolapse and liberation of nucleus pulposus with small ring cleavage was group Ⅰ;prolapse and liberation with large ring cleavage was group Ⅱ;contained fragment with integrated fibrous ring was group Ⅲ;no contained fragment with integrated fibrous ring was group Ⅳ;calcified nucleus pulposus with degenerative fibrous ring was group Ⅴ）.The associativity between five types of lumbar intervertebral disc herniation and preoperative pain degree was analyzed.Results：The preoperative pain in group Ⅰ and group Ⅱ was more severe than that of other groups（P〈0.01）.The preoperative pain in group Ⅱ was more severe than that of group Ⅰ（P〈0.01）.Conclusion：Nucleus pulposus can migrated into the spinal canal and will aggravate the nerve root pain if lumbar intervertebral disc herniation accompanies with fibrous ring cleavage;and freed materials can aggravate the nerve root pain by the chemical factor.
出处
《中国骨伤》
CAS
2011年第7期578-581,共4页
China Journal of Orthopaedics and Traumatology
关键词
腰椎
椎间盘
椎间盘移位
疼痛
Lumbar vertebrae
Intervertebral disk
Intervertebral disk displacement
Pain
