摘要
目的探讨椎间盘造影在诊断椎间盘源性腰痛中的应用价值。方法对19例椎间盘源性腰痛患者行椎间盘造影检查。根据注入造影剂时阻力的大小、注射过程中询问患者是否有与平时相同或者类似的疼痛以及通过造影剂聚集情况对椎间盘纤维环破裂程度进行分级。结果19例患者均穿刺成功。12例术中造影时疼痛与造影前相似,2例疼痛重于造影前,5例诱发疼痛不明显。患者均获得随访,时间3~12个月。14例(27个)纤维环2、3级破裂,注射造影剂时阻力较小,患者均有与平时相同或者类似的疼痛,其中23个纤维环3级破裂者行椎间盘切除+椎弓根螺钉固定+椎间植骨融合术,术后腰痛均基本消失。其余5例诱发疼痛不明显者行非手术治疗,疼痛有所缓解,但停止非甾体类止痛药后疼痛复发甚至加重。结论椎间盘造影在确定椎间盘源性腰痛的病变部位具有临床指导作用。
Objective To investigate the application value of discography in the diagnosis of discogenic low back pain.Methods The 19 patients with discogenic low back pain were examined by discography.The rupture degree of annulus fibrosus of intervertebral disc was graded according to the magnitude of resistance at injecting contrast agent,whether the patient experienced the same or similar pain as usual during the injection,and the accumulation of the contrast agent.Results All 19 patients were successfully punctured.In 12 cases,the pain was similar to that before discography;in 2 cases,the pain was worse than before discography,and in 5 cases,the pain was not obvious.All patients were followed up for 3~12 months.Fourteen cases(27 cases)had grade 2,3 annulus fibrosus ruptures,when the resistance was less during contrast agent injection,the patients had the same or similar pain as usual;among them,23 annulus fibrosus with grade 3 ruptures underwent discectomy+pedicle screw fixation+interbody bone graft fusion,and the lumbago basically disappeared after surgery.The remaining 5 cases with non-obvious induced pain were performed with non-surgical treatment,and the pain were relieved,but the pain recurred or even worsened after stopping non-steroid pain killers.Conclusions Discography can provide clinical guidance for the surgical treatment of patients with discogenic low back pain.
作者
周杨
葛韧
张远
邓豪
ZHOU Yang;GE Ren;ZHANG Yuan;DENG Hao(SecionⅡ,Dept of Orthopaedics,the TCM Hospital of Jiashan County,Jiaxing,Zhejiang 314100,China)
出处
《临床骨科杂志》
2024年第1期16-19,共4页
Journal of Clinical Orthopaedics
