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1、椎间盘源性腰痛的诊断与治疗郭钧陈仲强郭昭庆齐强杨民［摘要］目的探讨椎间盘源性腰痛的诊断与治疗方法。方法冋顾性收集并分析27例经椎间盘造影检查诊断为椎间盘源件腰痛的严重下腰痛患者的彩像学资料;男14例，女13例，年龄23〜68岁，平均44.7岁,L$4为4例,S5为14例,L5S1为5例，L&4与L"双间隙2例,L"与US】双间隙2例。治疗分三组：7例行经皮射频消融术，12例行前路椎间盘切除椎体间融合联合后路关节突螺钉固定术，8例行后路椎间盘切除后外侧融合术。三组患者年龄、性别、病程、术前疼痛及功能评分差开无统计学意义。术后观察患者腰痛及功能障碍评分
2、的改善程度。行腰椎融合术者在术后1年观察患者植佇融合情况。结果椎间盘造影是冃前诊断椎间盘源性腰痛的最皱感方法，腰椎MRI上出现椎间盘纤维环后方高信号区或终板信号改变预示诱发痛的敏感度低。术后随访1年〜9年，平均3.3年，三种治疗方法术后VAS评分依次降低：2.7±0.9,7.4±1.2,6.9±1.4；(F=19.311,P=0.000),其中后两组比较差异无统计学意义，功能障碍ODI评分依次降低：8.9±2.5,3&1±6.7,30.5±7.2,(F=32.513,P=().OOO),三组之间两两比较差异均有统计学意义。结论椎间盘造影是冃前诊断椎
3、间盘源性腰痛的可靠方法；前路或斤路椎间盘切除结合内固定融合术与射频消融术组比较在改善患者疼痛与功能方面有一定优势。［关键词］椎间盘源性腰痛;诊断;治疗;腰椎融合;射频DiagonisisandtreatmentofdiscogenicIowbackpainGUOJun,CHENZhong-qiang,GUOZhao-qing,etal.DepartmentofOrthopaedics,ThirdHospitalofPekingUniversity,Beijing100083,China[Abstract]ObjectiveToevaluatethe
4、bestdiagonosisandtreatmentmethodofdiscogeniclowbackpain.MethodTwenty-sevenpatientswithchroniclowbackpainwereselectedforprovocativediscographytodiagnosethediscogeniclowbackpainandtolocatedthediscstobetreated.Therewere14malesand13femaleswithanaverageageof44.7years(range,23〜68).T
5、heinvovleddiscsincludel3.44cases,u.514cases,l5Si5cases,bothl3,4andu,52cases,bothu.5andl5s,2cases.Thespecialtyoftheimagewereanalyzed.Fromthisgroup,7patientsweretreatedbyRadiofrequency,12patientsbydiscectomywithintervertebralfusion,8patientsbydiscectomywithpostlateralfusion.Ther
6、eisnodifferenceanongtheage作者单位：100083北京，北京大学第三医院骨科(Email:gzd713@163.com)diseasecourse,thepre-operationscoreofVAS(visualanaloguescale)andODI(OswestryDisabilityIndex)ofthe3groups,.AllthecaseswereassessedwithVASandODIafteroperation.Thefusionratewereevaluatedat12months.ResultsThed
7、iscographyisthemostsensitivemethodtodiagnosethediscogeniclowbackpain.Thethigh-intensity-zoneandtheModicchangeontheMRIcanrTtbereplacedfordiscographyforifslowsensitivity..ForpatientsinthreegroupsbyRF,ALIF,PLF,theVAS(backpain)improvedby：2.7土0.9,7.4±1.2,6.9±1.4pointsinturn,(F=19.3
8、11,P=0.000),thereisnostatisicalmeaningbetweenthelater2groups,
