间盘源性腰痛的诊断与微创治疗  

Lumbar discogenic pain: diagnosis and minimal invasive treatment

作　　者：周毅力[1] 宋文阁[2] 刘甬民[3] 谢珺田[2] 

机构地区：[1]美国迈阿密大学医学院Jackson医院 [2]济南山东省立医院,250021 [3]华中科技大学同济医学院附属协和医院,武汉430022

出　　处：《实用疼痛学杂志》2006年第1期33-39,共7页Pain Clinic Journal

摘　　要：纤维环撕裂所致间盘源性腰痛占腰痛患者的39％,其诊断和治疗仍然是临床上的一个难题,其发病机制仍不清楚,临床表现也不典型且缺乏特异性。磁共振成像有助于发现间盘内破裂存在的证据。而有创的间盘造影则可以直接明确疼痛的原因,还可为纤维环撕裂选择合适的治疗方案。间盘内注射甾体类药物未证明能产生长期的疗效。对于严格选择的病例,间盘内电热疗法可在一定程度上缓解疼痛。间盘内射频热凝治疗已经证实无效。交通支阻滞可抑制间盘疼痛信号向中枢神经系统的传导。间盘细胞移植有望成为预防和治疗间盘源性疾病的有效方法。Diagnosis and treatment of lumbar discogenic pain due to internal disc disrupture remains a challenge to the medical society, which may account for 39% of patients with low back pain. The mechanism ofdiscogenic pain remains unclear. The clinical presentation ofdiscogenic pain is atypical and nonspecific. MRI may offer a useful tool for screening the existence of internal disc disruption. Provocative discography can provide unique in^brmation about the pain source as well as the morphology of the disc. It may also provide information for selecting appropriate treatment modality for the annular tear. lntradiscal steroid injection has not been proved to provide long-term benefits for the discogenic pain. lntradiscal electrothermal therapy may offer some pain relief for a group of well-selected patients. No benefits have been found for the intradiscal radiofrequency thermocoagulation. Ramus communicans block may interfere the transition of painful information from the discs to the central nervous system. Disc cell transplantation is in the experimental stage. It has the potential to become a useful method for the prevention as well as treatment of discogenic pain due to internal disc disruption.

关 键 词：间盘源性腰痛 纤维环撕裂 诊断 微创治疗 

分 类 号：R687[医药卫生—骨科学]