腰椎间盘突出症的红外热像“下肢神经刺激征象”机制探讨  

STUDY ON THE MECHANISM OF NERVE STIMULATION SIGN IN LOWER EXTREMITIES BY INFRARED THERMAL IMAGING IN LUMBAR DISC HERNIATION

作　　者：贾和平[1] 张大伟[1] 周文生 金瑞林[3] 

机构地区：[1]解放军第251医院疼痛科 [2]66150部队卫生队 [3]解放军第251医院妇产科

出　　处：《中国疼痛医学杂志》2013年第3期152-155,共4页Chinese Journal of Pain Medicine

摘　　要：目的:探讨腰椎间盘突出症(lumbar disc herniation,LDH)红外热像(infrared thermal im-aging,ITI)"下肢神经刺激征象"的发生机制,并为腰椎间盘突出症新疗法提供理论依据。方法:将2010年9月至2012年3月我院疼痛科LDH患者分为2组。第1组为LDH不伴主诉患侧下肢发凉者(n=46),第2组为LDH伴主诉患侧下肢发凉者(n=20)。于治疗前、后分别评估患者VAS并行下肢ITI检查,研究ITI"下肢神经刺激征象"的机制。结果:两组治疗前下肢VAS分别为6.58±0.97、6.45±1.05,治疗后VAS分别降至1.33±0.64,1.30±0.73;两组患者治疗前ITI均出现"下肢神经刺激征象";下肢疼痛程度越重,"下肢神经刺激征象"越明显。第1组和第2组中11例患者经治疗疼痛缓解后其ITI未再表现为此征像,第2组有9例患者于治疗后ITI仍存在"下肢神经刺激征像",主要表现为患侧下肢前内侧或后侧低温区。结论:LDH患者ITI"下肢神经刺激征象"发生机制并非通常认为的腰、骶神经根中交感纤维和/或窦椎神经受刺激所致,而主要是由疼痛刺激引起的一种脊髓反射,进而引起患者下肢的交感缩血管反应;椎旁交感干和/或两侧交通支受刺激引起下肢缩血管反应是LDH患者ITI表现为"下肢神经刺激征象"次要机制。Objective： To explore the mechanism by infrared thermal imaging （ITI） in lumbar disc of nerve stimulation sign in lower extremites （NSSLE） herniation （LDH）, and provided theoretical basis for the new therapeutic methods of LDH. Methods： The patients of LDH in our department during Sep.2010 to Mar.2012 were divided into two groups in accordance with chief complaints of being cool （2 group） or not （1St group） in the affected lower extremities. VAS of the two groups was estimated before and after treatment and thermographic equipment was applied to analyze the results of infrared thermograms and study the mechanism of NSSLE. Results： VAS was 6.58 ：~ 0.97 and 6.45 ＋ 1.05, respectively before treatment and 1.33 ＋ 0.64 and 1.30 ＋ 0.73 after treatment in the affected lower extremites of the two groups. The ITIs in the two groups showed NSSLE in the affected lower extremites before treatment, the greater the pain intensity was, the more significant NSSLE was. NSSLEs were not seen in 1st group and 11 cases of and group, but were seen in nine cases of 2 group after treatment, and were obviously in anteromedial or posterior region of the affected lower extremities of the nine cases. Conclusion： The main mechanism of NSSLE by ITI in LDH was a kind of spinal cord reflex resulted from pain stimulation,leading to sympathetic vasoconstriction reaction in the affected lower extremites, not the results of stimulation of sympathetic fibers in the lumbosacral roots or sinus vertebral nerve; the stimulation to lumbar paravertebral sympathetic trunk and communicating branches leads to vasoconstriction in the affected lower extremites was the secondary mechanism of NSSLE in LDH.

关 键 词：腰椎间盘突出症 红外热像图 下肢 神经刺激 机制 

分 类 号：R681.5[医药卫生—骨科学]