椎间盘源性腰痛的影像学诊断  

Imaging Diagnosis of Discogenic Lumbar Pain

作　　者：郭林[1] 桂晓臣[1] 蔡跃增[2] 张继东[1] 王林森[1] 

机构地区：[1]天津市天津医院,天津300211 [2]天津医科大学总医院,天津300052

出　　处：《中国中西医结合外科杂志》2013年第3期254-257,共4页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

摘　　要：目的:探讨椎间盘源性腰痛的影像学诊断价值及其临床意义。方法:分析70例慢性下腰痛患者的腰椎MRI及其195个腰椎CT椎间盘造影表现,将一致性诱发痛者归为椎间盘造影阳性,非一致性疼痛和无痛者为阴性,椎体终板退变按Modic标准进行分级。结果:70例CT椎间盘造影中有42例62个椎间盘造影阳性,MRI显示椎间盘异常信号与造影一致性诱发痛两者间有相关性(P<0.05),HIZ与造影一致性诱发痛间有相关性(P<0.05),椎体终板骨软骨炎与造影一致性诱发痛间有相关性(P<0.05),Modic各型间椎间盘造影阳性率差异有统计学意义(P<0.01)。结论:MRI可作为诊断椎间盘源性疼痛的首选检查,HIZ对诊断椎间盘源性疼痛有一定特异性,ModicI型终板炎的椎间盘应高度怀疑为诱发椎间盘源性疼痛的责任椎间盘,MRI显示多个椎间盘信号异常,椎间盘造影可以准确定位需要脊柱融合的节段。Objective To discuss diagnostic value of imaging of discogenic pain and its clinical signifi- cance. Methods Lumbar MRI and 195 discographies of 70 patients with chronic low back pain were anal- ysed. The consistent pain induced by discography was considered positive; the unconsistent pain and painless were negative .Vertebral endplate degeneration was judged on the basis of Modic classification standard. Results Seventy cases were made by means of discography, 62 discs of 42 patients were positive. There was a correlation between abnormal disc signal on MRI and the consistent pain（P〈 0.05）. There was a correlation be- tween high intensity zone （HIZ） and the consistent pain（P 〈 0.05）.There was a correlation between vertebral end-plate osteochondritis and the consistent pain（P 〈 0.05）. Positive rates of discography among various Modic types were statistically significant different （P 〈 0.01）. Conclusion MRI can be used as the first choice for diagnosis of discogenic pain. HIZ may has some specificity for the diagnosis of discogenic pain. Especially when MRI showed Modic I-type of endplate osteochondritis , the disc should be highly suspected as the duty disc which induced discogenic pain. For multiple segments of abnormal disc signal on MRI, discography can locate accurately the segment needed for surgical disc fusion.

关 键 词：椎间盘源性疼痛 椎间盘造影 磁共振成像 诊断方法 

分 类 号：R445.2[医药卫生—影像医学与核医学]