腰部弥散痛对椎间盘源性腰痛的诊断意义及其神经解剖学原理  

Diagnostic significance of the symptoms of extensive low back pain for discogenic pain and its mechanism

作　　者：单建林[1] 王飞[1] 杜培[1] 单忠林[2] 李放[1] 

机构地区：[1]北京军区总医院骨科,北京100700 [2]河北省沧州市中心医院骨科,河北沧州061600

出　　处：《颈腰痛杂志》2015年第5期353-356,共4页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨腰部弥散痛症状对椎间盘源性腰痛的诊断意义并分析其原理。方法前瞻调查2010-01-2013-12我科收治的初步诊断为椎间盘源性腰痛患者164例,所有患者均行椎间盘造影,术前记录其有无腰部弥散痛。统计椎间盘造影阳性及阴性者,各自的有、无腰部弥散痛的例数。结果 164例中椎间盘造影者阳性129例(78.7%),造影阳性者中有腰部弥散痛者95例(73.6%),无腰部弥散痛者34例(26.4%)。在164例椎间盘造影者有腰部弥散痛者106例(64.6%),其中椎间盘造影阳性者95例(89.6%)。164例椎间盘造影者中无腰部弥散痛者58例(35.3%),其中椎间盘阴性者24例(41.4%)。不同节段腰椎间盘之间灵敏度和特异度的差异均无统计学意义。结论腰部弥散痛症状在椎间盘源性腰痛中具有较高的发生率,符合腰椎间盘神经传入理论和牵涉痛理论,对椎间盘源性腰痛具有较高的诊断价值。Objective To investigate the diagnostic significance of the symptoms of extensive low back pain for discogenic pain and its mechanism. Methods A prospective study was performed in 164 patients scheduled to be discographied for the primary diagnosed discogenic low back pain from January 2010 to December 2013. In this study,99 patients were male,65 were female, and the average age was 42 years （range 19-60 years）. All the patients were recorded of whether the symptoms of extensive low back pain existed or not prior to discography. The incidence rate of extensive low back pain in patients with positive or negative discography results was calculated respectively. The rate of positive discography in the patients with extensive low back pain and the rate of negative discography in the patients without extensive low back pain were calculated respectively. Results In all the 164 patients, 129 （78.7%） patients had positive result of discography,in which 95 （73.6%） patients had the symptoms of extensive low back pain and 34 （26.4%） patients did not have. In all the 164 patients, 106（64.6%） patients had the symptoms of extensive low back pain,in which 95（89.6%） patients had positive result of discography（i.e sensitivity was 89.6%）. In all the 164 patients, 58 （35.3%） patients did not have the symptoms of extensive＂ low back pain, in which 24（41.4%） patients had negative result of discography（i.e specificity was 41.4%）. No significant differences were noted among different levels of disc about sensitivity or specificity （P〉0.05）. Conclusion There was a high incidence rate of discogenic pain in the patients with the symptoms of extensive low back pain, in accord with the principle of the lumbar afferent nerve pathway and referred pain. Occurrence of extensive low back pain is valuable for diagnosis of discogenic low back pain.

关 键 词：腰部弥散痛 椎间盘源性腰痛 症状 椎间盘造影 

分 类 号：R681.55[医药卫生—骨科学]