下腹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 low abdomen pain for discogenic low back pain and its mechanism

作　　者：单建林[1] 杜培[1] 王飞[1] 谭小云 

机构地区：[1]北京军区总医院骨科,北京100700 [2]海军413医院骨二科,浙江舟山市316000

出　　处：《中国矫形外科杂志》2016年第11期986-989,共4页Orthopedic Journal of China

摘　　要：[目的]探讨下腹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年1月-2013年12月本科收治的初步诊断为椎间盘源性腰痛拟行椎间盘造影术患者164例;年龄19-60岁,平均42岁。对所有拟行椎间盘造影者,术前记录其有无下腹痛。统计椎间盘造影阳性者下腹痛的发生率及无下腹痛的发生率。统计下腹痛者椎间盘造影的阳性率及无下腹痛者椎间盘造影的阴性率。[结果]164例中椎间盘造影者阳性129例（78.7%%）,造影阳性者中有下腹痛者24例（18.6%）,无下腹痛者105例（81.4%）。在164例椎间盘造影有下腹痛者26例（15.9%）,其中椎间盘造影阳性者24例（92.3%）,即下腹痛诊断椎间盘源性疼痛的灵敏度为92.3%。164例椎间盘造影者中无下腹痛者138例（84.1%）,其中椎间盘阴性者33例（23.9%）,即下腹痛诊断椎间盘源性疼痛的特异度为23.9%。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]下腹痛症状发生于椎间盘源性腰痛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 symptom of low abdomen pain for discogenic low back pain and its mechanism. [Methods] A prospective study was performed on 164 patients diagnosed with discogenic low back pain and scheduled for discography 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）. Before discography examination,patients with or without symptoms of low abdomen pain were recorded. The incidence rate of low abdomen pain in patients with a positive or negative discography results was calculated respectively. The rate of positive discography in the patients with low abdomen pain and the rate of negative discography in the paients without low abdomen pain were calculated respectively. [Results] In all the 164 patients,129（ 78. 7%） patients had positive result of discography,in which 24（ 18. 6%） patients had the symptoms of low abdomen pain and105（ 81. 4%） patients did not have. In all the 164 patients,26（ 15. 9%） patients had the symptoms of low abdomen pain,in which 24（ 92. 3%） patients had positive result of discography（ sensitivity = 92. 3%）. In all the 164 patients,138（ 84. 1%） patients did not have the symptoms of low back pain,in which 33（ 23. 9%） patients had negtive result of discography（ speciality = 23. 9%）. No significant difference（ P〈0. 05） was noted among different level of disc about sensitivity or speciality. [Conclusion] The symptoms of low abdomen in discogenic low back pain is in accord with the lumbar disc afferent nerve pathway theory and referred pain theory. Occurrence of low abdomen pain is valuable for diagnosis of discogenic low back pain.

关 键 词：下腹痛 椎间盘源性腰痛 症状 椎间盘造影 

分 类 号：R681.57[医药卫生—骨科学]