椎间盘造影及造影后CT复查在腰椎间盘突出症患者诊断和确认责任椎间盘中的作用  

The role of intervertebral discography and post-contrast CT examination in the diagnosis of lumbar disc herniation and responsible intervertebral discs in patients with low back and leg pain

作　　者：陈世利 Chen Shili(Department of Spine, Kunming Orthopaedic Hospital, Kunming City, Yunnan Province 650000, China)

机构地区：[1]昆明骨科医院脊柱科,650000

出　　处：《实用疼痛学杂志》2019年第3期203-207,共5页Pain Clinic Journal

摘　　要：目的评价腰椎间盘造影结合造影后CT薄层扫描在腰椎间盘突出症诊断及确认责任节段椎间盘中的应用。方法收集2015年3月至2018年5月在昆明骨科医院脊柱科住院的腰腿痛患者,CT平扫示椎间盘突出不明显,或为多节段突出,或单一节段点状突出,或某一节段可疑突出的,责任节段椎间盘不明确的患者120例,性别、年龄不限。在行腰椎间盘造影术及造影节段造影后复查CT薄层扫描检查来明确是否为腰椎间盘突出症及明确责任节段椎间盘,最终对责任椎间盘进行手术。于术前、术后24h、术后6个月采用疼痛视觉模拟评分(VAS)进行疼痛改善情况评估。结果因手术禁忌证未行检查者4例。行腰椎间盘造影的116例患者中,有98例患者在注射造影剂时出现下肢复制痛,最终造影节段复查CT薄层扫描造影剂渗漏处压迫神经根的影像表现与注射造影剂时出现下肢复制痛的节段椎间盘一致者90例,诊断为腰椎间盘突出症,明确责任节段椎间盘,并实施手术治疗。VAS评分由术前(8.72±1.28)降低至术后24h时的(2.00±0.50)和术后6个月时的(0.80±0.15),差异有统计学意义(P<0.05),且术后VAS评分均小于3。未诊断腰椎间盘突出症者26例。结论对于无法明确是否为腰椎间盘突出症,无法判断哪一节段是责任椎间盘的腰腿痛患者,椎间盘造影结合造影后CT薄层扫描检查是可行的方法。Objective To apply lumbar discography combined with CT thin layer scanning in the diagnosis of lumbar disc herniation and responsible segment of the intervertebral discs in patients with low back and leg pain. Methods One hundred and twenty patients with low back and leg pain were selected, from March 2015 to May 2018 in Spine Department of Kunming Orthopaedic Hospital. CT showed that there was no obvious disc herniation, or multiple segments herniation, single segmental punctate herniation or one segment of suspicious herniation, and unclear responsibility intervertebral disc in all patients. Discography combined with CT thin layer scanning were performed to diagnose lumbar intervertebral disc herniation and the responsible segmental intervertebral disc. Finally, the responsible disc received operation. Visual analogue scale (VAS) was recorded before the operation and 24 h, 6 months after the operation. Results Four patients were excluded because of operative contraindications. Lower limb pain was duplicated by contrast radiography agent injection in 98 cases of all 116 patients received discography. The imaging manifestations of nerve root compression at the leakage site of CT thin layer scanning contrast medium with the appearance of duplicating painful segments of lower limb pain during injection is consistent in 90 cases, then the diagnosis of lumbar disc herniation and the responsible segmental intervertebral disc were clearly confirmed conformed. The operative treatment of the responsible segmental disc was performed. Compared with pre-operation, VAS was significantly decreased at 24 h and 6 months after the operation[(8.72±1.28) vs.(0.80±0.15),(8.72±1.28) vs.(2.00±0.50)]respectively (P<0.05). And all postoperative VAS was less than 3. Other 26 patients were excluded diagnosis of lumbar disc herniation. Conclusion For patients with low back and leg pain who are unable to determine whether they have lumbar disc herniation or which segment is responsible for the disc herniation, CT thin layer scanning af

关 键 词：体层摄影术 螺旋计算机 椎间板 椎间盘 椎间盘造影术 

分 类 号：R681.53[医药卫生—骨科学]