中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (22): 4171-4175.doi: 10.3969/j.issn.1673-8225.2011.22.043

• 骨与关节损伤基础实验 basic experiments of bone and joint injury • 上一篇    下一篇

椎间盘突出临近退变节段是否导致腰痛

王  刚1，刘尚礼2，陈志维1，关宏刚1，韩敦富2，施彦璋3   

  1. 1佛山市中医院骨科，广东省佛山市  528000
    2中山大学附属第二医院骨科，广东省广州市  510120
    3汕头市中心医院骨科，广东省汕头市  515031
  • 收稿日期:2011-02-25 修回日期:2011-04-03 出版日期:2011-05-28 发布日期:2011-05-28
  • 通讯作者: 刘尚礼，博士，教授，中山大学附属第二医院骨科，广东省广州市 510120 摘要
  • 作者简介:王刚☆，男，1975年生，湖北省鄂州市人，汉族，博士，主治医师，主要从事脊柱外科及创伤骨科研究。

Can the degeneration adjacent to herniated disc in patients with lumbar disc herniation cause low pack pain?

Wang Gang1, Liu Shang-li2, Chen Zhi-wei1, Guan Hong-gang1, Han Dun-fu2, Shi Yan-zhang3   

  1. 1Department of Orthopedic Surgery, Foshan Hospital of Traditional Chinese Medicine, Foshan  528000, Guangdong Province, China
    2Department of Orthopedic Surgery, the Second Affiliated Hospital of Sun Yat-sen University, Guangzhou  510120, Guangdong Province, China
    3Department of Orthopedic Surgery, the Central Hospital of Shantou City, Shantou  515031, Guangdong Province, China
  • Received:2011-02-25 Revised:2011-04-03 Online:2011-05-28 Published:2011-05-28
  • Contact: Liu Shang-li, Doctor, Professor, Department of Orthopedic Surgery, the Second Affiliated Hospital of Sun Yat-sen University, Guangzhou 510120, Guangdong Province, China gzxy168@126.com
  • About author:Wang Gang☆, Doctor, Attending physician, Department of Orthopedic Surgery, Foshan Hospital of Traditional Chinese Medicine, Foshan 528000, Guangdong Province, China wanggang2003@yeah.net

PDF

299

被引次数

9

摘要：

背景：椎间盘突出症患者腰痛原因很难判断，一直以来，认为突出的椎间盘是椎间盘突出症患者腰痛及腿痛重要原因，椎间盘突出临近退变节段是否导致腰痛需进一步研究证实。
目的：通过椎间盘造影判断突出临近退变节段是否是椎间盘突出症患者腰痛原因，并报告经椎间盘镜摘除椎间盘后残留腰痛在临近退变疼痛椎间盘经亚甲蓝注射治疗的效果。
方法：20例同时具有腰痛和腿痛椎间盘突出症患者行椎间盘造影检查，这些患者腰椎MRI表现为有1个突出椎间盘外至少合并1个或1个以上的临近退变的椎间盘，全部患者均经椎间盘镜摘除椎间盘切除突出的椎间盘，5例临近退变椎间盘造影阳性患者在椎间盘镜切除后经椎间盘内注射亚甲蓝治疗。腰痛、腿痛采用目测类比评分评定。
结果与结论：20例患者总共64个椎间盘行椎间盘造影，共11个椎间盘造影阳性，其中6个位于椎间盘突出临近退变节段，5个位于引起神经根性痛的椎间盘突出节段。全部病例腿痛行椎间盘镜切除突出椎间盘后明显缓解，腰痛有部分缓解，6例临近椎间盘造影阳性患者经椎间盘镜摘除椎间盘后腰痛明显，影响日常生活，其中5例行临近疼痛椎间盘亚甲蓝注射后腰痛缓解，1例患者拒绝亚甲蓝注射治疗仍有明显腰痛。结果显示椎间盘突出症患者腰痛可能来源于突出临近退变节段。

关键词: 椎间盘退变, 椎间盘突出, 腰痛, 椎间盘造影, 盘源性腰痛

Abstract:

BACKGROUND: It is often difficult to determine the cause of low back pain (LBP) in the patients with lumbar disc herniation. The herniated disc has long been thought to be an important cause of the patient’s complaint about LBP and sciatica. Whether the adjacent degenerative disc results in LBP needs further confirmations. 
OBJECTIVE: This study sought to determine whether the degenerative disc adjacent to the herniated disc in patients with LBP and radicular pain can result in discogenic LBP, as assessed by provocative discography, and to report the outcomes of the residual LBP when adjacent symptomatic disc were treated with methylene blue after microendoscopic discectomy.
METHODS: Twenty lumbar disc herniation patients complaint about LBP and radicular pain underwent provocative discography. There was one degenerative herniated disc with one or more adjacent degenerative discs in their MRI. Provocative discography was performed on all degenerative discs and at least one normal disc for control. The severity of LBP and leg pain of all patients was assessed using visual analog scale before discography. All patients underwent microendoscopic discectomy at herniated level, and intradiscal injection of methylene blue was given at painful adjacent level in five patients after microendoscopic discectomy.
RESULTS AND CONCLUSION: Discographies were performed on 64 discs of 20 patients, from L2-3 to L5-S1. There were 11 discs satisfying the positive response criteria, including 6 in degenerative segment adjacent to the herniated disc and 5 in the herniated disc that induced corresponding radiculopathy. The leg pains were evidently improved in all patients, while LBP was partially improved after microendoscopic discectomy. Six patients with symptomatic adjacent degenerative disc still had evident LBP, influencing their daily living. Five of them received intradiscal injection of methylene blue treatment and the LBP was relived. One patient refusing to the treatment still complained the LBP. Results evidenced that accompanying LBP for many LDH patients may come from the degenerative levels adjacent to the herniated disc.

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