摘要
目的：评价压力控制下椎间盘造影诊断椎间盘源性疼痛的临床价值。方法：2007年3月－2008年5月，对69例慢性腰痛患者的156个MRI“黑椎间盘”进行压力控制下造影。男26例，女43例；年龄29-48岁，平均39．7岁；病程6-120个月，平均36．1个月。采用椎间盘后外侧入路穿刺，穿刺针针尖到达椎间盘中央后连接压力泵，注射造影剂并连续观察压力变化和患者疼痛反应，记录注射压力和诱发疼痛情况。结果：69例患者156个“黑椎间盘”均完成在压力控制下的造影，同时对73个MRI信号正常的椎间盘造影作为对照。在不设定注射压力限制值情况下，58例（84．06％）共131个（83．97％）“黑椎间盘”造影时出现与平时一致性疼痛，22个出现非一致性疼痛，3个未出现疼痛；4个正常椎间盘出现疼痛。当注射压力≤30psi时，46例（66，67％）共105个（67．31％）“黑椎间盘”有一致性疼痛，未出现非一致疼痛和正常椎间盘疼痛。结论：椎间盘造影是诊断慢性腰痛患者椎间盘源性疼痛的有效方法，但应在较低压下注射和判断阳性结果。
Objective ：To assess the clinical value of pressure-controlled discography as diagnostic procedure of diseogenic pain in patients with chronic low back pain.Method：From March 2007 to May 2008, 156 discs in 69 patients with chronic low back pain that showed black disc on MRI underwent pressure-controlled discography,there were 26 males and 43 females with an average age of 39.7 years （range,from 29 to 48 years）,the duration of chronic low back pain was 36.1 months （range,6-120 months）.The puncture was applied to the discs through anterolateral approach by a 22-gauge needle which was linked with pressure monplitor when it reached the center of disc.The pressure variation and patient＇s pain response were observed while contrast medium was injected manually into the disc.Injection pressure,provocative pain were recorded and analyzed.Result：156 black discs of 69 patients with chronic low back pain underwent pressure-controlled discography,meanwhile,73 adjacent discs with normal MRI appearance received discography as control group. Regardless of pressure limitation,pain induced in 58 patients（84.06%） with 131 black discs（83.97%） was concordant to what used to be.22 black discs had discordant pain and 4 control discs had pain.When injection pressure was lower than 30psi,46 patients（66.67%） with 105 black discs（67.31%） had concordant pain. There were no discordant pain in black discs and no pain in control discs.Conclusion：Discography is an effective diagnostic method to determine the discogenic pain in the patients with chronic low back pain.However,the positive results should be judged at lower pressure discography.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2009年第6期408-411,共4页
Chinese Journal of Spine and Spinal Cord
