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腰椎间盘高信号区(HIZ)的发生率与腰椎间盘源性疼痛的关系
The relationship between the incidence of high intensity zone(HIZ) and discogenic low back pain.
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DOI:
作者:
张海林,马辉,张弛,陆洋阳,李波,叶斌,付强
MA Hui, ZHANG Chi, LU Yangyang, LI Bo, YE Bin,FU Qiang.
作者单位:
上海市第一康复医院(上海市杨浦区老年医院) 第二军医大学附属长海医院骨科(付强)
Department of Orthopaedic Surgery and Pain rehabilitation, Shanghai First Rehabilitation Hospital, No. 349 Hangzhou Road, Yangpu District, Shanghai 200090, People's Republic of China
关键词:
腰椎间盘源性疼痛 ;磁共振成像;高信号区
Lumbar discogenic pain; Magnetic resonance imaging ;High intensity zone
摘要:
目的 研究腰椎核磁共振(MRI)检查中腰椎间盘高信号区(HIZ)的发生率与腰椎间盘源性疼痛的关系,并探讨HIZ在诊断腰椎间盘源性疼痛中的作用。方法 回顾性研究2009年3月至2013年5月在我院和长海医院收治的下腰痛且行腰椎间盘造影术的病人54例,其中36例的腰椎磁共振含有所有HIZ,入选病人均无典型的神经根性症状和体征,否认外伤史,CT扫描无腰椎间盘突出,经各种非手术方法治疗无效,症状持续大于6个月。所有病人均于腰椎间盘造影术前2个月内进行腰椎MRI检查,其中男性21例,女性15例,年龄,21~62岁,平均45.9岁。根据临床症状和MRI检查结果,选择2-3个椎间盘进行造影,其中必须选择一个正常椎间盘作为对照。病人采用俯卧位,局部麻醉,造影剂为碘海醇。疼痛复制判断标准,在推注造影剂时,如诱发疼痛与平时的腰痛的部位、程度相似,为椎间盘造影阳性,否则为阴性。所有病人于腰椎间盘造影术后常规行CT扫描,并应用CT椎间盘造影分级方法评估纤维环撕裂程度。通过上述结果分析腰椎间盘MRI高信号区与腰椎间盘造影诱发的下腰痛之间的关系。结果 在含有HIZ的36例83个椎间盘造影术中,共有27例39个椎间盘呈现疼痛复制反应。且这27个含有HIZ的椎间盘在椎间盘造影过程中全部呈现2~3级的纤维环破裂。 结论 腰椎间盘高信号区(HIZ)是引起腰椎间盘源性疼痛的重要因素之一,如果病人腰椎某节段椎间盘MRI上存在高信号区,那么可以认为该节段是产生腰痛的责任椎间盘。
Objective:To study the lumbar magnetic resonance (MRI) examination of the relationship between lumbar disc high intensity zone (HIZ) and the incidence of lumbar discogenic pain and to explore the role of HIZ in the diagnosis of lumbar discogenic pain.Method:A retrospective study of low back pain from March 2009 to May 2013 in our hospital and lumbar discography of 54 patients, including 36 cases of lumbar magnetic resonance containing all HIZ, enrolled patients had no typical signs and symptoms of nerve root , denied a history of trauma, CT scan without lumbar disc herniation, through a variety of non-surgical method of therapy, symptoms last more than six months.All patients underwent MRI of the lumbar spine in the lumbar disc before angiography two months, including 21 males and 15 females, age 21 to 62 years old, average 45.9 years old.Based on clinical symptoms and MRI results, choose 2-3 intervertebral angiography, which must choose a normal disc as controls. Patient in the prone position, a local anesthetic, the contrast agent is iohexol.Pain replication criterion, the bolus of contrast agent, such as low back pain induced pain and the usual location, the degree of similarity for discography positive, otherwise negative. All patients underwent CT scans conventional angiography in lumbar disc surgery, and apply CT discography grading methods to assess the extent of the annulus tear.Analyze the relationship between lumbar disc lumbar MRI high signal areas and discography between low back pain induced by the above results.Result: Line of 83 lumbar disc discography in 36 patients, a total of 39 disc in 27 patients replication reaction showed pain, which 27 patients showed 2 to 3 annulus rupture in the course of the entire discography. Conclusion:If there is no disc in the lower back pain patients in the presence of a high signal area on lumbar MRI, may indicate that the rupture disc is to produce low back pain disc.
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