中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (39): 7366-7370.doi: 10.3969/j.issn.1673-8225.2011.39.037

• 骨与关节综述 bone and joint review • 上一篇    下一篇

椎间盘源性下腰痛的组织病理学变化

郭团茂,陈忠宁,王忠贵   

  1. 咸阳市中心医院骨二科,陕西省咸阳市   712000
  • 收稿日期:2011-05-13 修回日期:2011-07-22 出版日期:2011-09-24
  • 作者简介:郭团茂☆,男,1975年生,陕西省西安市人,汉族,2011年西安交通大学毕业,博士,主治医师,主要从事椎间盘退变性疾病的研究。 gtm0619@163.com

Histopathological changes of discogenic low back pain

Guo Tuan-mao, Chen Zhong-ning, Wang Zhong-gui   

  1. Second Department of Orthopedics, Xianyang Central Hospital, Xianyang  712000, Shaanxi Province, China
  • Received:2011-05-13 Revised:2011-07-22 Online:2011-09-24
  • About author:Guo Tuan-mao☆, Ph.D., Attending physician, Second Department of Orthopedics, Xianyang Central Hospital, Xianyang 712000, Shaanxi Province, China gtm0619@163.com

摘要:

背景:椎间盘源性下腰痛是一种椎间盘外周部基本保持完整,而内部各种病理(退变、终板损伤、炎症等)刺激椎间盘内疼痛感受器引起的功能丧失性下腰痛,并且不伴有根性症状,无神经或节段过度活动的放射学证据。
目的:综述了椎间盘源性下腰痛病理变化、临床诊断的特异性、敏感性和安全性以及各种诊断方法存在的争议观点。
方法:应用计算机检索中国期刊全文数据库、PubMed 数据库、EMBASE数据库1970/2010 有关椎间盘源性下腰痛诊断的文献,排除重复性研究。
结果与结论:共保留42篇文献归纳总结。目前临床上根据椎间盘源性下腰痛的病理变化有多种诊断方法,包括物理检查的中心化趋势和骨震动测试,MRI上的黑间盘、高密度区、Modic 改变,椎间盘超声检查,血清学中的高敏感性C-反应蛋白和椎间盘造影。其中腰椎间盘造影有较高的敏感性和特异性,是目前首选的诊断方法。

关键词: 椎间盘源性下腰疼, 临床诊断, 敏感性, 特异性, MRI

Abstract:

BACKGROUND: Discogenic low back pain is a loss of lower back function with pain. While the external outline of the disc remains intact, and multiple processes (degeneration, end plate injury, inflammation, etc.) can internally stimulate pain receptors inside the disc without nerve root symptoms. Additionally, there is no root symptom, and no radiological evidence of segmental activities.
OBJECTIVE: To overview the pathology, clinical diagnostic specificity, sensitivity and security and controversial point of diagnostic methods on discogenic low back pain.
METHODS: The first author searched literatures related to the diagnosis of discogenic low back pain from CNKI, PubMed and EMBASE databases from 1970 to 2010. Repetitive articles were excluded,
RESULTS AND CONCLUSION: Totally 42 papers were selected. At present, there are several clinical diagnostic methods of discogenic low back pain according to the pathological changes, including centralization phenomenon and bony vibration test in physical examinations, the “dark” discs, high-density zones and Modic changes on MRI, discography disc ultrasound examination,   and the high-sensitivity C-reactive protein in serology. Lumbar discography which has high sensitivity and specificity is the preferred diagnostic method.

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