發(fā)布時(shí)間：2018-04-22 22:08

  本文選題：盤源性下腰痛 + 磁共振��； 參考：《浙江大學(xué)》2014年碩士論文

【摘要】：研究背景： 下腰痛是初級保健醫(yī)生遇到的一種常見臨床癥狀,它的一個(gè)顯著特征是由椎間盤源性疼痛引起的,也有人稱之為椎間盤內(nèi)破裂(internal disc disruption, IDD)。 Crock[2]是這樣定義IDD的：椎間盤內(nèi)部結(jié)構(gòu)髓核的紊亂和纖維環(huán)出現(xiàn)裂隙,并特別排除了椎間盤膨出、突出以及椎間盤疝。作為一種疼痛激發(fā)試驗(yàn),椎間盤造影誘發(fā)的一致性疼痛是唯一能直接判斷患者影像學(xué)改變與疼痛相關(guān)性的方法,從試驗(yàn)的角度看,椎間盤造影是評價(jià)下腰痛的最佳方法。但是,由于其存在有創(chuàng)性、侵入性、X線輻射、椎間盤感染等風(fēng)險(xiǎn),該項(xiàng)技術(shù)從推出開始就存在各種爭論。盡管磁共振影像(magnetic resonance imaging, MRI)能確定退變的椎間盤水平,而且在判斷椎間盤退變的形態(tài)學(xué)改變方面具有較高的準(zhǔn)確性,但是它在確定責(zé)任椎間盤方面并不可靠。一些早期的研究嘗試找出椎間盤退變MRI特征性改變與椎間盤造影復(fù)制疼痛的相關(guān)性,但是結(jié)果存在有爭議。因此,本研究試圖通過CT引導(dǎo)下椎間盤造影(computed tomography discography, CTD)過程中誘發(fā)疼痛的反應(yīng),研究椎間盤源性腰痛是否與椎間盤造影結(jié)果、MRI的影像學(xué)結(jié)果具有相關(guān)性。MRI的結(jié)果包括椎間盤退變(Pearce分級)、椎間盤后方的弧形高信號區(qū)(highintensityzone, HIZ)、軟骨終板及終板下骨髓信號異常(modic變性)等。 目的： 基于CT腰椎間盤造影術(shù)(CTD)誘發(fā)的一致性疼痛,研究盤源性下腰痛(discogenic low back pain, DLBP)與MRI改變的相關(guān)性。 方法： 收集2009年12月至2012年12月間76例下腰痛患者,其中男性52例,女性24例,年齡18-67歲,平均39.3±3.8歲,所有患者在腰椎磁共振檢查后行CT腰椎間盤造影來評價(jià)下腰痛。MRI主要評價(jià)椎間盤的退變(Pearce分級)、HIZ、軟骨終板的modic變性。在椎間盤造影過程中,誘發(fā)一致性疼痛的椎間盤記錄為陽性,反之,誘發(fā)不一致的疼痛或者不痛的椎間盤記錄為陰性。76例下腰痛患者共計(jì)完成209個(gè)椎間盤造影,分析CTD分型、對比劑注射劑量、誘發(fā)的一致性疼痛與MRI表現(xiàn)的相關(guān)性,MR和椎間盤造影與誘發(fā)一致性疼痛的結(jié)果采用X2檢驗(yàn),對比劑注射劑量與誘發(fā)一致性疼痛的結(jié)果采用t檢驗(yàn)。 結(jié)果： 在完成CTD檢查的209個(gè)椎間盤中,83個(gè)誘發(fā)一致性疼痛,其它椎間盤誘發(fā)不一致疼痛或者不痛。CTDⅢ型椎間盤有36個(gè),其中7個(gè)椎間盤誘發(fā)一致性疼痛；CTDⅡ型椎間盤有58個(gè),46個(gè)椎間盤誘發(fā)一致性疼痛；CTDⅣ型椎間盤有26個(gè)23個(gè)椎間盤誘發(fā)一致性疼痛。CTD分型與誘發(fā)一致性疼痛有明顯的相關(guān)性,CTDⅢ型與CTDⅡ型比較(χ2=9.98,P0.01, r=0.57),與CTDⅣ型比較(X2=25.38,P0.01,r=0.62)。陽性和陰性椎間盤對比劑注射劑量有顯著的差異(t=6.61,P0.01)。 椎間盤的MRI影像結(jié)果與造影誘發(fā)的一致性疼痛有顯著的相關(guān)性。125個(gè)椎間盤在MRI上表現(xiàn)為Pearce Ⅰ-Ⅲ級,其中16椎間盤誘發(fā)一致性疼痛；84個(gè)椎間盤在MRI上表現(xiàn)為PearceⅣ-Ⅴ級,有67個(gè)椎間盤誘發(fā)一致性疼痛。有39椎間盤相鄰終板發(fā)生Modic變性,其中32個(gè)椎間盤誘發(fā)一致性疼痛。48個(gè)椎間盤纖維環(huán)后緣發(fā)現(xiàn)HIZ,其中41個(gè)椎間盤誘發(fā)一致性疼痛。造影誘發(fā)一致性疼痛與MRI上椎間盤改變有明顯的相關(guān)性,Ⅳ-Ⅴ級退變(χ2=94.09, P0.01, r=0.67), HIZ (χ2=39.93, P0.01, r=0.43),終板Modic變性(χ2=28.93, P0.01, r=0.37) 結(jié)論： CT腰椎間盤造影術(shù)能定性診斷腰椎間盤內(nèi)破裂,并進(jìn)一步確定責(zé)任椎間盤。盤源性下腰痛患者的病因可能與CTDⅡ型和CTDIV型椎間盤破裂,MRI上PearceIV-V級椎間盤退變、HIZ出現(xiàn)以及鄰近終板發(fā)生Modic變性有關(guān)。
[Abstract]:Research background:
Low back pain is a common clinical symptom encountered by a primary health care doctor. A significant feature of it is caused by intervertebral disc origin pain and internal disc disruption (IDD). Crock[2] is the definition of IDD: the disorder of the nucleus of the intervertebral disc and the crevice of the fibrous ring, and special exclusion. In addition to intervertebral disc swelling, herniation and intervertebral herniation. As a pain stimulation test, conformance pain induced by discography is the only way to directly determine the correlation between image changes and pain. From an experimental point of view, discography is the best way to evaluate low back pain. However, it is invasive and invasive. There are various controversies on the risk of sex, X-ray radiation, intervertebral disc infection and so on. Although magnetic resonance imaging (MRI) can determine the level of degenerative intervertebral disc and have high accuracy in judging the morphological changes of disc degeneration, it is in the determination of the responsible intervertebral disc. Unreliable. Some early studies have tried to identify the correlation between MRI characteristic changes in intervertebral disc degeneration and disc contrast replication pain, but the results are controversial. Therefore, this study attempted to study the pain induced by the CT guided computed tomography discography (CTD) and the study of discogenic low back pain. Whether or not with the results of disc angiography, the results of MRI's imaging findings were associated with.MRI, including disc degeneration (Pearce classification), the arc high signal area (highintensityzone, HIZ) behind the disc, and cartilage endplate and abnormality of bone marrow signal (Modic denaturation) at the end of the end of the plate.
Objective:
Based on the consistency pain induced by CT lumbar discography (CTD), the correlation between discogenic low back pain (DLBP) and MRI changes was studied.
Method錛，

本文編號：1789142