摘要目的 分析腰椎间盘源性疼痛的症状及其神经解剖学机制,探讨腰椎间盘源性疼痛症状学诊断的理论依据.方法 2010年1月至2013年12月收治椎间盘源性腰痛患者289例,根据MRI为单节段椎间盘病变的164例纳入研究,男99例,女65例;年龄19～60岁,平均42岁.对所有患者行腰椎间盘造影,术前记录有无符合腰椎间盘神经传入理论的各种症状,即腰部弥散痛、髂后痛、髋外侧痛、腹股沟区痛和下腹痛,术后统计椎间盘造影阳性者各症状的发生率、有症状者椎间盘造影的阳性率(相当于根据该症状诊断椎间盘源性腰痛的灵敏度)、无症状者椎间盘造影的阴性率(相当于该症状诊断椎间盘源性腰痛的特异度).结果 164例中椎间盘造影阳性者129例(78.7％).造影阳性者中腰部弥散痛者95例(73.6％)、髂后痛者99例(76.7％)、髋外侧痛者58例(45.0％)、腹股沟区痛者29例(22.3％)、下腹痛者24例(18.6％).有腰部弥散痛、髂后痛、髋外侧痛、腹股沟区痛及下腹痛症状者椎间盘造影阳性率分别为89.6％、90.8％、90.6％、90.6％及92.3％,即腰部弥散痛、髂后痛、髋外侧痛、腹股沟区痛、腹股沟区痛各症状诊断椎间盘源性疼痛的灵敏度分别为89.6％、90.8％、90.6％、90.6％和92.3％.结论 腰部弥散痛、髂后痛、髋外侧痛、腹股沟区痛和下腹痛等症状出现于腰椎间盘源性疼痛中符合腰椎间盘神经解剖原理,因而在腰椎间盘源性疼痛诊断中具有很高的诊断价值.

abstractsObjective To analyse the symptoms in discogenic low back pain and their neurological anatomic mechanism,and to explore the theoretical basis of symptomatic diagnosis of discogenic low back pain.Methods From January 2010 to December 2013, 289 patients were primarily diagnosed as discogenic discogenic low pain in our department, of which 164 patients showing only single abnormal segment on MRI were enrolled, including 99 male and 65 female patients, averaging 42 years old.All patients underwent discography.All the symptoms conform to the neurological anatomic mechanism of lumbar disc, i.e.extensive low back pain, posterior ilium pain, lateral thigh pain, groin pain, low abdomen pain, were recorded postoperatively.Then the occurrence rate of each symptom with positive discography was calculated.The positive rate (equal to sensitivity of the symptom to the diagnosis of discogenic low pain) of discography when each symptom occurred and the negative rate (equal to specificity of the diagnosis of the symptom to the discogenic low pain) of discography when each symptom did not occur were calculated respectively.Results The discographies of 129 (78.7％) in 164 patients were positive, of these patients 95 (73.6％) had the symptom of extensive low back pain, 99 (76.7％) had posterior ilium pain, 58 (45.0％) had lateral thigh pain, 29 (22.3％) had groin pain, and 24(18.6％) had low abdomen pain.The positive rate of discography in those with the symptom of extensive low back pain, posterior ilium pain, lateral thigh pain, groin pain and low abdomen pain was 89.6％, 90.8％, 90.6％, 90.6％ and 92.3％ respectively, i.e.the diagnostic sensitivity to the discogenic low back pain of the symptom of extensive low back pain, posterior ilium pain, lateral thigh pain, groin pain and low abdomen pain was 89.6％, 90.8％, 90.6％, 90.6％ and 92.3％ respectively.Conclusion The occurrence of the above-mentioned symptoms in the discogenic low back pain is conform to the neurological anatomic mechanism of efferent nerve of lumbar disc.These symptoms have great diagnostic significance for discogenic low back pain.