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目的探讨临床确诊为腰椎间盘突出症患者的影像学改变与临床症状是否有一定相关性,以及对临床诊断和治疗的指导意义。方法以影像学技术CT扫描检查145例临床确诊为腰椎间盘突出症患者的腰椎(L3～4、L4～5、L5～S1),并根据影像学提示,将腰椎间盘突出分为<0.5cm和>0.5cm两组。分别以视觉模拟评分法(VAS)和腰及下肢压痛点的计数率检查评估疼痛的程度以及与上述影像学改变的相关性。结果145例患者影像学检查均有改变。其中未见明显突出仅提示退行性病变者9例,仅L4～5椎间盘突出56例;仅L5～S1椎间盘突出67例;L4～5,L5～S12节椎间盘同时突出(包括膨出)者11例;L3～4,L4～5,L5～S13节椎间盘突出(包括膨出)者2例。突出伴椎体滑脱14例;突出伴退行性病变89例。突出程度<0.5cm55例,>0.5cm81例。VAS评估椎间盘突出<0.5cm和>0.5cm两组的平均积分无明显差异(χ2=0.12,P>0.05);两组压痛点的计数与椎间盘突出的程度也不成正比(χ2=1.31,P>0.05)。结论临床诊断腰椎间盘突出症与影像学诊断的腰椎间盘突出不能完全等同。影像学检查的阳性结论只有与临床所见相吻合时,才有诊断价值。
Objective To investigate whether there is some correlation between the imaging changes and clinical symptoms in patients with clinically diagnosed lumbar disc herniation, and to guide the clinical diagnosis and treatment. Methods The lumbar spine (L3 ~ 4, L4 ~ 5, L5 ~ S1) of 145 clinically diagnosed patients with lumbar disc herniation were examined by imaging technique. According to the imaging findings, the lumbar disc herniation was divided into <0.5cm and > 0.5cm two groups. Visual acuity score (VAS) and count rate of tenderness of lower extremity and leg were used to evaluate the degree of pain and the correlation with the above imaging changes. Results The imaging examination of 145 patients changed. There were no obvious prominence of degenerative lesions in 9 cases, only L4 ~ 5 disc herniation in 56 cases; only L5 ~ S1 disc herniation in 67 cases; L4 ~ 5, L5 ~ S12 disc herniation at the same time Cases; L3 ~ 4, L4 ~ 5, L5 ~ S13 section disc herniation (including bulging) in 2 cases. Prominent with spondylolisthesis in 14 cases; prominent with degenerative lesions in 89 cases. Outstanding degree <0.5cm55 cases,> 0.5cm81 cases. VAS evaluation of disc herniation <0.5cm and> 0.5cm in the two groups had no significant difference (χ2 = 0.12, P> 0.05); count of tenderness point and the extent of disc herniation are not proportional (χ2 = 1.31, P> 0.05). Conclusion Clinical diagnosis of lumbar disc herniation and imaging diagnosis of lumbar disc herniation can not be completely identical. The positive findings of imaging examination only with clinical findings consistent with the only diagnostic value.