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椎间盘源性腰痛护理常规
一、椎间盘源性腰痛的概述
椎间盘源性腰痛（lumbar intervertebral discogenic backache）
是指椎间盘病变所致的腰痛，其病因及病理病程主要包括椎间盘破裂、椎
间盘积液、椎间盘退变等。
病症表现为腰背部疼痛、痛引伸至腰部、大腿
后侧、膝关节及脚跟，伴有侧弯、屈腰等反射性活动障碍。
1、预防与教育
（1）宣传正确的生活习惯，如保证充足的睡眠、定期活动锻炼、戒
烟限酒等，以减轻椎间盘源性腰痛发病的危险因素。
（2）学习正确的体位姿势和活动方法，及时调整不良姿势，加强身
体的活动训练，增强腰腹部的力量，注意避免单一体位作业或坐姿作业，
尽量减少腰部的负荷。
（3）加强饮食管理。
多加食用富含维生素A、C、E、B6、钙、铁等
营养的食物，减少脂肪、膳食纤维及水分的摄入，注意控制体重，加强免
疫力，积极预防腰痛发作。
2、药物治疗
（1）选用复方丹参颗粒、脑淫羊藿、乌鸡白凤丸等中药具有临床疗效，可减轻卒中性腰痛、肌肉拘束及炎性症状，增强机体对疾病的抵抗力。
（2）应用止痛药、抗炎药、肌肉松弛剂等西药。
提要目的:探讨HIZ（high intensity zone）与椎间盘源性下腰痛的相关性。
方法:随机选取30例椎间盘源性下腰痛患者做为实验组，随机选取30例无椎间盘源性下腰痛患者（其中仅有根性症状的腰椎间盘突出症11例，查体10例，腰椎外伤9例）做为对照组，两组患者下腰痛VAS评分均在5～8分之间；所有患者行MRI检查，观察分析两组HIZ的出现率并进行统计学分析。
结果:实验组HIZ的出现率为63.33%，对照组为16.67%，经统计学分析两组HIZ的出现率有非常显著性差异（P<0.01）。
结论:HIZ与椎间盘源性下腰痛存在明显的正相关，可以做为椎间盘源性下腰痛诊断的重要依据。
关键词椎间盘源性下腰痛；高信号区；磁共振The research of the relationship between high intensity zone anddiscogenic low back painSpecialty: Orthopaedics of TCMAuthor: Zhao XinyouTutor: Dong JianwenAbstractObjective: To research the relationship between high intensity zone and discogenic low back pain. Methods: 30 cases of discogenic low back pain patients were randomly selected as the experimental group, and 30 cases of non-discogenic low back pain patients were randomly selected as the control group (11 cases of only radicular symptoms of lumbar disc herniation, 10 cases of investigation , 9 cases of spinal trauma) .The Visual Analogue Score of two groups was 5～8 points; The lumbar spinal magnetic resonance imaging examinations were taken in the two groups of patients. And the statistical analysis was taken on the HIZ occurrence rate of the two groups. Results: The occurrence rate of HIZ in the experimental group was 63.33%.And it in the control group was 16.67%. By statistical analysis on HIZ occurrence rate of the two groups, it had significant difference in the statistical significance (P<0.01). Conclusions: The HIZ and discogenic low back pain showed direct relationship, and it can be used as a marker for diagnosis of discogenic low back pain.Key words Discogenic low back pain; High intensity zone; Magnetic resonance imaging目录引言 (1)临床研究 (3)一、材料与方法 (3)（一）诊断标准 (3)（二）临床资料 (5)（三）检查方法 (6)（四）观察指标 (6)（五）统计学方法 (6)二、研究结果及分析 (7)（一）两组HIZ的出现数比较（见表4） (7)（二）实验组中男、女性患者HIZ的出现数比较（见表5） (7)（三）HIZ出现位置的比较（见表6） (7)（四）HIZ的节段分布（见表7） (8)（五）HIZ的形态特点（见表8） (8)讨论 (9)一、HIZ的临床发现 (9)二、HIZ的临床意义 (9)三、HIZ的解剖部位和信号特征 (11)四、HIZ的病理特点 (12)结语 (14)参考文献 (15)综述 (17)附录 (34)致谢 (38)引言下腰痛正日益成为严重影响人体健康的一种疾病，60％～80％的成年人均经历过不同程度的下腰痛。
椎间盘源性下腰痛物理治疗研究进展李猛;蒋戈利;石晓明;周金生【期刊名称】《解放军医药杂志》【年(卷),期】2016(000)002【总页数】4页(P28-31)【关键词】椎间盘源性下腰痛;手法治疗;物理治疗【作者】李猛;蒋戈利;石晓明;周金生【作者单位】天津 300319，解放军天津疗养院全军中医针灸康复中心国家中医药管理局颈腰椎脊柱疾病中心;天津 300319，解放军天津疗养院全军中医针灸康复中心国家中医药管理局颈腰椎脊柱疾病中心;天津 300319，解放军天津疗养院全军中医针灸康复中心国家中医药管理局颈腰椎脊柱疾病中心;天津 300319，解放军天津疗养院全军中医针灸康复中心国家中医药管理局颈腰椎脊柱疾病中心【正文语种】中文【中图分类】R681.533.1;R242[作者单位]天津 300319，解放军天津疗养院全军中医针灸康复中心国家中医药管理局颈腰椎脊柱疾病中心[DOI]10.3969/j.issn.2095-140X.2016.02.008椎间盘源性下腰痛(discgenic low back pain, DLBP)是一种常见的慢性腰痛疾病，由于椎间盘内部的物理结构和代谢功能异常所致，不伴神经根性症状或节段间过度活动的影像学表现[1]。
据流行病学调查，DLBP在世界范围内普遍存在[2]，发病率仅次于普通感冒，每个人一生中的某个时期出现腰痛的比率70%～85%，其中约18%的人一直都在遭受腰痛困扰[3]。
同时，90%的急性腰痛发作者采取自然恢复的方式并在1个月内回到工作岗位[4]，7%的急性腰痛逐渐发展成为慢性下腰痛[5]，并引发持续失能3～12个月[6]，每年超过25%的患者都要去医院接受治疗[7]，至今已形成严重的医学和社会经济问题。
因此，其治疗和预防显得尤为重要。
本文将从最常见且患者最易接受的无创物理治疗等方法进行文献综述。
1.1 现代康复手法治疗现代康复手法治疗DLBP，主要以McKenzie治疗理念为主，强调自我运动训练在腰部疾患治疗中的作用及重要性，通过姿势矫正、医疗体操及健康教育为脊柱疾患的康复提供一种全新的诊疗思维和途径。
Many patients with back pain, leg pain, or weakness of the lower extremity muscles arediagnosed with a herniated disc.许多患腰腿疼痛，下肢肌端乏力的病患均为椎间盘突出症。
When a disc herniation occurs, the cushion that sits between the spinal vertebra is pushedoutside its normal position.椎间盘突出发生时，脊柱间的缓冲带将发生侧突。
A hrniated disc would not be a problem if it werent for the spinal nerves that are very close tothe edge of these spinal discs.如果脊神经不是离椎间盘特别近的话，椎间盘突出就不是什么大问题了。
HOW ARE THE SPINE AND ITS DISCS *****D脊柱与椎间盘The vertebras are the bony building blocks of the spine.脊椎是建造脊柱的构件。
Between each of the largest parts (bodies) of the vertebrae are the discs.各椎骨之间为椎间盘。
Ligaments are situated around the spine and discs.脊椎和椎间盘周围散布着韧带。
The spine has seven vertebrae in the neck (cervical vertebrae), 12 vertebrae in the mid-back(thoracic vertebrae) , and five vertebrae in the low back (lumbar vertebrae).颈部有7条椎骨，胸部为12条，腰部有5条。
盘源性下腰痛的鉴别诊断
With so many possible causes of lower back pain, physicians must pinpoint the source(s) of pain to recommend appropriate action or no action. The IDET procedure is not suitable for every form of lower back pain. Chronic discogenic lower back pain unresponsive to aggressive non-operative therapy is the principal indication for the IDET procedure.
IDET不是适合于任何下腰痛患者。
盘源性下腰痛才是IDET的手术指征。
∙Differential diagnosis starts with a detailed history, physical examination and an MRI.
鉴别诊断要从相信的病史、体检及MRI检查开始。
∙Non-musculoskeletal causes of back pain such as tumor, infection, aneurysm and renal and vascular pathology should be considered and ruled out.
排除非肌肉骨骼原因引起的下腰痛，如：肿瘤、感染、动脉瘤、肾脏疾病等，都需要被考虑到并排除。
∙Fractures and ankylosing spondylitis should also be ruled out.
排除骨折及强直性脊柱炎。
∙Discogenic pain should be differentiated from radicular pain, which may also be present.
还需与神经根痛相鉴别。
盘源痛与神经根痛的比较
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∙Pain which is unilateral and predominantly below lumbar vertebra 5 is probably not discogenic. 单侧疼痛而且疼痛点低于腰5的情况下大多不是盘源性的。
∙Diagnostic joint blocks can be used to trace the source of pain, which can be attributed to the sacroiliac joint in about 20% of patients and lumbar zygapophysial joint pain in up to 40% of patients.
压痛点有助于医师发现疼痛的根源，大约20%的病人压痛点在骶髂关节，而40%以上的患者压痛点在腰椎小关节处。
∙Patients with discogenic pain may have no abnormalities visible on the MRI or may have a bright spot in the posterior anulus referred to as the high intensity zone or HIZ. This is best seen on sagittal views and indicates a tear in the disc.
大多数盘源性疼痛患者MRI图像没有明显的异常。
或在纤维环后方有高强度区域。
这种情况在矢状面时比较容易看到。
常表明椎间盘有微小的裂纹。
椎间盘源性痛可以通过椎间盘造影刺激并重建症状。
Discography is a minimally invasive diagnostic procedure performed while the subject is awake. Sedation and analgesia can be provided to minimize discomfort. Contrast medium is injected into the three or four discs under investigation as the source of the low back pain.
椎间盘造影是一种微创的复制患者症状的检查方法。
操作中可适当给以镇静止痛药物以减轻患者不安，将对比造影剂注射入3-4个椎间盘内以确定疼痛源。
∙The injection of fluid into each disc increases the fluid volume and pressure in the disc and may reproduce the subject’s usual pain pattern.
将造影剂注射入每个椎间盘内可以增加椎间盘内液体体积及压力可以重建患者的疼痛症状。
∙ A positive response in one disc confirmed by the absence of a pain response in one or more other adjacent discs confirms the origin of the pain.
椎间盘内注射出现的阳性反应与患者疼痛区域相同可以证实某个椎间盘为症状根源。
∙In addition, the contrast medium allows the morphology of the disc to be visualized fluoroscopically.
另外，造影剂可以通过透视显示椎间盘的形状。
Since provocation discography is minimally invasive and produces some discomfort, it should only be performed when a definitive diagnosis will lead to treatment that would otherwise not be performed.
尽管椎间盘造影是微创过程仅有较少不适，但这一检查方式仅应在为确定诊断或确定手术部位时才能使用。
确定疼痛源
The disc which is the source of the low back pain can be confirmed when:
如下步骤以证实引起下腰痛的椎间盘：
∙The pain elicited is similar to patient’s usual pain pattern.
复制出的症状与患者平时的症状相同或相似。
∙At least one adjacent disc (preferably two) does not reproduce pain. 至少一个相近的椎间盘不能复制出症状。
