China J Orthop TraumaDec.2013Vol.26No.12 LIDH [2] 1. 1 ( ) 1. 3 ( ) ( ) ( ) 1965 Armstrong ( ) 3 3 LIDH ( ) LIDH [5-7] LIDH LIDH (

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1 China J Orthop TraumaDec.2013Vol.26No ( ) 腰椎间盘突出症临床症状与体征复杂多变腰腿痛是其最具特征性的临床症状表现在疼痛的部位 ( 范围或区域 ) 强度性质演变情况影响因素与伴随症状等具有一定的特点与规律临床上可将其总结归纳为皮节痛运动痛动态变化痛和病变节段椎旁深压痛这些疼痛特点与规律成为该病临床诊断的主要依据也是该文从痛论诊的核心内容腰椎 ; 椎间盘移位 ; 腰腿痛 ; 诊断 DOI: / j.issn Clinical significance of specific lumbocrural pain for the diagnosis of lumbar intervertebral disc herniation HUANG Shi rongshi Yin yuzhan Hong sheng. Department of Orthopaedics & TraumatologyShuguang Hospital Affiliated to Shanghai University of Traditional Chinese MedicineInstitute of Orthopaedics & Traumatology Affiliated to Shanghai Academy of Traditional Chinese MedicineShanghai China ABSTRACT Lumbar intervertebral disc herniation clinical symptoms and signs are very complicated lumbocrural pain is the most characteristic clinical symptomsand show the site (range or area)intensitynatureevolutioninfluence factors and adjoint symptoms and so on has certain characteristics and rules. Among them the dermatomal painkinesthetic dysesthesia dynamic changing pain and lesions segment vertebral side deep tenderness are the most impotent characteristics and rules of painthereforecan be regarded as the main basis of clinical diagnosis of the diseaseand also the core content of this article. KEYWORDS Lumbar vertebrae; Intervertebral disk displacement; Lumbago leg pain; Diagnosis Zhongguo Gu Shang / China J Orthop Trauma201326(12): (lumbar intervertebral disc herniationlidh) LIDH 1 LIDH [1] [1-2] ( ) ( [3-4] ) : ( :ZYSNXD-CC-HPGC- JD-001); ( :100508); ( :041); ( : 09dZ ); ( : ); ( :PW2010D-7) Fund program:supported by the Research Base for the School of Shanghai style TCM Inheritance(No. ZYSNXD-CC-HPGC-JD- 001) : E mail:huangshirong3268@ sina. com

2 China J Orthop TraumaDec.2013Vol.26No.12 LIDH [2] 1. 1 ( ) 1. 3 ( ) ( ) ( ) 1965 Armstrong ( ) 3 3 LIDH ( ) LIDH [5-7] LIDH LIDH ( ( ) - ) ( LIDH ) ( ) LIDH (superficial pain) ; 1. 2 (sharp pain) (burning pain) (aching pain) LIDH [8] (etiological diagnosis) (pathological diagnosis) ( ) 1. 4 ; (lumbar back myofascitis) ; ; LIDH : ; ;LIDH ( )

3 China J Orthop TraumaDec.2013Vol.26No [15] 1. 5 [9] [16] LIDH LIDH 95% LIDH L 5 S 1 20~50 <19 [17] ;>60 (0.98) (0.88) [18] LIDH LIDH ( ) [10-11] ; [12] LIDH (pain diagram) LIDH [13] [19] [14] 2 LIDH L 5 S 1 L 45 L 34 75% 63% 71.4% [20] ; [21] LIDH [22] [23] [24] LIDH (dermatomal pain) (kinesthetic dysesthesia) (dynamic changing pain) 2. 2 LIDH LIDH (neuralgia) (kinesthetic dysesthesia) (lumbar back myofascitis) (proliferative spinal inflammation) (ankylosing spondylitis) 2. 1 (morning stiffness) (isometric dysesthesia) LIDH ( ) :1 ( ) 2 LIDH LIDH

4 China J Orthop TraumaDec.2013Vol.26No.12 LIDH 1 ; 3 LIDH (52.15%) (27.27%) [25] (19.13%) [14] [26-27] 4 ( LIDH ) ; [28] LIDH LIDH 3 ( 80% ) 10% [9] ( ) 95% LIDH ( ) LIDH ( ) ( ) LIDH ( ) LIDH LIDH ( ) - [27] ( ) ( )

5 China J Orthop TraumaDec.2013Vol.26No [31] ; [15] LIDH LIDH ( L % [29] ) 21.6% 55.1%(n=165) [32] X LIDH ( ) LIDH [23] ( ) LIDH 4 LIDH LIDH LIDH LIDH [33] [34] ; [1] ; (program diagnosis) ; ; ( ) ( ) 4 LIDH [834-35] [36] 5 LIDH (trigger points) (tender points) [30] ( ) -

6 China J Orthop TraumaDec.2013Vol.26No.12 [36] nese. [9].. :. [M]. 2. : 2005: LIDH Zhou BWZhang P. Epidemiological of low back pain. In:Zhou BW. Low Back Pain[M]. 2nd Edition. Beijing:People's Medical Publishing House2005: Chinese. LIDH [10] ( (9): Xu GDWang ZHLuo XH. Diagnosis and treatment of lumbar intervertebral disc herniation in the adolescents[j]. Zhongguo Gu Yu Guan Jie Sun Shang Za Zhi200924(9): Chinese. [1] ( ): [J] (2): Huang SRShi YYZhan HS. Individual stratification diagnosis of lumbar intervetebral disc herniation[j]. Zhongguo Gu Shang / China J Orthop Trauma201225(2): Chinese with abstract in English. [12] Huang SRShi YY. Curing of a child lumbar intervertebral disc herniation by single poin telectro acupuncture therapy:a case report[j]. Zhongguo Gu Shang / China J Orthop Trauma (Suppl): Chinese.. [J]. [2]. [J] (9): (3): Huang SRShi YYZhan HS. Diagnostic ideas and programs of lumbar intervetebral disc herniation[j]. Zhongguo Gu Shang / China J Orthop Trauma201225(3): Chinese with abstract in English.. )[J]. [11]. 1 Zhang SMJiang WZZhou Wet al. Intervertebral lumbar disc herniation of senile person[j]. Zhongguo Gu Shang / China J Orthop Trauma200013(9): Chinese with abstract in English.. [13]. 500 [J] (4): [3]. [J]. Zhu XFLu JH. Disease factor analysis for 500 patients with lumbar (10): Huang SRShi YYZhan HS. Treating lumbar intervetebral disc herniation from pain[j]. Zhongguo Zhong Yi Gu Shang Ke Za Zhi (10): Chinese. [14] intervertebral disc herniation [J]. Zhe Jiang Lin Chuang Yi Xue (4): Chinese.. [M]. 3. : 2004: [4]. Hu YG. Lumbar Intervertebral Disc Herniation[M]. 3rd Edition. [J] (18): Huang SR. Standardization and individualized non operative therapy of lumbar intervetebral disc herniation[j]. Dang Dai Yi Xue (18): Chinese. [15] Beijing:People's Medical Publishing House2004: Chinese (5): [5]. Huang SR. Differential diagnosis in atypical lumbar intervertebral 19992(4): Dai LY. Diagnosis and differential diagnosis of sciatica[j]. Lin Chuang Gu Ke Za Zhi19992(4): Chinese. [16] disc herniation [J]. Dang Dai Yi Xue (5): Chinese... :. [6] (5): Qu SY. Etiological diagnosis of sciatica[j]. Zhongguo Liao Yang Yi Xue19987(5): Chinese. [M]. : 2002: Wang JZSun YP. Neuropathic pain. In:Wang JZ. Neurology Nervous System Clinical Diagnostics [M]. Beijing:People's Military Medical University Press2002: Chinese. [7]. [17] Deyo RARainville JKent DL. What can the history and physical [J] (4): Niu GYZhang XG. Causes analysing for the cases with lumbocrural pain for primary symptom misdiagnosed as lumbar intervetebral disc herniation[j]. Gan Su Zhong Yi Xue Yuan Xue Bao200926(4): Chinese. [18] examination tell us about low back pain[j]. JAMA (6): John AMDerek SBradley KWeiner.. : Tollsion CDJohn R SJoseph WT.. [M]. : 2004: [8].. :. John AMDerek SBradley KW.Differential diagnosis of lumbocrural pain. In:Tollsion CDJohn RSJoseph WTeditor. Song [M]. : 2010: Zhao XLFu ZJ. Diagnosis of neuropathic pain. In:Huang YGXu JG. Neuropathic Pain from Basic Research to Clinical Practice [M]. Beijing:People s Medical Publishing House2010: Chi- [19] WGFu ZJtranslator. Practical Pain Management [M]. Jinan: Sandong Science and Technology Publishing House2004: Chinese. Vucetic NM 覿覿 tt 覿 nen HSvensson O. Pain and pathology in lumbar disc hernia[j]. Clin Orthop1995(320):65-72.

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