伴终板改变的腰椎间盘突出症的手术方式选择  

Selection of surgical methods for lumbar disc herniation with degenerative endplates changes

作　　者：杨耀琦[1] 曹鹏[1] 潘玉涛[2] 梁裕[1] 龚耀成[1] 郑涛[1] 张兴凯[1] 吴文坚[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院骨科上海市伤骨科研究所,200025 [2]上海同济大学附属东方医院急诊科

出　　处：《中华医学杂志》2009年第27期1902-1906,共5页National Medical Journal of China

摘　　要：目的分析并判断伴腰椎退行性终板Modic变化并以腰腿痛为主诉的腰椎间盘突出症的术式选择及其疗效差异。方法回顾性地分析了自2005年1月至2008年1月采用单纯髓核摘除术或减压伴椎间融合术治疗的30例伴有腰椎退行性终板Modic变化的单节段腰椎间盘突出症患者。男18例，女12例，平均年龄38．5岁（26～53岁），平均随访1年9个月（4—3年4个月）。结果单纯髓核摘除术组共15例，术前和最后随访时的JOA、下腰痛及下肢根性痛的VAS的平均值分别为13．2（5—17）、6．8（4～10）、4．8（1～8）和19．8（14—24）、4．8（2—10）、1．2（0～6）；手术前后JOA评分的平均改善率为41．9％；手术前后下肢根性痛的VAS平均差值为3．7；术后有5例患者的下腰痛加剧。ModicⅠ、Ⅱ和I／U混和型分别占5、9、1例。减压伴椎间融合术组共15例，术前和最后随访时的JOA、下腰痛及下肢根性痛的VAS的平均值分别为12．9（5～17）、7．0（4～10）、4．9（1～8）和22．6（19～28）、2．8（2～8）、1．3（0～6）；手术前后JOA评分的平均改善率为63．4％；手术前后下腰痛及下肢根性痛的VAS平均差值分别为4．3和3．6。ModicⅠ、Ⅱ和Ⅰ／Ⅱ混和型分别占6、8、1例。减压伴椎问融合术组在术后的下腰痛VAS和日本骨科学会下腰痛JOA评分及其改善率上优于单纯髓核摘除术组。结论对于伴有腰椎退行性终板Modic变化且以下肢根性痛和下腰痛为共同主诉的腰椎间盘突出症患者，如果术前下腰痛的程度大于下肢根性痛，采用单纯髓核摘除术或减压伴椎间融合术尽管均能显著地改善下肢根性痛，但前者在改善下腰痛及功能评分上不及后者，因此采用腰椎减压伴融合术是较佳的选择。Objective To analyze the selection of surgical methods for lumbar disc herniation with low back and leg pain and degenerative lumbar Modie endplate changes and their different postoperative therapeutic effects. Methods All 30 cases of single segment lumbar disc herniation accompanied by Modic endplate changes operated at our hospital using simple discectomy or decompressions with interbody fusion from January 2005 to January 2008 were retrospectively identified. There were 18 males and 12 females with an average age of 38.5 years old （26 - 53 years old） and an average follow-up of 21 months （4 - 40 months）. Results Discectomy alone group included 15 cases. The average score of Japanese Orthopedics Association （JOA） and visual analysis scale （VAS） of low back pain and lower extremity radicular pain at the preoperative and final follow-up time was 13.2 （5 - 17 ）, 6. 8 （4 - 10）, 4. 8 （ 1 - 8） and 19. 8 （ 14 - 24）, 4. 8（2 - 10）, 1.2 （0 - 6） respectively. The average improvement rate of JOA was 41.9%. The difference of VAS of lower extremity radicular pain between pre and post-operation was 3.7 on average. Among these 15 cases, Modic Ⅰ , Ⅱ and Ⅰ / Ⅱ mixed-type was 5, 9, and 1 respectively. Decompression with interbody fusion group included 15 cases. VAS of low back pain and lower extremity radicular pain at the preoperative and final follow-up time was 12. 9 （ 5 - 17 ）, 7.0 （4 - 10 ） ,4. 9 （ 1 - 8 ） and 22. 6 （ 19 - 28 ）,2. 8 （ 2 - 8 ） and 1.3 （ 0 - 6 ） respectively. The average improvement rate of JOA was 63.4%. The differences of VAS of lower extremity radicular pain and low back pain between pre and post-operation were 4. 3 and 3.6 on average respectively. Among these cases, Modic Ⅰ ,Ⅱ and Ⅰ / Ⅱ mixed-type was 6, 8, and 1 respectively. Comparing the VAS of low back pain, JOA average score and the improvement rate of JOA score of two groups at pre-operation and post-operation, statistical analysis showed that decompression with interbody

关 键 词：椎间盘移位 椎间盘切除术 腰椎 

分 类 号：R686[医药卫生—骨科学]