椎间盘造影与盘内阻滞术在预测伴终板变化盘源性腰痛手术疗效中的意义  

Retrospective and comparative analysis of therapy for degenerative chronic discogenic low back pain with end plate Modic changes with discography and intradiscal injection blockage

作　　者：孙长惠[1] 郑涛[2] 陈哲[2] 郑月焕[2] 曹鹏[2] 张仲伟[3] 陆炯[1] 邹灵[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院卢湾分院骨科,200020 [2]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 [3]上海交通大学医学院附属瑞金医院放射科

出　　处：《中华医学杂志》2013年第23期1806-1810,共5页National Medical Journal of China

基　　金：上海市科学技术委员会生物医药及临床重大项目基金（10dz1950400）;上海市卫生局优秀学科带头人培养项目（新百人计划）（XBR2011024）;上海市卫生局重点科研基金（2011018）

摘　　要：目的评判术前采用椎问盘造影和盘内介入阻滞术预测腰椎后路椎间融合术治疗伴终板Modic改变的慢性退行性盘源性腰痛效果。方法2004年1月至2010年12月，上海交通大学医学院附属瑞金医院卢湾分院骨科经椎间盘造影术后证实有单节段的退行性慢性盘源性腰痛患者60例，按核磁共振图像上的终板Modic变化分为以ModicⅠ型和以ModicU型变化为主者2种情况，2周后进行责任椎间盘内阻滞术。择期对上述患者进行腰椎后路椎间融合术。患者共分为4组，每组均为15例：A组（椎间盘造影术阳性组±责任椎问盘内阻滞术阴性组），进一步分为：A1组（以ModicⅠ型变化为主者）和A2组（以ModicⅡ型变化为主者）。B组（椎间盘造影术阳性组±责任椎间盘内阻滞术阳性组），进一步分为：B1组（以ModicⅠ型变化为主者）和B2组（以ModicⅡ型变化为主者）。采用疼痛视觉模拟法（VAS10分法）和Oswestry伤残指数（ODI）进行疼痛和功能评分，比较各组在术前和术后24个月时的疗效差异。采用CT重建和动力位X线片对术后融合状态进行评估。结果各小组术前的VAS及Oswestry评分差异无统计学意义。术后24个月时A组和B组的VAS及Oswestry评分均显著优于术前评分；术后24个月时B组的VAS及Oswestry评分均显著优于A组（1．3±0．7）、（1．2±0．6）分比（2．2±0．8）、（2．3±0．7）分，P〈0．05。B组在手术前后的VAS及Oswestry评分改善率上优于A组，但终板Modic变化的类型与VAS及Oswestry评分改善率间无明显相关性。结论术前的椎间盘内阻滞术能更好地预测腰椎后路椎间融合术的术后疗效。终板Modic变化的类型与术后功能评分的改善率之间无明显相关性。Objective To evaluate the prognosticating effects of discography and intradiseal injection blockage for patients with degenerative chronic discogenic low back pain and end plate Modie changes when posterior lumbar interbody fusion （ PLIF ） was adopted. Methods Patients who received diagnostic discography for suspected degenerative diseogenic low back pain were recruited. A total of 60 patients（42 males and 18 females） with positive discography and end plate Modic changes at a single level were enrolled in the study and allocated into Groups A and B ： Group A was both positive sign of discography and negative sign of intradiscal injection blockage twe weeks later, whieh further was subdivided into Group A1 （Modic Ⅰ endplate change） and Group A2 （Modic Ⅱ endplate change）. Group B was both positive sign of discography and intradiscal injection blockage twe weeks later, which further was subdivided into Group A1 （Modic Ⅰ endplate change ） and Group A2 （Modic Ⅱ endplate change）. There were 15 cases in each subgroup, with a mean age of 43.2 years old （29 to 62 years old） . The lumbar decompression combined with interbody fusion was performed for these patients. The clinical outcome of each patient was evaluated and recorded by using the VAS and ODI before operation and at 24 months after the procedure. The bone fusion state was evaluated by both dynamic X-ray and CT reconstruction films. Results There was no statistical difference of the scales of VAS and ODI before operation. Compared with the scales before operation, although the scales of VAS and ODI of both group A and group B at 24 months ＇after the procedure were significantly improved, the scales of both VAS and ODI of group B were significantly superior to group A. The statistics analysis showed that comparing the improvement rate of VAS and ODI before and after operation, group B was significantly superior to group A, but there was no obviously correlations between the type of Modc endplate change and the the improvement

关 键 词：腰痛 椎间盘 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]