MED与微创TLIF治疗伴Modic改变的腰椎间盘突出症的对比研究  

Microendoscopic discectomy versus minimally invasive transforaminal lumbar interbody fusion for lumbar disc herniation with Modic changes

作　　者：蒲小兵[1] 周强[2] 杨双石[1] 夏虹[3] 

机构地区：[1]解放军第188医院脊柱外科,广东潮州521000 [2]第三军医大学西南医院骨科,重庆400038 [3]广州军区广州总医院骨科医院,510010

出　　处：《中国骨科临床与基础研究杂志》2014年第2期79-83,共5页Chinese Orthopaedic Journal of Clinical and Basic Research

摘　　要：目的：对比分析椎间盘镜下髓核切除术（MED）与微创经椎间孔腰椎椎间融合术（TLIF）治疗伴Modic改变的腰椎间盘突出症的临床疗效。方法回顾性分析2003年9月至2008年12月解放军第188医院收治的59例伴Modic改变腰椎间盘突出症患者的临床资料，其中MED组30例、微创TLIF组29例，对比两组疼痛视觉模拟量表（VAS）评分和Oswestry功能障碍指数（ODI）评分的差异。结果59例患者均获得有效随访，随访时间0.5～5年，平均随访时间3年2个月。两组患者术后切口均获Ⅰ期愈合，无椎间隙感染和神经功能损伤。MED组术后5例复发，均表现为下腰痛伴下肢放射性疼痛，MRI检查证实为原位椎间盘再次突出，后采用TLIF术治愈；微创TILF组术后无复发，X线片检查示所有患者骨性融合。术前两组患者VAS及ODI评分比较，差异无统计学意义（P＞0.05）。末次随访时，两组患者VAS及ODI评分均较术前显著下降（P＜0.05）；微创TLIF组明显优于MED组，两组比较，差异有统计学意义（P＜0.05）。结论与MED比较，微创TLIF治疗伴Modic改变的腰椎间盘突出症具有复发率低、疼痛缓解理想、功能恢复快等优势。Objective To compare the clinical outcomes of microendoscopic discectomy （MED） and minimally invasive transforaminal lumbar interbody fusion （TLIF） for lumbar disc herniation （LDH） with Modic changes. Methods Clinical data of 59 LDH patients with Modic changes were retrospectively analyzed, who were treated in the 188th Hospital of PLA from September 2003 to December 2008. According to different surgical procedures, they were divided into 2 groups, MED group （n = 30） and minimally invasive TLIF （n = 29）. Visual analogue scale （VAS） scores and Oswestry disability index （ODI） scores in 2 groups were evaluated and compared with each other. Results All patients were followed up for 0.5-5 years with the average of 3 years and 2 months. Surgical incision were healed in all patients, and no intervertebral space infection and nerve injury were observed. In MED group, recurrence was found in 5 patients which was proved by clinical symptoms and MRI examination, and then was cured by TLIF; while no recurrence was found in minimally invasive TLIF group, and X-ray showed all 29 patients had bony fusion. At preopertion, there was no statistical difference of VAS and ODI scores between 2 groups （P〉0.05）. At the final follow-up, VAS and ODI scores improved compared with preoperative results （P 〈0.05）; The scores in minially invasive TLIF group were better than those in MED group, there was statistical difference between 2 groups （P 〈0.05）. Conclusion Compared with MED, minimally invasive TLIF had the advantages of lower recurrence rate, satisfactory pain relief and function rehabilitation.

关 键 词：腰椎 椎间盘移位 终板退变 外科手术 微创性 脊柱融合术 内窥镜检查 

分 类 号：R681.53[医药卫生—骨科学] R687.3[医药卫生—外科学]