腰椎Modic改变对腰椎间盘突出症患者术后症状的影响  

The Effect of Nucleus Pulposus Resection through Lamina Fenestration for Lumbar Disc Herniation Accompanied by Endplate Modic Changes on Lumbago and Scelalgia after Operation

作　　者：万安营 唐淼[1] 芦磊磊[1] 汤瑞新 

机构地区：[1]安徽医科大学附属宿州医院骨科,安徽宿州234000

出　　处：《实用骨科杂志》2015年第2期101-104,共4页Journal of Practical Orthopaedics

摘　　要：目的探讨腰椎终板Modic改变对椎板间开窗椎间盘摘除术术后腰腿痛的影响。方法 2009年7月至2011年8月,我院采用椎板间开窗椎间盘摘除术治疗单节段腰椎间盘突出症患者114例,男45例,女69例;平均年龄48岁（28~69岁）;L4~5突出43例,L5S1突出71例。根据有无终板改变分为A、B两组。A组：MRI影像显示终板有信号改变,共50例,其中ModicⅠ、Ⅱ、Ⅲ型分别为11例、35例、3例（其余1例为混合型）;B组：MRI影像示终板无信号改变,共64例。分别记录术前和末次随访时的VAS、ODI值及腰腿痛的术后复发率,并进行统计学分析。结果本组平均随访14个月（4~27个月）术前A、B组的VAS、ODI值差异无统计学意义（P〉0.05）。A组术后腰痛VAS值、腿痛VAS值、ODI值改善率分别为75.6%、89.2%、79.2%,B组分别为86.4%、90.6%、87.3%。A组腰痛VAS值及ODI值改善率与B组比较差异有统计学意义（P〈0.05）,但A、B组腿痛VAS值改善率差异无统计学意义（P〉0.05）。术后不同类型Modic改变的腰痛VAS值、腿痛VAS值及ODI值改善率之间差异无统计学意义（P〉0.05）。A组术后腰腿痛的复发率高于B组。结论椎板间开窗椎间盘摘除术能显著减轻椎间盘突出患者腰腿痛症状,对与伴有终板Modic改变的椎间盘突出患者,术后腰痛的缓解程度较无Modic改变者差,但腰腿痛复发率高,其可能原因之一是未处理发生Modic改变的终板。Objective To investigate the effect of nucleus pulposus resection through lamina fenestration for lumbar disc herniation complicated with lumbar endplate Modic changes on lumbago and scelalgia after operation. Methods From July2009 to August 2011,114 cases with single level lumbar disc（ 43 L4 ~ 5discs and 71 L5S1discs） herniation underwent nucleus pulposus resection through lamina fenestration,including 64 males and 50 females with an average age of 48 years（ rang,28 ~69） and an average 14 months follow-up（ range,4 ~ 27）. They were divided into group A（ 50 had endplate Modic changes,composing of 11 type Ⅰ,35 type Ⅱ,3 type Ⅲand 1 mixed type） and group B（ 64 had no endplate Modic changes） according different MRI expression. The VAS and ODI scales at the preoperation and final follow-up were compared between two groups. At the same time,recurrence rate of lumbago and scelalgia was recorded in group A after operation,and these data was used to statistical analysis. Results There was no significant difference between two groups before operation with respect to the scale of VAS and ODI（ P 〉0. 05）. After operation,the scales of lumbago and scelalgia VAS and ODI in group A increased 75. 6% 、89.2% 、79. 2%,respectively,and the group B were 86. 4% 、90. 6% 、87. 3%,respectively. There was significant difference between two groups at the improvement rate of lumbago scales and ODI scale（ P 〈0. 05）,however,improvement rate of scelalgia scale in two groups showed no statistical significance（ P 〉0. 05）. Among the three types（ Ⅰ,Ⅱ,Ⅲ） of Modic changes in group A after operation,VAS（ lumbago and scelalgia） and ODI scales indicated no significant difference（ P〉 0. 05）. At the same time,the postoperative recurrence rate of lumbago and scelalgia in group A was higher than that in group B. Conclusion Nucleus pulposus resection through lamina fenestration can obviously relieve lumbago and scelalgia symptoms in patients with lumbar disc herniation. To those patients su

关 键 词：MODIC改变 腰椎终板 腰腿痛 

分 类 号：R681.5[医药卫生—骨科学]