合并Modic改变的腰椎间盘突出行单纯髓核摘除术后疗效观察  

Clinical effects of simple discectomy for protrusion of lumbar intervertebral disc combined with Modic changes

作　　者：邵建树[1] 阮渊 王生介[1] 刘伟峰[1] 厉晓龙[1] 

机构地区：[1]江苏大学附属武进人民医院骨科,江苏常州213002

出　　处：《生物医学工程与临床》2016年第3期286-292,共7页Biomedical Engineering and Clinical Medicine

摘　　要：目的探讨有Modic改变的腰椎间盘突出患者,在行单纯髓核摘除术后中远期治疗效果。方法选择单纯髓核摘除术治疗腰椎间盘突出患者118例,其中男性53例,女性65例;年龄21-77岁,平均年龄47.5岁。根据患者腰椎MRI是否伴有Modic改变及其分型分为4组。A组62例,无Modic改变;B组22例,ModicⅠ型改变;C组25例,ModicⅡ型改变;D组9例,ModicⅢ型改变。统计分析术前及术后分期随访（6、12、36个月）时患者疼痛视觉模拟量表（VAS）评分及Oswestry功能障碍指数（ODI）。结果术前B、C、D组与A组VAS及ODI评分差异无统计学意义,术后各组VAS及ODI评分均有明显改善。根据术后随访6、12、36个月VAS评分及ODI结果示,B、C、D组治疗效果差于A组（P〈0.01）;B、C、D组各组间VAS评分及ODI差异无统计学意义（P〉0.05）。6个月随访时B、C、D组改善率差异无统计学意义（P〉0.05）,12个月随访时C组术后治疗效果维持最佳（P〈0.05）。36个月随访时部分患者复发,其中B组复发率最高（7/22）。结论合并Modic改变的腰椎间盘突出患者行单纯髓核摘除术后效果差于无Modic改变患者;但其中以ModicⅡ型改变术后效果维持最优,故选择ModicⅡ型改变时手术为最佳手术时机。Objective To study the postoperative efficacy and mid-long-term follow-up of lumbar intervertebral disc combined with Modic changes patients after simple discectomy. Methods A total of 118 patients with protrusion of lumbar intervertebral disc were enrolled, which included 53 males and 65 females, aged 21- 77 years old with mean age 47.5 years old.All of them were divided into 4 groups based on Modic changes and its classification, which were Group A（n = 62, non-Modic changes）, group B（n = 22, Modic type Ⅰ）, group C（n = 25, Modic type Ⅱ） and group D（n = 9, Modic type Ⅲ）. The data of preoperative and postoperative follow-up phases（6-month, 12-month and 36-month） in patients with pain visual grading（VAS）and Oswestry disability index（ODI） were analyzed. Results The scores in VAS and ODI of preoperative between group B, C,D and group A were no statistically significant differences, but scores in VAS and ODI of postoperative were improved significantly. For scores in VAS and ODI at six-month, 12-month and 36-month follow-up, effects of Modic changes in group B, C and D were worse than that in group A（P〈0.01）, there was no difference between group B, C and D（P〈0.05）; the improvement rates of group B, C and D at 6-month follow-up were no significant differences（P〈0.05）, group C maintained the best treatment effect at 12-month follow-up（P〈0.05）. At the time of 36-month follow-up, some patients relapsed and recurrence rate of group B was highest（7/22）. Conclusion It is demonstrated that simple discectomy is one of the effective methods in treatment of non-Modic change lumbar intervertebral disc protrusion, and shows 12-month optimum therapeutic effect in Modic type Ⅱ, but the highest recurrence rate in 36-month.

关 键 词：腰椎间盘突出 髓核摘除术 MODIC改变 治疗效果 

分 类 号：R687.3[医药卫生—骨科学]