消髓化核汤治疗伴有终板炎改变的巨大型腰椎间盘突出症  

Clinical Observation of Xiaosui Huahe Decoction in the Treatment of Giant Lumbar Disc Herniation with Modic Changes

作　　者：王青华 俞鹏飞[1] 姜宏[1] 刘锦涛[1] WANG Qinghua;YU Pengfei;JIANG Hong;LIU Jintao(Suzhou Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine,Suzhou 215009,Jiangsu China.)

机构地区：[1]南京中医药大学附属苏州市中医医院,江苏苏州215009

出　　处：《中国中医骨伤科杂志》2021年第1期54-58,共5页Chinese Journal of Traditional Medical Traumatology & Orthopedics

基　　金：江苏省自然科学基金项目(BK20190191);江苏省青年医学人才计划项目(QNRC2016257);苏州市科技发展计划项目(SYSD2019220)。

摘　　要：目的:观察终板炎改变(Modic改变,即MCs)对口服消髓化核汤保守治疗的巨大型腰椎间盘突出症疗效的影响。方法:分析2018年6月至2019年7月治疗的119例巨大型腰椎间盘突出症患者的病历资料,按照磁共振影像学表现将其分组为伴有Modic改变组和无Modic改变组,所有患者均采用口服中药保守治疗。对两组患者在治疗前及治疗后的磁共振表现突出物大小及日本矫形科学学会(JOA)评分进行对比分析。结果:119例患者均获得有效随访,其中Modic改变组患者重吸收发生率为48.57%,无Modic改变组患者重吸收发生率为70.24%;两组患者治疗后JOA评分较治疗前均显著提高,差异有统计学意义(P<0.05);两组患者治疗后JOA评分改善率差异无统计学意义(P>0.05)。结论:MCs并非腰椎间盘突出症患者保守治疗的不利因素,而是腰椎间盘突出症重吸收的不利因素,但当伴有MCs的腰椎间盘突出症患者启动重吸收过程时,MCs并不会影响其突出物重吸收发生率。Objective:To explore the effect of Modic changes(MCs)on Xiaosui Huahe decoction in treating giant lumbar disc herniation.Methods:119patients with giant lumbar disc herniation were treated from June 2018to July 2019.They were divided into Modic changed group and no Modic changed group according to their magnetic resonance imaging findings.All patients were treated conservatively by traditional Chinese medicine of Xiaosui Huahe decoction.The size of the herniated lumbar disc on magnetic resonance imaging(MRI)and the scores of the Japanese orthopaedic association(JOA)of the two groups before and after treatment were documented and compared.Results:All 119patients were followed up effectively.Among them,the incidence of reabsorption in the Modic group was 48.57%,and the incidence of reabsorption in the Modic-free group was 70.24%.After treatment,the JOA scores of the two groups were significantly higher than before treatment(P<0.05).No significant difference was found in the JOA score improvement rate after treatment between two groups(P>0.05).Conclusion:MCs is an unfavorable factor for reabsorption of lumbar disc herniation,but MCs is not unfavorable factor for conservative treatment of patients with intervertebral disc herniation.However,MCs will not affect the reabsorption rate of their protrusions once the herniated lumbar disc reabsorption procedure form patients with changes in MCs start.

关 键 词：终板炎 腰椎间盘突出症 重吸收 JOA评分 

分 类 号：R681.5[医药卫生—骨科学]