ModicⅡ型改变对腰椎间盘突出症手术疗效的影响

Effects of Modic Ⅱ changes on clinical outcomes of discectomy

目的探讨ModicⅡ型改变对腰椎间盘突出症患者手术疗效的影响。方法选取2007年1月至2009年1月收治的腰痛合并单侧下肢放射痛的腰椎间盘突出症患者65例，其中有ModicⅡ型改变30例（A组），无ModicⅡ型改变35例（B组），均行单纯椎板开窗椎间盘髓核摘除术。采用MacNab标准进行临床疗效评定，采用视觉模拟疼痛评分（VAS）评估患者腰痛程度。结果两组术后临床症状都有明显缓解，随访12—36（20．6±7．5）个月，按MacNab标准进行疗效评价：A组优10例（33．33％）、良17例（56．67％）、可3例（10．00％）；B组优28例（80．00％）、良5例（14．29％）、可2例（5．71％），两组疗效比较差异有统计学意义（P〈0．05）。术后VAS：A组（2．63±1．30）分，B组（1．09±0．50）分，两组比较差异有统计学意义（P〈0．05）。结论ModicⅡ型改变可能是腰椎间盘突出症患者椎间盘髓核摘除术后遗留腰痛的原因之一。

Objective To discuss the effects of Modic Ⅱ changes on clinical outcomes of discectomy for lumbar disc herniation （LDH） with low back pain associated with unilateral sciatica. Methods Sixty- five cases of LDH with low back pain associated with unilateral sciatica received single segment discectomy during January 2007 to January 2009.There were 30 cases with Modic Ⅱ changes in group A, 35 cases without Modic Ⅱ changes in group B. Assessed the clinical outcomes by using MacNab analyzing system and visual analog scale （VAS）. Results Two groups of the postoperative clinical symptoms had significant relief, the follow-up of 12 - 36 months, average （20.6± 7.5 ） months. MacNab efficacy evaluation by group A of optimal 10 cases （33.33%）, good 17 cases （56.67%）, general 3 cases （10.00%）. Group B optimal 28 cases （ 80.00% ）, good 5 cases （ 14.29% ）, general 2 cases （5.71%）, there was significant difference in fine rate （P 〈 0.05 ）. Preoperative group A VAS was （8.67 ± 0.30） scores, group B was （8.60 ± 0.32） scores （P 〉 0.05 ）. Postoperative group A VAS was （2.63± 1.30） scores,group B was （1.09 ±0.50） scores （P 〈 0.05）. Conclusion Modic Ⅱ changes may be one of the reasons which cause the residual low back pain after the disceetomy for LDH.