椎间盘切除术治疗腰椎间盘突出症腰痛的疗效观察

OUTCOME OF DISCECTOMY IN PATIENTS WITH LOW BACK PAIN ASSOCIATED WITH LUMBAR DISC HERNIATION

目的:观察腰椎间盘突出伴有或不伴有腰椎退变Modic改变腰痛患者行椎间盘切除术后的疗效。方法:38例行椎间盘切除术的单节段椎间盘突出症腰痛患者,1组17例患者伴有腰椎退变Modic改变,包括8男,9女,平均年龄35.8岁(22～55岁),ModicⅠ型10例,ModicⅡ型7例。2组21例患者没有腰椎退变Modic改变,包括11男,10女,平均年龄35.5岁(21～60岁)。在术后3、6、12个月通过VAS疼痛评分评估疼痛改善情况,术后12个月通过JOA量表进行失能评估。结果:术前1组和2组VAS评分和JOA评分没有明显差异(P<0.05)。术后1组和2组患者腰痛和失能情况均明显改善(P<0.05)。在3、6、12个月,1组VAS评分分别是1.9±0.6、2.1±0.8和2.3±0.9,2组VAS评分分别是1.9±1.0、2.2±0.6和2.4±0.8;在术后12个月,1组和2组JOA评分分别是13.3±1.1和12.1±2.1,较术前明显改善(P<0.05)。结论:对于单节段伴有或不伴有Modic改变的椎间盘突出症腰腿痛患者,椎间盘切除术是一种良好的治疗方法。

Objective：To observe the outcome after lumbar discectomy in patients with disc herniation,concordant sciatica,and low-back pain with or without Modic degenerative changes Methods：Thirty-eight consecutive patients with single level disc herniation and low-back pain with Modic degenerative changes underwent fusion or lumbar dics neuclectomy.Group 1 consisted of 17 patients with Modic degenerative changes,8 men and 9 women,with a mean age of 35.8 years（range,22 to 55 y）.Group 2 contained 21 patients without Modic degenerative changes,11 men and 10 women,with a mean age of 35.5 years（range,21 to 60 y）.The visual analog scale（VAS） was used to grade low-back pain at 3,6,and 12 months and the Oswestry and JOA score were used to grade overall disability at 12 months postoperatively.Results：There was no significant difference in VAS and JOA scores for group 1 versus group 2 patients preoperatively.Average VAS scores of patients in group 1 were 1.9±0.6,2.1±0.8 and 2.3±0.9 at 3,6,12 months,VAS score in group 2 were 1.9±1.0,2.2±0.6 and 2.4±0.8 respectively.JOA scores in group 1 at 12 months were 13.3±1.1,the scores in group 2 were 12.1±2.1.The patients of both groups show significant improvement in postoperative JOA score（P0.05）.Conclusions：Discectomy was an effective treatment for single level disc herniation and concordant sciatica and low-back pain with or without Modic I and II degenerative changes.