经后路微创治疗伴终板Modic改变腰椎间盘突出症的疗效分析

The outcome of microendoscopic discectomy for disc herniation complicated with lumbar endplate Modic changes

目的：探讨经后路内窥镜下微创治疗伴腰椎终板信号改变（Modic改变）腰椎间盘突出症患者的手术疗效。方法：回顾性分析自2005年5月2009年12月我院采用经后路内窥镜下髓核摘除术（MED）治疗单节段腰椎间盘突出症患者78例,男43例、女35例,平均年龄44.3岁（2367岁）,平均随访36.7个月（762个月）,根据有无终板改变分为A、B两组。A组：MRI影像显示终板无信号改变,共33例;B组：MRI影像示终板有信号改变,共45例,其中ModlcⅠ、Ⅱ、Ⅲ型分别为13、25、7例。分别记录术前、术后及最终随访时的VAS、ODI值,并进行统计学分析。结果：术前A、B组的VAS、ODI值差异均无统计学意义（P〉0.05）。术后ODI值改善率分别为A组86.2%、B组81.3%,VAS改善率分别为A组89.2%、B组77.2%,A组ODI值及VAS改善率与B组比较差异有显著性（P〈0.05）,B组终板不同Modic改变类型间疗效：术前、术后及末次随访间差异无显著性（P〉0.05）。结论：后路内窥镜下髓核摘除术（MED）是治疗腰椎间盘突出症的一种有效术式,终板Modic改变可能是引起术后腰痛的一个原因,并影响术后腰痛的缓解,且MED术对治疗不同类型Modic改变腰椎间盘突出症的临床疗效无差异。

Objective：To evaluate the outcome of microendoscopic discectomy for disc herniation complicated with lumbar endplate Modic changes.Method：78 patients including 43 mals and 35 femals,aged from 23 to 67 years old（mean 44.3 years） suffering from single level disc herniation in L4-L5 or L5-S1 from May 2005 to December 2009 were reviewed retrospectively,of them,33 had no lumbar endplate Modic changes（group A）,45 had lumbar endplate Modic changes（group B）,cases with Modic Ⅰ,Ⅱ,Ⅲ-type accounted 13,25,7,respectively.All patients underwent microendoscopic discectomy and at least 7 month follow-up（mean 36.7 months）,the VAS and ODI scales at the preoperative and final follow-up were compared between two groups.Result：There was no difference between two groups before operation with respect to VAS（low back pain） and ODI（P〉0.05）,however,significant difference between two groups was noted after operation（P〈0.05）.ODI scales increased 86.2% and 81.3% for group A and B respectively;VAS scales increased 89.2% in group A and 77.2% in group B,which showed statistical significance（P〈0.05）,however,no statistical significance respect to either VAS（lower back pain） or ODI among three types of Modic change in group B was noted at the preoperative and final follow-up（P〉0.05）.Conclusion：MED is effective for lumbar disc herniation,Modic changes in endplate may lead to postoperative low back pain,and even poor prognosis,moreover the outcomes of MED for different types of Modic changes remain no difference.