Modic改变对腰椎间盘突出症手术方案选择的影响及疗效分析

Surgical options and clinical outcomes in patients of lumbar disc herniation with Modic changes

目的比较单纯开窗间盘摘除术和后路椎间融合术对伴有终板Modic改变的腰椎间盘突出症患者的中远期疗效。方法回顾2002年1月至2007年1月天津医院脊柱外科486例伴有终板Modic改变的腰椎间盘突出症患者。按手术方式不同，分为开窗组（n=215）和融合组（n=271）。分别记录两组患者术前和术后3、6、12个月以及随后每年1次随访时的Oswestry功能障碍指数（ODI）和视觉模拟量表（VAS）评分，并进行统计学分析。结果所有患者术后平均随访88．9（60～120）个月。末次随访所有患者症状较术前均有明显缓解，融合组腰痛VAS评分平均改善率优于开窗组（77．9％比68．0％）；开窗组腰痛VAS评分改善率ModicⅡ型优于Ⅰ型（72．8％比64．9％）；ModicⅠ型ODI、腰痛VAS评分改善率融合组优于开窗组，分别为（78．3％比70．4％）和（77．4％比64．9％）（P〈0．05）。结论建议对于伴有ModicⅠ型改变的腰椎间盘突出患者考虑椎间融合术，而对于伴有ModicⅡ型改变的腰椎间盘突出，如无其他合并因素，可以考虑单纯间盘摘除术。

Objective To retropspectively evaluate medium and long-term outcomes of conventional fenestration discectomy versus posterior lumbar interbody fusion in lumbar disc herniation with Modic changes. Methods From January 2002 to January 2007, a total of 486 patients of lumbar disc herniation with Modic changes were analyzed retrospectively. They were divided into fenestration group （n = 215 ） and fusion group （ n = 271 ） according to the operative approaches. The scores of Oswestry disability index （ODI） and visual analog scale （VAS） pre-and post-operative 3, 6, 12 month and annually were recorded and analyzed. Results All of them had complete records during a mean follow-up period of 88.9 （60 -120） months. At the end of the latest follow-up, all symptoms were relieved postoperatively. Significantly difference existed in the improvement rate of back pain VAS between two groups （77. 9% vs 68.0% ）. In the fenestration group, the improvement rate of VAS （ back pain） of Modic type Ⅱwas better than that of Modic type Ⅰ （72. 8% vs 64.9% ）. And the difference was-statistically significant. For those with Modic type Ⅰ changes, the improvement rate of ODI and VAS （back pain） of the fusion group were better than those of the fenestration group （78.3% vs 70. 4% and 77, 4% vs 64. 9% ）. And the differences were statistically significant （P 〈 0. 05 ）. Conclusion The patients with Modic Ⅰ and Ⅱ changes were recommended to undergo lumbar fusion and undergo fenestration discectomy respectively.