Modic改变对开窗治疗腰椎间盘突出症疗效的影响

IMPACT OF MODIC CHANGES ON CURATIVE EFFECT OF FENESTRATION TO LUMBAR INTERVERTEBRAL DISC PROTRUSION

目的探讨腰椎终板及椎体信号改变,即Modic改变,对开窗髓核摘除术治疗腰椎间盘突出症疗效的影响。方法分析采用开窗髓核摘除术治疗腰椎间盘突出症患者78例,根据患者腰椎MRI是否伴有Modic改变分为2组。A组47例,MRI显示无Modic改变;B组31例,其中MRI显示终板及椎体Modic I型改变11例,ModicⅡ型改变17例,ModicⅢ型改变3例。统计分析术前及术后1年随访时患者疼痛视觉评分(visual analogue scale,VAS)及Oswestry功能障碍指数(Oswestry disability index,ODI)。结果术前A、B组VAS及ODI评分差异无统计学意义,术后A、B组VAS及ODI评分均有明显改善。术后1年随访时A、B组VAS分别为(0.99±O.23)分、(2.21±0.69)分,A组优于B组(P<0.01);术后1年随访时A、B组ODI评分分别为(6.13±1.12)分、(9.05±2.54)分,A组优于B组(P<0.01)。术前和术后1年B组内不同类型Modic改变患者VAS及ODI评分差异均无统计学意义。结论开窗髓核摘除术是治疗腰椎间盘突出症的有效方式之一,终板及椎体Modic改变可能是影响患者术后腰部疼痛缓解的原因之一。

Objective To investigate the impact of the signal changes of lumbar endplate and vertebral body,namely Modic change,to the curative effect of fenestration with excision of nucleus pulposus to lumbar intervertebral disc protrusion. Methods We collected 78 patients of lumbar intervertebral disc protrusion who were treated by fenestration with excision of nucleus in our hospital,the patients were divided into two groups according to Modic changes or not on MRI of lumbar spinal,47 cases in group A,MRI showed no Modic changes,and 31 cases in group B,including 11 cases of Modic type Ⅰ changes on the endplate and vertebral body showed by MRI,17 cases of Modic type Ⅱchanges, and 3 patients of Modic type Ⅲ changes,patients＆#39; visual analogue scale（ VAS）and Oswestry disability index（ODI）before operation and one year after operation were analyzed statistically. Results The preoperative VAS score and ODI score of patients in group A and B had no significant difference,and these scores were improved significantly one year after surgery. At follow-up of one year after surgery,VAS score of group A was（0. 99 ± 0. 23）scores,and the score of group B was（2. 21 ± 0. 69）scores,the score of group A was better than that of group B（P﹤0. 01）;ODI score of group A was（6. 13 ± 1. 12）scores, and the score of group B was（9. 05 ± 2. 54）scores,the score of group A was better than that of group B＇nbsp;（P﹤0. 01）. At the preoperative and one year after surgery,there were no significant difference in patients with different types of Modic changes on VAS scores and ODI scores. Conclusion Fenestration with excision of nucleus pulposus was one of the effective ways of treatment to lumbar intervertebral disc protrusion. Modic changes on the endplate and vertebral body may be one of the reasons affecting the relief of lumbar pain after surgery.