ModicⅡ型改变对腰椎椎间盘突出症手术疗效的影响

Influence of Modic type Ⅱ change to curative effect for lumbar disc herniation

目的 探讨腰椎椎间盘突出症伴ModicⅡ型改变对手术疗效的影响.方法 回顾性分析本院2009年6月～2012年12月收治的腰椎椎间盘突出症患者86例,随访12～18个月,平均14.6个月.根据其是否伴发Modic Ⅱ型改变分为观察组（伴有ModicⅡ型改变）与对照组（不伴ModicⅡ型改变）,均行单节段开窗减压髓核摘除术,采用MacNab评价标准进行术后疗效的评定.分别记录各组患者术前及随访时疼痛视觉模拟量表（visual analogue scale,VAS）评分和Oswestry功能障碍指数（Oswestry disability index,ODI）,并进行统计分析.结果 按MacNab疗效评价,分别比较2组优、良率,差异均有统计学意义（P＜0.05）.术后所有患者VAS评分及ODI都得到不同程度的改善,与术前比较差异均有统计学意义（P＜0.05）.2组间术前VAS评分及ODI比较差异均无统计学意义（P＞0.05）;2组间术后VAS评分及ODI比较差异均有统计学意义（P＜0.05）.结论 对腰椎椎间盘突出症患者实施手术治疗具有良好的临床疗效,能够有效缓解患者疼痛及功能障碍,但伴有ModicⅡ型改变的患者临床疗效较差.

Objective To explore the influence of Medic type Ⅱ change to curative effect for lumbar disc herniation. Methods From June 2009to December 2012, 86 eases with lumbar disc herniation were analyzed, retrospectively. All eases were followed up for 12-18 months, with an average of 14. 6 months. According to with/without Medic type Ⅱ change, all eases were divided into observation group （with Modic type Ⅱ change） and control group（ without Medic type Ⅱ change）. All patients were performed single segmental windowing decompression with excision of nucleus pulposus. MacNab evaluation criterion was used to evalUat postoperative curative effect The visual analgue Scale（VAS） score and Oswestry disability index （ODI） at the preoperative and final foliow-up According to the MacNab evaluation criteria, excellent rate and good rate were significantly different between 2 groups （ P 〈 0.05 ）. The postoperative VAS scores and ODI of all cases were improved, and the difference has statistical significance（ P 〈 0.05 ）. Preoperative VAS score and ODI of 2 groups had no statistically significant difference（ P 〉0.05） ; VAS score and ODI of 2 groups had statistically significant difference（P 〈 0.05 ）. Conclusion For patients with lumbar disc herniation, surgery has good clinical curative effect, which can effectively relieve patients＇ pain and ameliorate dysfunction. However, its clinical curative effect for cases with Modic type Ⅱ change is poor.