Modic改变对腰椎间盘突出症经皮椎间孔镜手术疗效的影响

The effect of Modic changes on the efficacy of percutaneous transforaminal endoscopic discectomy for lumbar disc herniation

目的探讨Modic改变对腰椎间盘突出症经皮椎间孔镜手术疗效的影响。方法将因单节段腰椎间盘突出症行椎间孔镜手术治疗的89例患者,根据手术节段终板Modic改变的类型,分为ModicⅠ型改变组(A组,13例),ModicⅡ型改变组(B组,31例)和无Modic改变组(C组,45例)。分别记录各组术前、末次随访时血浆高敏C反应蛋白(hs-CRP)浓度、腰痛VAS评分、腿痛VAS评分和ODI评分,并评估末次随访时的Macnab疗效和复发率。结果本组患者术后随访时间为6~22个月,平均(12.23±4.55)个月。术前腰痛VAS评分、腿痛VAS评分及ODI评分三组间比较差异无统计学意义(P>0.05),A组hs-CRP浓度明显高于B、C组(P<0.05)。末次随访时各组腰痛VAS评分、腿痛VAS评分及ODI评分均明显低于术前(P<0.05),但hs-CRP浓度无明显下降(P>0.05)。A、B组腰痛VAS评分高于C组(P<0.05),但腿痛VAS评分、ODI评分三组间比较差异无统计学意义(P>0.05)。A组hs-CRP浓度仍高于B、C组。A、B组复发率高于C组(P<0.05),Macnab疗效不如C组(P<0.05),但A、B组之间差异无统计学意义(P>0.05)。结论腰椎间盘突出症予以经皮椎间孔镜手术治疗时,Modic改变可能是术后遗留下腰痛及复发的影响因素之一。

Objective To investigate the effect of Modic changes on the efficacy of percutaneous transforaminal endoscopic discectomy for lumbar disc herniation.Methods A total of 89 patients received percutaneous transforaminal endoscopic discectomy for single-segment lumbar disc herniation were included.According to the types of Modic endplate changes of the surgical segments,the patients were classified into Modic TypeⅠchange group(Group A,n=13),Modic typeⅡchange group(Group B,n=31),and non-Modic change group(Group C,n=45).The concentration of serum high-sensitivity C-reactive protein(hs-CRP),VAS scales of back and leg pain,and the ODI scores were recorded before surgery and at the last follow-up.The recurrence rate,and Macnab score at the last follow-up were evaluated.Results The follow-up ranged from 6 to 22 months,with a mean follow-up of(12.23±4.55)months.There was no significant difference in VAS scale of back orleg pain,as well as ODI scores before surgery among the three groups(P>0.05).The hs-CRP concentration in Group A was significantly higher than those in Group B and C(P<0.05).The VAS scales of back and leg pain as well as ODI scores of each group at the last follow-up were significantly lower than those before surgery(P<0.05),but the hs-CRP concentration was not significantly reduced(P>0.05).The VAS scales of back pain in Group A and B were significantly higher than that in Group C(P<0.05),but the VAS scales of leg pain and ODI scores were not significantly different among the three groups(P>0.05).The hs-CRP concentration in Group A was significantly higher than thosein Group B and C(P<0.05).The recurrence rate of Group A and B was significantly higher than that of group C(P<0.05),and the Macnab scores of Group A and B were significantly less than Group C(P<0.05).However,there was no significant difference in the Macnab score between Group A and B(P>0.05).Conclusion Modic changes might be one of the influence factors of low back pain and recurrence after percutaneous transforaminal endoscopic discectomy in patients with lumbar disc herniation.