伴有Modic改变对腰椎间盘突出症患者接受PTED手术疗效的影响

Influence of Modic changes on the efficacy of PTED operation in patients with lumbar disc herniation

目的探讨经皮椎间孔镜下髓核摘除术(percutaneous transforaminal Endoscopic Discectomy,PTED)治疗腰椎间盘突出症的临床疗效,并观察伴有终板Modic改变对PTED手术疗效的影响。方法回顾性分析2017年3月-2019年3月采用PTED手术治疗的LDH患者127例,根据其术前终板Modic信号变化,分为三组:正常组82例,终板MRI信号无异常;ModicⅠ组20例,其终板MRI呈ModicⅠ型信号;ModicⅡ组25例,终板MRI呈ModicⅡ型信号。术后随访2年以上,统计三组患者PTED术后疗效、并发症及复发情况。结果三组患者术后3个月、1年和末次随访的腰痛VAS评分、腿痛VAS评分、ODI指数,均较术前有显著改善(P<0.05);但ModicⅠ组和ModicⅡ组的腰痛VAS评分和ODI指数在术后1年和末次随访时呈逐渐升高趋势,与正常组之间呈显著性差异(P<0.05),尤其以ModicⅠ组为甚。末次随访时,正常组的优良率为90.24%,ModicⅠ组为80.00%,ModicⅡ组为88.00%,三组差异无统计学意义(P>0.05)。三组患者术后发生一过性下肢感觉障碍(8例)和神经根损伤(2例)共10例,分别为正常组6例,ModicⅠ组2例,ModicⅡ组2例,差异无统计学意义(P>0.05)。结论PTED手术在伴或不伴Modic改变的LDH患者均可取得良好疗效,但伴有ModicⅠ型改变者术后远期可出现腰痛和功能障碍逐渐恶化的趋势。

Objective To explore the clinical efficacy of percutaneous transforaminal endoscopic discectomy(PTED)in the treatment of lumbar disc herniation(LDH),and to observe the effect of Modic changes in the endplate on the efficacy of PTED surgery.Methods The clinical data of 127 patients with LDH who underwent PTED surgery from March 2017 to March 2019 were retrospectively analyzed.The patients were divided into three groups according to the change of pre-operative endplate Modic signal:82 cases in the normal group had no abnormalities in endplate MRI signal;20 cases in ModicⅠgroup showed ModicⅠsignal in the end plate MRI;25 cases in ModicⅡgroup showed ModicⅡsignal in the end plate MRI.The patients were followed up for more than 2 years.The curative effect,complications and recurrence of PTED in the three groups were analyzed.Results The lumbar pain VAS,leg pain VAS,and ODI index of three groups at 3 months,1 year and last follow-up were significantly improved compared with before surgery(P<0.05).However,the low back pain VAS score and ODI index in ModicⅠand ModicⅡgroups showed a gradual increase trend at 1 year after operation and at the last follow-up,and showed significant differences compared with those of the normal group(P<0.05),especially in Modic I group.At the last follow-up,the excellent and good rate of the normal group was 90.24%,that of ModicⅠgroup was 80.00%,that of ModicⅡgroup was 88.00%,and there was no statistically significant difference among the three groups(P>0.05).The postoperative lower limb feel barriers(8 cases)and nerve root injury(2 cases)were observed in three groups,a total of 10 cases,6 cases in normal group,2 cases in ModicⅠgroup,2 cases in ModicⅡgroup,there was no statistically significant difference among three groups(P>0.05).Conclusion PTED surgery can achieve good results in LDH patients with or without Modic changes,but patients with Modic typeⅠchanges can have a tendency to gradually deteriorate back pain and dysfunction in the long term.