不同手术方式治疗腰椎间盘突出伴Modic改变的临床疗效研究

目的：探讨不同手术方式治疗腰椎间盘突出伴Modic改变的临床疗效。方法82例腰椎间盘突出伴Modic改变的患者作为观察对象,随机分为MED组（即椎间盘髓核摘除术组,42例）和PLIF组（即椎间融合内固定术组,40例）,观察两组患者术前、随访末临床基本情况,包括Oswedtry功能障碍指数评分（ODI）（0~45）、视觉疼痛模拟标尺（VAS）（腰,0~10）、VAS（腿,0~10）。结果术后,两组患者症状均较术前改善,MED组手术后ODI、下腰痛及下肢根性痛的改善率分别为81.7%、76.6%、90.3%,PLIF组手术后ODI、下腰痛及下肢根性痛的改善率分别为85.0%、86.7%、91.8%,PLIF组总体优于MED组,差异具有统计学意义（P〈0.05）；PLIF组内ModicI型下腰痛的改善程度优于ModicII型,差异具有统计学意义（P〈0.05）,MED组不同终板类型间VAS、ODI值差异无统计学意义（P〉0.05）。结论术后下腰痛的改善与终板Modic改变间存在相关性,MED术和PLIF术治疗腰椎间盘突出症伴有Modic改变均有效,但处理终板后的PLIF术疗效优于MED术,特别是对ModicI型效果更佳。

Study on the clinical curative effect of different operation mode in the treatment of lumbar disc herniation with Modic change

Objective To investigate the clinical curative effect of different operation mode in the treatment of lumbar disc herniation with Modic change.Methods Divided 82 cases of lumbar disc herniation with Modic changes randomly into MED group（Micro-encoscopy discectomy group, 42 cases） and PLIF group （posterior lumbar interbody fusion group, 40 cases）, observed the clinical basic situation, including ODI（0~45）, VAS （waist, 0~10）, VAS （leg, 0~10） in two groups before operation and end of follow-up.Results After the operation, symptoms in two patients were improved after operation, ODI（oswedtry dysfunction index） score, low back pain and leg pain improvement rate in group MED were 81.7%, 76.6%, 90.3%, ODI, low back pain and leg pain improvement rate in PLIF group after operation were 85.0%, 86.7%, 91.8%, PLIF group was better than MED group, the difference was statistically significant（P〈0.05）; Modic type I low back pain improvement in PLIF group was better than Modic type II, the difference was statistically significant（P〈0.05）, the value of ODI and VAS of different types in MED group had no significant difference（P〉0.05）.Conclusion Postoperative low back pain improvement and endplate Modic changes are correlated, MED and PLIF operation are effective in the treatment of lumbar disc herniation with Modic changes, PLIF is superior to that of MED after the endplate, especially for Modic type I.