Modic改变对腰椎间盘突出症经皮椎间孔镜手术疗效的影响

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Modic Ⅰ型改变组（A组,13例），Modic Ⅱ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。

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

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 Type Ⅰ change group (Group A, n=13), Modic type Ⅱ change 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.