盘内注射治疗伴终板Modic改变的退行性慢性盘源性腰痛

目的 观察伴终板Modic改变的退行性慢性盘源性腰痛患者在使用不同类型注射液进行椎间盘内介入治疗的疗效差异,评判采用适当的注射液对伴不同类型终板Modic改变的退行性慢性盘源性腰痛进行盘内注射的潜在治疗价值.方法 将经椎间盘造影术后证实有单节段的退行性慢性盘源性腰痛患者按核磁共振图像上的终板Modic变化分为以Modic Ⅰ型变化为主者(包括ModicⅠ型及以Modic Ⅰ型为主的混和Ⅰ/Ⅱ型)和以Modic Ⅱ型变化为主者(包括ModicⅡ型及以ModicⅡ型为主的混和Ⅱ/Ⅰ型)两种情况,采用椎间盘内注射的方法 进行治疗,共分为3组:(1)A组(对照组):盘内注射液体为生理盐水3 ml;(2)B组(治疗组):盘内注射液体为得宝松(复方倍他米松)3ml;(3)C组(治疗组):盘内注射液体为得宝松(复方倍他米松)1 ml+松梅乐鹿瓜多肽注射液2 ml.采用疼痛视觉模拟法(VAS 10分法)和Oswestry伤残指数(2.0版)(ODI)进行疼痛和功能评分,使用t检验比较各组在盘内注射术前、术后3和6个月的疗效差异.结果 本组共60例,平均年龄41.6岁(26～58岁).A-Modic Ⅰ,A-Modic Ⅱ;B-Modic Ⅰ,B-Modic Ⅱ;C-Modic Ⅰ,C-Modic Ⅱ各小组均为10例.各小组术前的VAS及Oswestry评分在统计学上无明显差异;术后3、6个月时B组和C组的VAS及Oswestry评分均显著优于术前评分,也优于对照组(A组)的同时期评分,但B、C两组在各自的3与6个月评分做自身前后的相互比较时却无显著性差异;B、C两组间在各个时间点上的VAS及Oswestry评分也无差异,不同Modic变化的类型与各组在各个时间点上的VAS及Oswestry评分间无相关性.结论 椎间盘内介入治疗可在术后的3～6个月内减轻盘源性腰痛的程度并改善Oswestry伤残指数功能评分值;伴终板Modic Ⅰ型者的术后疗效与Ⅱ型者之间无统计学差异.激素是盘内注射镇痛的主要因素,但协同应用松梅乐鹿瓜多肽注射液可在减少激素用量的情况下维持有效的镇痛效应和持续时间.

Intradiscal interventianal therapy for degenerative chronic discogenic low back pain with end-plate Modic changes

Objective To observe the different efficacies of intradiscal interventional therapy for patients with degenerative chronic discogenic low back pain and end-plate Modic changes through different types of injection and to evaluate the potential therapeutic value of intradiscal injection treatment for degenerative chronic discogenic low back pain with different types of end-plate Medic changes by using appropriate injection. Methods Patients with single segmental degenerative chronic discogenic low back pain proved by discography were classified as Modic type Ⅰ predominant change (including Medic Type Ⅰ & Modic type Ⅰ predominant mixed Type Ⅰ/Ⅱ) and Modic type Ⅱ predominant change (including Modic Type Ⅱ & Modic Type Ⅱ predominant mixed Type Ⅱ/Ⅰ) according to the end-plate Modic changes on MRI. All received the intradiscal injection treatment. Patients were divided into three groups: (1) A group (control group): intradiscal injection of normal saline 3 ml; (2) B group (treatment group): intradiscal injection of diprospan (compound betamethasone) 3 ml; (3) C group (treatment group): interventional injection of diprospan (compound betamethasone) 1 ml + songmeile (cervus & cucumis polypeptide injection) 2 ml. Pain and function were evaluated by pain visual analogue scale (VAS) and Oswestry disability index (ODI). T-test was applied for efficacy comparison in each group at pre-operation, 3 months and 6 months post-oporation. Results Sixty patients were included. There were 39 males and 21 females with a mean age of 41.6 years old (26-58). There were 10 patients in each group: A-Modic Ⅰ, A-Modic Ⅱ; B-Medic Ⅰ, B-Modic Ⅱ; C-Modic Ⅰ, C-Modic Ⅱ. There was no significant statistical difference in preoperative VAS and Oswestry scores among groups; VAS and Oswestry scores of B group and C group at 3 months and 6 months post-operation were significantly better than those pre-operative scores, and also better than that of control group (A group) at the same time. But there was no significant difference in scores between 3 months and 6 months in ether B group or C group, and there was also no significant difference in VAS and Oswestry scores between B group and C group at various time points. Various Modic types had no correlation with either VAS score or Oswestry score in each group at various time points. Conclusion Intradiscal interventional therapy can relieve discogenic low back pain and improve Oswestry disability index score of function between 3 and 6 months post-operation. There is no significant difference in post-operative efficacy between Modic Type Ⅰ and Medic Type Ⅱ. Steroids are the major analgesic factor of intradiscal injection. But the synergistic application of songmeile (cervus & cucumis polypeptide injection) can maintain the analgesic effect and duration with a decreased dose of steroids.