Modic Ⅱ型改变对经皮椎间孔镜术疗效的影响

Clinical effects of percutaneous endoscopic discectomy in patients with Modic change type Ⅱ

摘要:

目的 探讨Modic改变对经皮椎间孔镜术疗效的影响。方法 回顾性分析2018年1月－2019年12月在该科行经皮椎间孔镜下腰椎髓核切除术（PELD）的43例腰椎间盘突出症（LDH）患者，根据磁共振成像（MRI）示是否伴有Modic改变将其分为MC组与对照组，分析两组患者术中出血量、手术时间、术前、术后3 d、术后3和6个月的腰痛及腿痛视觉模拟评分（VAS）、日本骨科协会评分（JOA）及Oswestry功能障碍指数（ODI）。结果 两组患者术中出血量、手术时间、术前腰痛VAS评分、术前及术后腿痛VAS评分、术前ODI与JOA评分比较，差异均无统计学意义（P > 0.05），但术后3 d、术后3和6个月腰痛VAS评分MC组高于对照组（P < 0.01），术后3和6个月MC组JOA评分均低于对照组（P < 0.01），术后3和6个月MC组ODI均高于对照组（P < 0.01），同时与术前相比，两组患者6个月时腰痛VAS评分、腿痛VAS评分、JOA评分及ODI均有改善（P < 0.05）。结论 经皮椎间孔镜术对伴随Modic改变（Ⅱ型）的LDH患者具有良好的疗效，是一种可靠、安全的治疗手段，但Modic改变会影响术后腰痛的缓解，针对此类患者需综合考虑治疗方案。

Abstract:

Objective A retrospective study was conducted to analyze the effect of Modic change type Ⅱ on the therapeutic effect of lumbar disc herniation (LDH) by percutaneous endoscopic lumbar disc discectomy (PELD).Methods 43 patients suffered LDH with or without Modic change type Ⅱ who were treated from January 2018 to December 2019 were included. All these patients underwent PELD treatment. According to the lumbar MRI, they divided into Modic change group (MC group with 23 patients) and pure LDH group (control group with 20 patients). Visual analogue scale (VAS) of lumbar and legs, Japanese Orthopedics Association (JOA) scores and lumbar Oswestry disability index (ODI) were recorded before surgery and during follow-up respectively.Results Operation time, surgical bleeding, pre-operative lumber VAS score, pre-operative and post-operative leg VAS score, pre-operative JOA score and ODI of both two groups has no statistic difference (P > 0.05). However, back pain VAS score of MC group was higher than control group at 3 days, 3 months and 6 months after surgery (P < 0.01). Meanwhile, JOA score of MC group was lower than that in the control group (P < 0.01), and ODI of MC group was higher than that in the control group at 3 months and 6 months after surgery (P < 0.01). Compared with pre-operation, all the indication of the two groups was improved (P < 0.05).Conclusion PELD had excellent clinical outcome for patients who suffered with LDH with Modic change type Ⅱ, and was a safe and reliable clinical technique. However, Modic change can affect the relieve of postoperative back pain. When treated with such patients, comprehensive considerations should be taken into account.