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[1]秦曉彬,翟亞業(yè),李含,等.合并Modic改變對經(jīng)皮內(nèi)鏡椎間孔入路椎間盤切除術治療腰椎間盤突出癥療效的影響[J].中醫(yī)正骨,2022,34(09):17.
　QIN Xiaobin,ZHAI Yaye,LI Han,et al.Effects of Modic changes on the clinical outcomes of percutaneous endoscopic transforaminal discectomy for treatment of lumbar disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(09):17.
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合并Modic改變對經(jīng)皮內(nèi)鏡椎間孔入路椎間盤切除術治療腰椎間盤突出癥療效的影響()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期數(shù):
2022年09期
頁碼:
17
欄目:
臨床研究
出版日期:
2022-09-20

文章信息/Info

Title:
Effects of Modic changes on the clinical outcomes of percutaneous endoscopic transforaminal discectomy for treatment of lumbar disc herniation
作者:
秦曉彬; 翟亞業(yè); 李含; 孫秀欽; 張超遠
(南陽市中心醫(yī)院,河南南陽473009)
Author(s):
QIN Xiaobin; ZHAI Yaye; LI Han; SUN Xiuqin; ZHANG Chaoyuan
Nanyang Central Hospital,Nanyang 473009,Henan,China
關鍵詞:
椎間盤移位;  腰椎;  Modic改變;  內(nèi)窺鏡;  椎間盤切除術
Keywords:
intervertebral disc displacement;  lumbar vertebrae;  Modic changes;  endoscopes;  diskectomy
摘要:
目的:探討合并Modic改變對經(jīng)皮內(nèi)鏡椎間孔入路椎間盤切除術(percutaneous endoscopic transforaminal discectomy,PETD)治療腰椎間盤突出癥療效的影響。方法:收集2016年1月至2018年12月在南陽市中心醫(yī)院采用PETD治療的腰椎間盤突出癥患者的病例資料,從中提取數(shù)據(jù)。按照合并Modic改變情況,將符合要求的患者分為無Modic改變組、ModicⅠ型改變組和ModicⅡ型改變組。比較3組患者的腰痛視覺模擬量表(visual analogue scale,VAS)評分、腿痛VAS評分、Oswestry功能障礙指數(shù)(Oswestry disability index,ODI)、以改良Macnab分級標準評價的綜合療效、腰椎間盤突出癥復發(fā)情況。結果:①分組結果。共納入142例患者,無Modic改變組62例、ModicⅠ型改變組32例、ModicⅡ型改變組48例。②腰痛VAS評分。術前3組患者的腰痛VAS評分比較,差異無統(tǒng)計學意義[(5.53±0.82)分,(5.31±0.90)分,(5.44±0.90)分,F=0.689,P=0.504]。末次隨訪時3組患者的腰痛VAS評分均較術前降低(t=25.983,P=0.000; t=12.810,P=0.000; t=20.666,P=0.000)。末次隨訪時3組患者的腰痛VAS評分比較,差異有統(tǒng)計學意義[(1.26±0.96)分,(2.16±0.85)分,(2.02±0.98)分,F=13.363,P=0.000]; ModicⅠ型改變組和ModicⅡ型改變組的腰痛VAS評分均高于無Modic改變組(P=0.000; P=0.000); ModicⅠ型改變組和ModicⅡ型改變組的腰痛VAS評分比較,差異無統(tǒng)計學意義(P=1.000)。③腿痛VAS評分。術前3組患者的腿痛VAS評分比較,差異無統(tǒng)計學意義[(7.19±0.97)分,(7.03±0.78)分,(6.92±0.96)分,F=1.221,P=0.307]。末次隨訪時3組患者的腿痛VAS評分均較術前降低(t=30.137,P=0.000; t=25.393,P=0.000; t=29.662,P=0.000)。末次隨訪時3組患者的腿痛VAS評分比較,差異無統(tǒng)計學意義[(1.42±1.08)分,(1.38±0.91)分,(1.48±1.03)分,F=0.104,P=0.901]。④ODI。術前3組患者的ODI比較,差異無統(tǒng)計學意義[(59.90±8.68)%,(61.75±10.95)%,(60.38±7.73)%,F=0.455,P=0.635]。末次隨訪時3組患者的ODI均較術前降低(t=34.613,P=0.000; t=15.577,P=0.000; t=25.133,P=0.000)。末次隨訪時3組患者的ODI比較,差異有統(tǒng)計學意義[(11.26±6.82)%,(21.13±7.55)%,(19.71±9.61)%,F=22.364,P=0.000]; ModicⅠ型改變組和ModicⅡ型改變組的ODI均高于無Modic改變組(P=0.000; P=0.000); ModicⅠ型改變組和ModicⅡ型改變組的ODI比較,差異無統(tǒng)計學意義(P=1.000)。⑤綜合療效。末次隨訪時,按照改良Macnab標準評定綜合療效,無Modic改變組優(yōu)39例、良18例、可4例、差1例,ModicⅠ型改變組優(yōu)14例、良10例、可6例、差2例,ModicⅡ型改變組優(yōu)21例、良16例、可9例、差2例。3組患者的綜合療效比較,差異有統(tǒng)計學意義(χ2=6.935,P=0.031); 無Modic改變組的綜合療效優(yōu)于ModicⅠ型改變組和ModicⅡ型改變組(χ2=-17.192,P=0.035; χ2=-16.285,P=0.023),ModicⅠ型改變組和ModicⅡ型改變組綜合療效的差異無統(tǒng)計學意義(χ2=0.906,P=0.915)。⑥腰椎間盤突出癥復發(fā)情況。至隨訪結束時,無Modic改變組2例復發(fā)、ModicⅠ型改變組5例復發(fā)、ModicⅡ型改變組7例復發(fā); 3組患者的復發(fā)率比較,差異有統(tǒng)計學意義(χ2=5.969,P=0.049)。進一步兩兩比較(α'=0.017),組間差異均無統(tǒng)計學意義(P=0.043; P=0.040; P=1.000)。復發(fā)患者再次行PETD或經(jīng)椎間孔腰椎椎體間融合術治療后,癥狀均緩解。結論:合并Modic改變會影響腰椎間盤突出癥PETD術后癥狀緩解。
Abstract:
Objective:To explore the effects of Modic changes(MCs)on the clinical outcomes of percutaneous endoscopic transforaminal discectomy(PETD)for treatment of lumbar disc herniation(LDH).Methods:The medical records of patients who underwent PETD for LDH in Nanyang Central Hospital from January 2016 to December 2018 were collected,and the information of patients enrolled in the study was extracted from their medical records,and they were divided into non-MCs group,typeⅠMCs group and typeⅡMCs group according to whether combined with MCs and its severity.The low back pain visual analogue scale(VAS)score,leg pain VAS score,Oswestry disability index(ODI),total outcomes evaluated by using modified Macnab's criterion and LDH recurrence were compared between the 3 groups.Results:①One hundred and forty-two patients were enrolled in the study,62 cases in non-MCs group,32 cases in typeⅠMCs group and 48 cases in typeⅡMCs group.②There was no statistical difference in low back pain VAS score between the 3 groups before PETD(5.53±0.82,5.31±0.90,5.44±0.90 points,F=0.689,P=0.504).The low back pain VAS scores decreased in the 3 groups at the last follow-up compared to pre-PETD(t=25.983,P=0.000; t=12.810,P=0.000; t=20.666,P=0.000).There was statistical difference in low back pain VAS score between the 3 groups at the last follow-up(1.26±0.96,2.16±0.85,2.02±0.98 points,F=13.363,P=0.000).The low back pain VAS scores were lower in non-MCs group compared to typeⅠMCs group and typeⅡMCs group(P=0.000; P=0.000),while there was no statistical difference between typeⅠMCs group and typeⅡMCs group(P=1.000).③There was no statistical difference in leg pain VAS score between the 3 groups before PETD(7.19±0.97,7.03±0.78,6.92±0.96 points,F=1.221,P=0.307).The leg pain VAS scores decreased in the 3 groups at the last follow-up compared to pre-PETD(t=30.137,P=0.000; t=25.393,P=0.000; t=29.662,P=0.000).There was no statistical difference in leg pain VAS scores between the 3 groups at the last follow-up(1.42±1.08,1.38±0.91,1.48±1.03 points,F=0.104,P=0.901).④There was no statistical difference in ODI between the 3 groups before PETD(59.90±8.68,61.75±10.95,60.38±7.73%,F=0.455,P=0.635).The ODI decreased in the 3 groups at the last follow-up compared to pre-PETD(t=34.613,P=0.000; t=15.577,P=0.000; t=25.133,P=0.000).There was statistical difference in ODI between the 3 groups at the last follow-up(11.26±6.82,21.13±7.55,19.71±9.61%,F=22.364,P=0.000).The ODI was lower in non-MCs group compared to typeⅠMCs group and typeⅡMCs group(P=0.000; P=0.000),while there was no statistical difference between typeⅠMCs group and typeⅡMCs group(P=1.000).⑤At the last follow-up,the total outcomes were evaluated according to the modified Macnab's criterion.Thirty-nine patients obtained an excellent result,18 good,4 fair and 1 poor in non-MCs group; 14 ones obtained an excellent result,10 good,6 fair and 2 poor in typeⅠMCs group; and 21 ones obtained an excellent result,16 good,9 fair and 2 poor in typeⅡMCs group.There was statistical difference in the total outcomes between the 3 groups(χ2=6.935,P=0.031).The total outcomes were better in non-MCs group compared to typeⅠMCs group and typeⅡMCs group(χ2=-17.192,P=0.035; χ2=-16.285,P=0.023),while there was no statistical difference between typeⅠMCs group and typeⅡMCs group(χ2=0.906,P=0.915).⑥The LDH recurrence was found in 2 patients in non-MCs group,5 cases in typeⅠMCs group and 7 cases in typeⅡMCs group by the end of follow-up,and the symptoms were relieved after treatment with another PETD or transforminal lumbar interbody fusion.There was statistical difference in the recurrence rate of LDH between the 3 groups(χ2=5.969,P=0.049).Further pairwise comparison(α'=0.017)showed that there was no statistical difference in the recurrence rate of LDH between the 3 groups(P=0.043; P=0.040; P=1.000).Conclusion:Modic changes can affect the relief of symptoms in LDH patients after PETD.

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更新日期/Last Update: 1900-01-01