[1]任冬杰 王羽丰△ 林定坤 李永津.终板炎对经皮椎间孔镜治疗腰椎间盘突出症疗效的影响[J].中国中医骨伤科杂志,2020,28(07):38-42.
 REN Dongjie WANG Yufeng LIN Dingkun LI Yongjin.The Effect of Modic Changes on the Treatment of Lumbar Disc Herniation by Percutaneous Endoscopic Lumbar Discectomy[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2020,28(07):38-42.
点击复制

终板炎对经皮椎间孔镜治疗腰椎间盘突出症疗效的影响()
分享到:

《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第28卷
期数:
2020年07期
页码:
38-42
栏目:
临床研究
出版日期:
2020-07-10

文章信息/Info

Title:
The Effect of Modic Changes on the Treatment of Lumbar Disc Herniation by Percutaneous Endoscopic Lumbar Discectomy
文章编号:
1005-0205(2020)07-0038-05
作者:
任冬杰1 王羽丰2△ 林定坤2 李永津2
1广州中医药大学第二临床医学院(广州,510405) 2广东省中医院
Author(s):
REN Dongjie1 WANG Yufeng2△ LIN Dingkun2 LI Yongjin2
1The Second Clinical College of Guangzhou University of Chinese Medicine,Guangzhou 510405,China; 2Guangdong Province Traditional Chinese Medical Hospital,Guangzhou 510120,China.
关键词:
腰椎间盘突出症 腰痛 终板炎 经皮椎间孔镜
Keywords:
lumbar disc herniation low back pain Modic changes percutaneous endoscopic lumbar discectomy
分类号:
R681.5
文献标志码:
A
摘要:
目的:通过回顾性分析终板炎(Modic改变)对经皮椎间孔镜治疗腰椎间盘突出症疗效的影响。方法:选取本院在2017年1月至2018年12月期间97例经皮椎间孔镜治疗腰椎间盘突出症伴或不伴Modic改变的患者,根据腰椎核磁共振成像(MRI)分析有无终板Modic改变,分为Modic改变组和无Modic改变组,其中Modic改变组(A组)54例,无Modic改变组(B组)53例。两组病例数、男女构成比、平均年龄、病变节段差异无统计学意义(P>0.05)。分别记录两组术前及随访时的视觉疼痛模拟量表(VAS)和改良Macnab的疗效评估。结果:两组术后1 d及术后6,12个月腰痛、腿痛VAS评分均明显低于术前,差异有统计学意义(P<0.05)。术后6,12个月两组腰痛的VAS评分比较,A组的腰痛VAS评分均高于B组,差异有统计学意义(P<0.05); 术后6,12个月,B组的优良率均大于A组,差异有统计学意义(P<0.05); Modic改变与经皮椎间孔镜术后复发没有明显的相关性(P>0.05)。结论:经皮椎间孔镜治疗合并Modic改变的腰椎间盘突出症是一种安全有效的技术手段,Modic改变可能会影响术后腰痛的缓解,但Modic改变不是经皮椎间孔镜术后复发的危险因素。
Abstract:
Objective:A retrospective study to analyze the effect of Modic changes on the treatment of lumbar disc herniation(LDH)by percutaneous endoscopic lumbar discectomy(PELD). Methods:97 patients suffered LDH with or without Modic changes who were treated in our hospital from January 2017 to December 2018 were included. All patients underwent PELD treatment. According to the lumbar magnetic resonance imaging,they were divided into Modic changes group(group A with 54 cases)and no Modic changes group(group B with 53 cases). There was no significant difference in the number of cases,gender,average age,and pathological segment between the two groups(P>0.05). Visual analog scale(VAS)pain scores and modified Macnab clinical were recorded before surgery and during follow-up. Results:Postoperative VAS scores at one day at 6 and 12 months of low back pain and leg pain in the two groups were significantly lower than the preoperative one,the difference was statistically significant(P<0.05). Postoperative VAS scores of low back pain were higher in group A than it in group B at 6 and 12 months(P<0.05). The excellent and good rates in group B were higher than those in group A at 6 and 12 months after surgery(P<0.05). There was no significant correlation between Modic changes and recurrence after PELD(P>0.05). Conclusion:PELD is a safe and effective technique for the treatment of LDH with Modic changes. Modic changes may affect the relief of postoperative low back pain but is not a risk factor for recurrence after PELD.

参考文献/References:

[1] WEISHAUPT D,ZANETTI M,HODLER J,et al.Painful lumbar disk derangement relevance of endplate abnormalities at MR imaging [J]. Radiology,2001,218(2):420-427.
[2] MAATTA J H,WADGE S,MACGREGOR A,et al.ISSLS prize winner:vertebral endplate(Modic)change is an independent risk factor for episodes of severe and disabling low back pain[J].Spine,2015,40(15):1187-1193.
[3] FIELDS A J,BALLATORI A,LIEBENBERG E C,et al.Contribution of the endplates to disc degeneration[J].Current Molecular Biology Reports,2018,4(4):151-160.
[4] MOK F P S,SAMARTZIS D,KARPPINEN J,et al.Modic changes of the lumbar spine:prevalence,risk factors,and association with disc degeneration and low back pain in a large-scale population-based cohort[J].The Spine Journal,2016,16(1):32-41.
[5] OHTORI S,INOUE G,ITO T,et al.Tumor necrosis factor-immunoreactive cells and PGP9.5-immunoreactive nerve fibers in vertebral endplates of patients with discogenic low back Pain and Modic type 1 or type 2 changes on MRI[J].Spine,2006,31(9):1026-1031.
[6] DUDLI S,LIEBENBERG E,MAGNITSKY S,et al.Modic type 1 change is an autoimmune response that requires a proinflammatory milieu provided by the 'Modic disc'[J].The Spine Journal:Official Journal of the North American Spine Society,2018,18(5):831-844.
[7] DUDLI S,SING D C,HU S S,et al.ISSIS prize in basic science 2017:intervertebral disc/bone marrow cross-talk with Modic changes [J].Eur Spine J,2017,26(5):1362-1373.
[8] OHTORI S,YAMASHITA M,YAMAUCHI K,et al.Low back pain after lumbar discectomy in patients showing endplate Modic type 1 change [J]. Spine,2010,35(13):596-600.
[9] 贺宪,黄东生,梁安靖,等.椎体间融合术与单纯髓核摘除术治疗合并Modic Ⅱ型改变的单节段腰椎间盘突出症的疗效比较[J].中国脊柱脊髓杂志,2014,24(11):1007-1012.
[10] DONG Z,HU C D,YI M,et al.Surgical options and clinical outcomes in patients of lumbar disc herniation with Modic changes [J].Chinese Medical Journal,2013,93(39):3111-3115.
[11] WANG H,ZHOU Y,LI C,et al.Risk factors for failure of single-level percutaneous endoscopic lumbar discectomy[J].Journal of Neurosurgery Spine,2015,23(3):320-325.
[12] SUNG K H,DUCK Y J,IL J C.Predictive scoring and risk factors of early recurrence after percutaneous endoscopic lumbar discectomy[J]. BioMed Research International,2019:6492675.
[13] 张坡,王运涛,洪鑫,等.经皮内窥镜下腰椎间盘切除术治疗腰椎间盘突出症术后再手术的危险因素分析[J].中国脊柱脊髓杂志,2019,29(4):319-24.
[14] 李莹,唐谨,吴从俊,等.椎间孔镜下治疗腰椎间盘突出症术后复发相关因素及再次处理效果探讨[J].中国中医骨伤科杂志,2018,26(11):37-41.
[15] 梁智林,海涌,杨晋才,等.经皮椎间孔镜治疗腰椎间盘突出症术后复发影响因素研究[J].中国骨与关节杂志,2020,9(1):5-10.
[16] SHEN Z,ZHONG Z M,WU Q,et al. Predictors for poor outcomes after percutaneous endoscopic lumbar discectomy:a retrospective study of 241 patients [J]. World Neurosurgery,2019,126:e422-e431.

备注/Memo

备注/Memo:
(收稿日期:2020-01-10) 通信作者 E-mail:wyf1974@139.com
更新日期/Last Update: 2020-07-10