[1]王青华 俞鹏飞△ 姜宏 刘锦涛.消髓化核汤治疗伴有终板炎改变的巨大型腰椎间盘突出症[J].中国中医骨伤科杂志,2021,29(01):54-58.
　WANG Qinghua YU Pengfei JIANG Hong LIU Jintao.Clinical Observation of Xiaosui Huahe Decoction in the Treatmentof Giant Lumbar Disc Herniation with Modic Changes[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2021,29(01):54-58.
点击复制

消髓化核汤治疗伴有终板炎改变的巨大型腰椎间盘突出症()
分享到：

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

卷:
第29卷
期数:
2021年01期
页码:
54-58
栏目:
临床报道
出版日期:
2021-01-15

文章信息/Info

Title:
Clinical Observation of Xiaosui Huahe Decoction in the Treatmentof Giant Lumbar Disc Herniation with Modic Changes
文章编号:
1005-0205(2021)01-0054-05
作者:
王青华1 俞鹏飞1△ 姜宏1 刘锦涛1
Author(s):
WANG Qinghua1 YU Pengfei1△ JIANG Hong1 LIU Jintao1
1Suzhou Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine,Suzhou 215009,Jiangsu China.
关键词:
终板炎;  腰椎间盘突出症;  重吸收;  JOA评分
Keywords:
Modic changes;  lumbar disc herniation;  spontaneous regression;  JOA score
分类号:
R681.5
文献标志码:
B
摘要:
目的:观察终板炎改变(Modic改变,即MCs)对口服消髓化核汤保守治疗的巨大型腰椎间盘突出症疗效的影响。方法:分析2018年6月至2019年7月治疗的119例巨大型腰椎间盘突出症患者的病历资料,按照磁共振影像学表现将其分组为伴有Modic改变组和无Modic改变组,所有患者均采用口服中药保守治疗。对两组患者在治疗前及治疗后的磁共振表现突出物大小及日本矫形科学学会(JOA)评分进行对比分析。结果:119例患者均获得有效随访,其中Modic改变组患者重吸收发生率为48.57%,无Modic改变组患者重吸收发生率为70.24%; 两组患者治疗后JOA评分较治疗前均显著提高,差异有统计学意义(P<0.05); 两组患者治疗后JOA评分改善率差异无统计学意义(P>0.05)。结论:MCs并非腰椎间盘突出症患者保守治疗的不利因素,而是腰椎间盘突出症重吸收的不利因素,但当伴有MCs的腰椎间盘突出症患者启动重吸收过程时,MCs并不会影响其突出物重吸收发生率。
Abstract:
To explore the effect of Modic changes(MCs)on Xiaosui Huahe decoction in treating giant lumbar disc herniation.Methods:119 patients with giant lumbar disc herniation were treated from June 2018 to July 2019.They were divided into Modic changed group and no Modic changed group according to their magnetic resonance imaging findings.All patients were treated conservatively by traditional Chinese medicine of Xiaosui Huahe decoction.The size of the herniated lumbar disc on magnetic resonance imaging(MRI)and the scores of the Japanese orthopaedic association(JOA)of the two groups before and after treatment were documented and compared.Results:All 119 patients were followed up effectively.Among them,the incidence of reabsorption in the Modic group was 48.57%,and the incidence of reabsorption in the Modic-free group was 70.24%.After treatment,the JOA scores of the two groups were significantly higher than before treatment(P<0.05).No significant difference was found in the JOA score improvement rate after treatment between two groups(P>0.05).Conclusion:MCs is an unfavorable factor for reabsorption of lumbar disc herniation,but MCs is not unfavorable factor for conservative treatment of patients with intervertebral disc herniation.However,MCs will not affect the reabsorption rate of their protrusions once the herniated lumbar disc reabsorption procedure form patients with changes in MCs start.

参考文献/References:

[1] 戴锋,俞鹏飞,徐坤林,等.中医药保守治疗破裂型腰椎间盘突出症42例[J].中国中医骨伤科杂志,2017,25(11):56-58.
[2] YAMAN M E,KAZANCI A,YAMAN N D,et al.Factors that influence recurrent lumbar disc herniation[J].Hong Kong Med J,2017,23(3):258-263.
[3] 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.
[4] 俞鹏飞,马智佳,刘锦涛.巨大 游离型腰椎间盘突出症非手术治疗的病例研究[M].苏州:苏州大学出版社,2018.
[5] OKTAY K,OZSOY K M,DERE U A,et al.Spontaneous regression of lumbar disc herniations:a retrospective analysis of 5 patients[J].Niger J Clin Pract,2019,22(12):1785-1789.
[6] GUINTO F C,HASHIM H,STUMER M.CT demonstration of disc regression after conservative therapy[J].Am J Neuroradiol,1984,5(5):632-633.
[7] MURPHY K,ELIAS G,STEPPAN J,et al.Percutaneous treatment of herniated lumbar discs with ozone:investigation of the mechanisms of action[J].J Vasc Interv Radiol,2016,27(8):1242-1250.
[8] KAWAGUCHI K,HARIMAYA K,MATSUMOTO Y,et al.Effect of cartilaginous endplates on extruded disc resorption in lumbar disc herniation[J].PLoS One,2018,13(4):e0195946.
[9] SUN H,QI L,WANG S,et al.Hydrogen sulfide is expressed in the human and the rat cultured nucleus pulposus cells and suppresses apoptosis induced by hypoxia[J].PLoS One,2018,13(2):e0192556.
[10] CUNHA C,SILVA A J,PEREIRA P,et al.The inflammatory response in the regression of lumbar disc herniation[J].Arthritis Res Ther,2018,20(1):251.
[11] VISWANATHAN V K,SHETTY A P,RAJASEKARAN S.Modic changes:an evidence-based,narrative review on its patho-physiology,clinical significance and role in chronic low back pain[J].J Clin Orthop Trauma,2020,11(5):761-769.
[12] ELDIN C,MéLENOTTE C,MEDIANNIKOV O,et al.From Q fever to coxiella burnetii infection:a paradigm change[J].Clin Microbiol Rev,2017,30(1):115-190.
[13] KANNA R M,SHANMUGANATHAN R,RAJAGOPALAN V R,et al.Prevalence,patterns,and genetic association analysis of modic vertebral endplate changes[J].Asian Spine J,2017,11(4):594-600.
[14] 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].Spine J,2018,18(5):831-844.
[15] GEORGY M M,VAIDA F,STERN M,et al.Association between type 1 Modic changes and propionibacterium acnes infection in the cervical spine:an observational study[J].Am J Neuroradiol,2018,39(9):1764-1767.
[16] BR?TEN L C H,ROLFSEN M P,ESPELAND A,et al.Efficacy of antibiotic treatment in patients with chronic low back pain and Modic changes(the AIM study):double blind,randomised,placebo controlled,multicentre trial[J].British Med J,2019,367:l5654.
[17] FREIDIN M,KRAATARI M,SKARP S,et al.Genome-wide meta-analysis identifies genetic locus on chromosome 9 associated with Modic changes[J].J Med Genet,2019,56(7):420-426.

备注/Memo

备注/Memo:
基金项目:江苏省自然科学基金项目(BK20190191)江苏省青年医学人才计划项目(QNRC2016257)苏州市科技发展计划项目(SYSD2019220)
1南京中医药大学附属苏州市中医医院(江苏 苏州,215009)
△通信作者 E-mail:yupengfei86@163.com
更新日期/Last Update: 2021-01-15