[1]秦晓彬,翟亚业,李含,等.合并Modic改变对经皮内镜椎间孔入路椎间盘切除术治疗腰椎间盘突出症疗效的影响[J].中医正骨,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改变对经皮内镜椎间孔入路椎间盘切除术治疗腰椎间盘突出症疗效的影响()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期数:
2022年09期
页码:
17
栏目:
临床研究
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:
秦晓彬; 翟亚业; 李含; 孙秀钦; 张超远
(南阳市中心医院,河南南阳473009)
Author(s):
QIN Xiaobin; ZHAI Yaye; LI Han; SUN Xiuqin; ZHANG Chaoyuan
Nanyang Central Hospital,Nanyang 473009,Henan,China
关键词:
椎间盘移位;  腰椎;  Modic改变;  内窥镜;  椎间盘切除术
Keywords:
intervertebral disc displacement;  lumbar vertebrae;  Modic changes;  endoscopes;  diskectomy
摘要:
目的:探讨合并Modic改变对经皮内镜椎间孔入路椎间盘切除术(percutaneous endoscopic transforaminal discectomy,PETD)治疗腰椎间盘突出症疗效的影响。方法:收集2016年1月至2018年12月在南阳市中心医院采用PETD治疗的腰椎间盘突出症患者的病例资料,从中提取数据。按照合并Modic改变情况,将符合要求的患者分为无Modic改变组、ModicⅠ型改变组和ModicⅡ型改变组。比较3组患者的腰痛视觉模拟量表(visual analogue scale,VAS)评分、腿痛VAS评分、Oswestry功能障碍指数(Oswestry disability index,ODI)、以改良Macnab分级标准评价的综合疗效、腰椎间盘突出症复发情况。结果:①分组结果。共纳入142例患者,无Modic改变组62例、ModicⅠ型改变组32例、ModicⅡ型改变组48例。②腰痛VAS评分。术前3组患者的腰痛VAS评分比较,差异无统计学意义[(5.53±0.82)分,(5.31±0.90)分,(5.44±0.90)分,F=0.689,P=0.504]。末次随访时3组患者的腰痛VAS评分均较术前降低(t=25.983,P=0.000; t=12.810,P=0.000; t=20.666,P=0.000)。末次随访时3组患者的腰痛VAS评分比较,差异有统计学意义[(1.26±0.96)分,(2.16±0.85)分,(2.02±0.98)分,F=13.363,P=0.000]; ModicⅠ型改变组和ModicⅡ型改变组的腰痛VAS评分均高于无Modic改变组(P=0.000; P=0.000); ModicⅠ型改变组和ModicⅡ型改变组的腰痛VAS评分比较,差异无统计学意义(P=1.000)。③腿痛VAS评分。术前3组患者的腿痛VAS评分比较,差异无统计学意义[(7.19±0.97)分,(7.03±0.78)分,(6.92±0.96)分,F=1.221,P=0.307]。末次随访时3组患者的腿痛VAS评分均较术前降低(t=30.137,P=0.000; t=25.393,P=0.000; t=29.662,P=0.000)。末次随访时3组患者的腿痛VAS评分比较,差异无统计学意义[(1.42±1.08)分,(1.38±0.91)分,(1.48±1.03)分,F=0.104,P=0.901]。④ODI。术前3组患者的ODI比较,差异无统计学意义[(59.90±8.68)%,(61.75±10.95)%,(60.38±7.73)%,F=0.455,P=0.635]。末次随访时3组患者的ODI均较术前降低(t=34.613,P=0.000; t=15.577,P=0.000; t=25.133,P=0.000)。末次随访时3组患者的ODI比较,差异有统计学意义[(11.26±6.82)%,(21.13±7.55)%,(19.71±9.61)%,F=22.364,P=0.000]; ModicⅠ型改变组和ModicⅡ型改变组的ODI均高于无Modic改变组(P=0.000; P=0.000); ModicⅠ型改变组和ModicⅡ型改变组的ODI比较,差异无统计学意义(P=1.000)。⑤综合疗效。末次随访时,按照改良Macnab标准评定综合疗效,无Modic改变组优39例、良18例、可4例、差1例,ModicⅠ型改变组优14例、良10例、可6例、差2例,ModicⅡ型改变组优21例、良16例、可9例、差2例。3组患者的综合疗效比较,差异有统计学意义(χ2=6.935,P=0.031); 无Modic改变组的综合疗效优于ModicⅠ型改变组和ModicⅡ型改变组(χ2=-17.192,P=0.035; χ2=-16.285,P=0.023),ModicⅠ型改变组和ModicⅡ型改变组综合疗效的差异无统计学意义(χ2=0.906,P=0.915)。⑥腰椎间盘突出症复发情况。至随访结束时,无Modic改变组2例复发、ModicⅠ型改变组5例复发、ModicⅡ型改变组7例复发; 3组患者的复发率比较,差异有统计学意义(χ2=5.969,P=0.049)。进一步两两比较(α'=0.017),组间差异均无统计学意义(P=0.043; P=0.040; P=1.000)。复发患者再次行PETD或经椎间孔腰椎椎体间融合术治疗后,症状均缓解。结论:合并Modic改变会影响腰椎间盘突出症PETD术后症状缓解。
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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