椎体间融合术与单纯髓核摘除术治疗合并ModicⅡ型改变的单节段腰椎间盘突出症的疗效比较

The clinical outcomes comparison between interbody infusion and simple discectomy for single segmental lumbar disc herniation with type Ⅱ Modic changes

中文关键词:  腰椎间盘突出症  Modic Ⅱ型改变  椎体间融合术  髓核摘除术  疗效

英文关键词:Lumbar disc herniation  Modic Ⅱ change  Interbody fusion  Simple discectomy  Surgical outcome

中文摘要:

  【摘要】 目的：比较后路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。方法：将2008年1月~2012年1月因合并Modic Ⅱ型改变的单节段后外侧型腰椎间盘突出症且需手术治疗的62例患者随机分为椎体间融合术组（A组）和单纯髓核摘除术组（B组）。A组31例，男14例，女17例，年龄26~58岁，平均40.77±10.27岁，病变节段L4/5 17例，L5/S1 14例，采用后路单侧开窗、椎间盘切除、椎间cage植入融合内固定术（简称椎体间融合术）。B组31例，男16例，女15例，年龄25~56岁，平均38.48±9.77岁，病变节段L4/5 15例，L5/S1 16例，采用传统的后路开窗椎间盘髓核摘除术（简称单纯髓核摘除术）。两组病例数、男女构成比、平均年龄、平均病程及病变节段无统计学差异（P>0.05）。分别记录两组患者术前1d和术后6、12个月的腰痛VAS评分、腿痛VAS评分及ODI评分，并完成术后6、12个月的Macnab疗效评估。结果：术后共54例患者（A组28例，B组26例）获得随访，腰腿痛均明显减轻。每组术后6、12个月腰痛VAS评分、腿痛VAS评分及ODI评分均明显低于术前（P<0.05），但术后6个月和12个月比较无明显差异（P>0.05）。两组术前腰痛VAS评分、腿痛VAS评分及ODI评分比较无明显差异（P>0.05），术后6、12个月A组的腰痛VAS评分、ODI评分均低于B组（P<0.05），但腿痛VAS评分与B组比较无明显差异（P>0.05）。按照Macnab标准评价，术后6个月，A组优20例、良6例、可2例，B组优10例、良12例、可4例；术后12个月，A组优22例、良5例、可1例，B组优13例、良10例、可3例；A组优良率大于B组（P<0.05）。结论：椎体间融合术治疗合并Modic Ⅱ型改变的腰椎间盘突出症近期疗效优于单纯髓核摘除术。

英文摘要:

  【Abstract】 Objectives: To compare the clinical results of simple discectomy and interbody infusion in single segmental lumbar disc herniation(LDH) with type Ⅱ Modic changes(MCs). Methods: Sixty-two patients suffering from LDH with type Ⅱ MCs treated in our hospital from January 2008 to January 2012 were included in the study. Patients were randomly divided into interbody fusion group and simple discectomy group. There were 31 patients(14 males and 17 females, 17 L4/5 and 14 L5/S1) in the interbody fusion group with a mean age of 40.77±10.27 years(range, 26-58 years). In the simple discectomy group, there were 31 patients(16 males and 15 females, 15 L4/5 and 16 L5/S1) with a mean age of 38.48±9.77 years(range, 25-56 years). There were no significant differences between group A and B in the number of cases, gender, average age, average duration and involved segments(P>0.05). Visual analog scale(VAS) pain scores and Oswestry disability index(ODI) scores were recorded at 1 day preoperatively, 6 and 12 months postoperatively. Macnab clinical efficacy was evaluated at 6 and 12 months postoperatively. Results: Fifty-four patients completed the follow-ups(28 cases in group A and 26 cases in group B). Preoperative VAS and ODI scores showed no statistical differences between 2 groups(P>0.05). The postoperative VAS and ODI scores at 6 and 12 months were significantly lower than the preoperative ones(P<0.05). However, there were no statistical differences between the postoperative 6 and 12 month scores(P>0.05). Low back pain VAS score and ODI score in the interbody fusion group were statistical lower than those in simple discectomy group at 6 and 12 months postoperatively(P<0.05), but the leg pain VAS score showed no statistical difference(P>0.05). According to Macnab result, at 6 months after operation, surgical outcomes were as follows: 20 excellent, 6 good and 2 fair in group A; 10 excellent, 12 good and 4 fair in group B. At 12 months after operation, surgical outcomes were as follows: 22 excellent, 5 good and 1 fair in group A; 13 excellent, 10 good and 3 fair in group B, the interbody fusion group had better results than the simple discectomy group(P<0.05). Conclusions: The early results of interbody fusion are better than those of simple discectomy for single segmental LDH with type Ⅱ MCs.