下腰痛患者伴腰椎核磁上Modic改变或椎间盘高信号区手术疗效分析

摘要

目的：探讨下腰痛患者伴腰椎核磁上Modic改变或椎间盘高信号区（HIZ）的手术疗效。方法回顾性分析2011年3月至2012年6月入院的32例行腰椎后路植骨融合内固定术的腰椎间盘突出症患者和17例行椎间盘内射频消融术的椎间盘源性腰痛患者的临床资料，腰椎间盘突出症患者按入院时核磁分为Ⅰ组（不伴M o dic改变组）和Ⅱ组（伴M o dic改变组），其中Ⅱ组再进一步分为Ⅱa组（ModicⅠ型）和Ⅱb组（ModicⅡ型）；椎间盘源性腰痛患者按入院时核磁分为A组（不伴HIZ组）和B组（伴HIZ组）。分别记录各组患者术前及随访时视觉疼痛模拟量表（VAS）评分和Oswestry 功能障碍指数评分（ODI），并进行统计分析。结果术后所有患者VAS评分及ODI评分都得到不同程度的改善，且与术前比较均差异有统计学意义（P＜0．05）。对于腰椎间盘突出症患者，3组间比较差异无统计学意义（P＞0．05）；对于腰椎间盘源性疼痛患者，A组与B组之间比较，A组腰痛缓解明显优于B组，且差异有统计学意义（P＜0．05），腿痛VAS评分和ODI评分差异无统计学意义（P＞0．05）。结论对于伴Modic改变的腰椎间盘突出症患者，腰椎后路植骨融合内固定术是一种有效的手术方式，可获得较好的临床效果；对于伴 H IZ的椎间盘源性腰痛患者，椎间盘内射频消融术可使临床症状获得一些缓解，但效果欠佳。%Objective To explore the effect of surgical treatment of low back pain patients with Modic change or high intensity zone(HIZ) on MRI of the lumbar spine .Methods 32 cases with intervertebral disc herniation underwent posterior lumbar inter-body fusion and 17 cases with lumbar discogenic pain underwent radiofrequency ablation from March 2011 to July 2012 were retro-spectively reviewed .For intervertebral disc herniation patients ,all patients were divided into two groups :groupⅠ (no with Modic changes group)and groupⅡ(with Modic changes group) ,according to the Admission MRI .GroupⅡ was sub-divided intoⅡa(Mod-ic type Ⅰgroup) andⅡb(Modic type Ⅱgroup) .For lumbar discogenic pain patients ,all patients were divided into group A (without HIZ group) and group B(with HIZ group) .The VAS and ODI scales at the preoperative and follow-up were recorded and analyzed . Results The postoperative scores of VAS and ODI of all the patients were improved ,and the difference was statistically significant (P<0 .05) .For intervertebral disc herniation patients ,three groups have no statistically significant difference (P>0 .05) .For lum-bar discogenic pain patients ,the improvement rate of VAS (low backpain) of A was better than that of B ,and the difference was sta-tistically significant(P<0 .05) ,but the differences of VAS (leg pain) and ODI scores weren′t statistically significant (P>0 .05) . Conclusion Posterior lumbar interbody fusion is effective for lumbar disc herniation patients with Modic changes ,and can obtain good clinical effect .For lumbar discogenic pain patients with high intensity zone on MRI ,radiofrequency ablation can cause clinical symptoms get some relief ,but the effect is poor .