中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2013年
39期
3111-3115
,共5页
赵栋%邓树才%马毅%郝永宏%贾占华%赵合元
趙棟%鄧樹纔%馬毅%郝永宏%賈佔華%趙閤元
조동%산수재%마의%학영굉%가점화%조합원
椎间盘移位%腰椎%脊柱融合术%磁共振成像%终板
椎間盤移位%腰椎%脊柱融閤術%磁共振成像%終闆
추간반이위%요추%척주융합술%자공진성상%종판
Intervertebral disk displacement%Lumbar vertebrae%Spinal fusion%Magnetic resonace imaging%Endplate
目的 比较单纯开窗间盘摘除术和后路椎间融合术对伴有终板Modic改变的腰椎间盘突出症患者的中远期疗效.方法 回顾2002年1月至2007年1月天津医院脊柱外科486例伴有终板Modic改变的腰椎间盘突出症患者.按手术方式不同,分为开窗组(n =215)和融合组(n=271).分别记录两组患者术前和术后3、6、12个月以及随后每年1次随访时的Oswestry功能障碍指数(ODI)和视觉模拟量表(VAS)评分,并进行统计学分析.结果 所有患者术后平均随访88.9(60～120)个月.末次随访所有患者症状较术前均有明显缓解,融合组腰痛VAS评分平均改善率优于开窗组(77.9％比68.0％)；开窗组腰痛VAS评分改善率ModicⅡ型优于Ⅰ型(72.8％比64.9％)；ModicⅠ型ODI、腰痛VAS评分改善率融合组优于开窗组,分别为(78.3％比70.4％)和(77.4％比64.9％)(P＜0.05).结论 建议对于伴有Modic Ⅰ型改变的腰椎间盘突出患者考虑椎间融合术,而对于伴有ModicⅡ型改变的腰椎间盘突出,如无其他合并因素,可以考虑单纯间盘摘除术.
目的 比較單純開窗間盤摘除術和後路椎間融閤術對伴有終闆Modic改變的腰椎間盤突齣癥患者的中遠期療效.方法 迴顧2002年1月至2007年1月天津醫院脊柱外科486例伴有終闆Modic改變的腰椎間盤突齣癥患者.按手術方式不同,分為開窗組(n =215)和融閤組(n=271).分彆記錄兩組患者術前和術後3、6、12箇月以及隨後每年1次隨訪時的Oswestry功能障礙指數(ODI)和視覺模擬量錶(VAS)評分,併進行統計學分析.結果 所有患者術後平均隨訪88.9(60～120)箇月.末次隨訪所有患者癥狀較術前均有明顯緩解,融閤組腰痛VAS評分平均改善率優于開窗組(77.9％比68.0％)；開窗組腰痛VAS評分改善率ModicⅡ型優于Ⅰ型(72.8％比64.9％)；ModicⅠ型ODI、腰痛VAS評分改善率融閤組優于開窗組,分彆為(78.3％比70.4％)和(77.4％比64.9％)(P＜0.05).結論 建議對于伴有Modic Ⅰ型改變的腰椎間盤突齣患者攷慮椎間融閤術,而對于伴有ModicⅡ型改變的腰椎間盤突齣,如無其他閤併因素,可以攷慮單純間盤摘除術.
목적 비교단순개창간반적제술화후로추간융합술대반유종판Modic개변적요추간반돌출증환자적중원기료효.방법 회고2002년1월지2007년1월천진의원척주외과486례반유종판Modic개변적요추간반돌출증환자.안수술방식불동,분위개창조(n =215)화융합조(n=271).분별기록량조환자술전화술후3、6、12개월이급수후매년1차수방시적Oswestry공능장애지수(ODI)화시각모의량표(VAS)평분,병진행통계학분석.결과 소유환자술후평균수방88.9(60～120)개월.말차수방소유환자증상교술전균유명현완해,융합조요통VAS평분평균개선솔우우개창조(77.9％비68.0％)；개창조요통VAS평분개선솔ModicⅡ형우우Ⅰ형(72.8％비64.9％)；ModicⅠ형ODI、요통VAS평분개선솔융합조우우개창조,분별위(78.3％비70.4％)화(77.4％비64.9％)(P＜0.05).결론 건의대우반유Modic Ⅰ형개변적요추간반돌출환자고필추간융합술,이대우반유ModicⅡ형개변적요추간반돌출,여무기타합병인소,가이고필단순간반적제술.
Objective To retropspectively evaluate medium and long-term outcomes of conventional fenestration discectomy versus posterior lumbar interbody fusion in lumbar disc herniation with Modic changes.Methods From January 2002 to January 2007,a total of 486 patients of lumbar disc herniation with Modic changes were analyzed retrospectively.They were divided into fenestration group (n =215) and fusion group (n =271) according to the operative approaches.The scores of Oswestry disability index (ODI) and visual analog scale (VAS) pre-and post-operative 3,6,12 month and annually were recorded and analyzed.Results All of them had complete records during a mean follow-up period of 88.9 (60-120) months.At the end of the latest follow-up,all symptoms were relieved postoperatively.Significantly difference existed in the improvement rate of back pain VAS between two groups (77.9％ vs 68.0％).In the fenestration group,the improvement rate of VAS (back pain) of Modic type Ⅱ was better than that of Modic type Ⅰ (72.8％ vs 64.9％).And the difference was statistically significant.For those with Modic type Ⅰ changes,the improvement rate of ODI and VAS (back pain) of the fusion group were better than those of the fenestration group (78.3％ vs 70.4％ and 77.4％ vs 64.9％).And the differences were statistically significant (P ＜ 0.05).Conclusion The patients with Modic Ⅰ and Ⅱ changes were recommended to undergo lumbar fusion and undergo fenestration discectomy respectively.
