CAJ | 학술논문

目的：探讨显微椎间盘切除术后终板信号转变及其临床意义。方法2004年7月至2007年1月，我院采用显微椎间盘切除术治疗85例单节段腰椎间盘突出症患者，术前根据 Modic 分型标准分组，Modic 0型33例、ModicⅠ型25例、Modic Ⅱ型27例。采用 VAS 及 ODI 评估手术疗效，观察术后 Modic 退变的临床转归及对手术疗效的影响。结果全部患者均获随访，平均随访4.1年。末次随访时，终板 Modic 退变发生率由术前61.1％升至84.7％，60例患者手术节段为 Modic Ⅱ型。术前 Modic 0型33例，末次随访时7例转变为Ⅰ型，15例转变为Ⅱ型，11例仍为Modic 0型。术前 ModicⅠ型25例，末次随访时18例转变为Ⅱ型，2例逆转为 Modic 0型，5例仍为Ⅰ型。术前 ModicⅡ型27例，随访期间无 Modic 分型变化。术前三组腰腿痛 VAS 及 ODI 评分比较差异无统计学意义（P ＞0.05）；末次随访时均较术前明显改善（P ＜0.05）。末次随访时，三组腰痛 VAS 及 ODI 评分改善率差异有统计学意义（P ＜0.05），但腿痛 VAS 评分差异无统计学意义（P ＞0.05）。三组任意两者间腰痛 VAS 及 ODI 改善率比较均差异有统计学意义（P ＜0.05），疗效比较依次为：Modic Ⅰ型＞ Modic 0型＞ Modic Ⅱ型。结论显微椎间盘切除术是治疗伴 Modic 退变腰椎间盘突出症的有效术式。术后 Modic 分型可以相互转变，可能是腰痛恢复的影响因素。
목적：탐토현미추간반절제술후종판신호전변급기림상의의。방법2004년7월지2007년1월，아원채용현미추간반절제술치료85례단절단요추간반돌출증환자，술전근거 Modic 분형표준분조，Modic 0형33례、ModicⅠ형25례、Modic Ⅱ형27례。채용 VAS 급 ODI 평고수술료효，관찰술후 Modic 퇴변적림상전귀급대수술료효적영향。결과전부환자균획수방，평균수방4.1년。말차수방시，종판 Modic 퇴변발생솔유술전61.1％승지84.7％，60례환자수술절단위 Modic Ⅱ형。술전 Modic 0형33례，말차수방시7례전변위Ⅰ형，15례전변위Ⅱ형，11례잉위Modic 0형。술전 ModicⅠ형25례，말차수방시18례전변위Ⅱ형，2례역전위 Modic 0형，5례잉위Ⅰ형。술전 ModicⅡ형27례，수방기간무 Modic 분형변화。술전삼조요퇴통 VAS 급 ODI 평분비교차이무통계학의의（P ＞0.05）；말차수방시균교술전명현개선（P ＜0.05）。말차수방시，삼조요통 VAS 급 ODI 평분개선솔차이유통계학의의（P ＜0.05），단퇴통 VAS 평분차이무통계학의의（P ＞0.05）。삼조임의량자간요통 VAS 급 ODI 개선솔비교균차이유통계학의의（P ＜0.05），료효비교의차위：Modic Ⅰ형＞ Modic 0형＞ Modic Ⅱ형。결론현미추간반절제술시치료반 Modic 퇴변요추간반돌출증적유효술식。술후 Modic 분형가이상호전변，가능시요통회복적영향인소。
Objective To evaluate the clinical course of Modic changes and significance following microendoscopic dis-cectomy. Methods A retrospective analysis was made in 85 patients with single-level lumbar disc herniation who underwent microendoscopic discectomy and had complete follow-up data from July 2004 to January 2007. According to Modic classification standard,85 patients were divided into three groups:Modic type 0(n = 33 cases),Modic type Ⅰ(n = 25 cases),Modic type Ⅱ(n = 27 cases). The operative effect was assessed according to Visual Analogue Score(VAS)and Oswestry Disability Index (ODI). Then,the clinical course of Modic changes and impact to operative effect were observed. Results All patients were followed up for 4. 1 years on average. At last follow-up,the prevalence of Modic changes increased from 61. 1% to 84. 7% ,and 60 patients had Modic Type Ⅱ at the operated level. Of the 33 patients without Modic changes,7 converted to Type Ⅰ,15 to Type Ⅱ,11 remained Type 0. Of the 25 Type Ⅰ changes,18 converted to Type Ⅱ,2 reversed to Modic Type 0,5 remained Type Ⅰ. None of the 27 Type Ⅱ changes converted to the other type. There were no significant differences in VAS(low back pain and leg pain)and ODI score within three groups before operation(P > 0. 05). At last follow-up,VAS(low back pain and leg pain)and ODI score were significantly improved(P < 0. 05). At last follow-up,there were significant differences in low back pain VAS and ODI score improvement rate within three groups(P < 0. 05),but the leg pain VAS score were not signifi-cant differences within the three(P > 0. 05). There were significant differences in low back pain VAS and ODI score improve-ment rate in any two groups within the three(P < 0 05),operative effect comparison as follows:Modic type Ⅰ > Modic type 0> Modic type Ⅱ. Conclusion Microendoscopic discectomy is an effective treatment for lumbar disc herniation. Modic chan-ges can convert each other following discectomy,and appear to affect the prognosis of low back pain.