葛灵 秦璟灏 仇胥斌 张建伟 吴亮

【摘要】 目的：分析Modic改变对椎间孔镜下治疗腰椎间盘突出症术后效果的影响。方法：选取2019年1月-2020年6月在本院采用椎间孔镜下进行治疗的腰椎间盘突出症患者90例，根据核磁共振成像分析是否合并Modic改变分为观察组（存在Modic改变）和对照组（无Modic改变），每组45例。比较两组手术前后日本骨科协会（JOA）评分、视觉模拟评分法（VAS）评分、血清5-羟色胺（5-hydroxytryptamine，5-HT）和前列腺素E2（prostaglandin E2，PGE2）水平，比較两组临床治疗效果。结果：两组治疗总有效率比较，差异无统计学意义（P>0.05）。术前，两组JOA、VAS评分和血清5-HT、PGE2水平比较，差异均无统计学意义（P>0.05）;术后3个月，两组JOA评分比较，差异无统计学意义（P>0.05）。术后3个月，观察组血清5-HT、PGE2水平和VAS评分均显著高于对照组，差异均有统计学意义（P<0.05）。结论：椎间孔镜治疗腰椎间盘突出症合并Modic改变的临床效果较好，Modic改变可能会影响患者术后的疼痛指标。

【关键词】 磁共振成像 经皮椎间孔镜 Modic改变 腰椎间盘突出症

Analysis of the Influence of Modic Change on the Postoperative Effect of Lumbar Disc Herniation under Foraminal Microscopy/GE Ling， QIN Jinghao， QIU Xubin， ZHANG Jianwei， WU Liang. //Medical Innovation of China， 2021， 18（33）： 0-035

[Abstract] Objective： To analyze the influence of Modic change on the postoperative effect of lumbar disc herniation under foraminal microscopy. Method： A total of 90 patients with lumbar disc herniation treated by foraminal microscopy in our hospital from January 2019 to June 2020 were selected， according to whether Modic changes were combined with MRI analysis， they were divided into observation group （with Modic changes） and control group （without Modic changes）， 45 cases in each group. The Japanese Orthopaedic Association （JOA） score， visual analog scale （VAS） score， serum 5-hydroxytryptamine （5-HT） and prostaglandin E2 （PGE2） levels were compared between the two groups before and after surgery， and the clinical treatment effect was compared between the two groups. Result： There was no significant difference in the total effective rate between the two groups （P>0.05）. Before surgery， there were no significant differences in JOA and VAS scores and serum 5-HT and PGE2 levels between the two groups （P>0.05）. 3 months after surgery， there was no significant difference in JOA score between the two groups （P>0.05）. 3 months after surgery， serum 5-HT and PGE2 levels and VAS score in the observation group were significantly higher than those in the control group， the differences were statistically significant （P<0.05）. Conclusion： The clinical effect of foraminal endoscopy in the treatment of lumbar disc herniation combined with Modic changes is good， and Modic changes may affect the postoperative pain index of patients.

[Key words] Magnetic resonance imaging Percutaneous foraminoscopy Modic change Lumbar disc herniation

First-author’s address： The Third Affiliated Hospital of Soochow University， Changzhou 213003， China

doi：10.3969/j.issn.1674-4985.2021.33.009

腰椎间盘突出症是中老年的多发疾病之一，以臀部、腰骶部、后背部疼痛为主要症状。长期以来，人们普遍认为腰椎间盘突出症是导致腰痛的主要原因，然而，据统计，仅有20%～30%的患者可明确腰痛成因。随着核磁共振成像（magnetic resonance imaging，MRI）技术的不断发展，借助MRI成像原理，发现了腰痛患者的诸多阳性病变，如终板炎（Modic改变）、腰椎间盘突出等。软骨终板处于椎间盘的上下位置，对脊柱发挥着稳定、连接及抗压等重要作用[1-2]。Modic改变是指MRI上显示邻近椎体终板退变导致的骨髓信号改变，倪婷等[3]研究发现Modic改变与机体下腰痛及腰椎间盘退变均具有相关性。……