Modic改变在腰椎后路椎间融合术后变化的对比研究

目的对伴有Modic改变（Modic Changes）的下腰痛（low back pain, LBP）患者行腰椎后路椎间融合术，探讨腰椎后路椎间融合术对伴有Modic改变的下腰痛患者手术节段终板信号的影响，观察术后终板信号的转归情况。方法对2015年1月至2017年12月在本院骨科诊治的86例伴有Modic改变的下腰痛患者进行回顾性分析。所选择的研究对象的病变责任节段均为L4/5间隙，根据术前腰椎核磁共振检查（magnetic resonance imaging，MRI）确定的Modic改变类型进行分组，将患者分成Ⅰ型Modic改变组即A组：30例，Ⅱ型Modic改变组即B组：52例和Ⅲ型Modic改变组即C组：4例。三组患者均进行术前相关检查，且三组患者均由同一组主刀医师完成手术。对三组患者分组进行术前视觉模拟量表评分(visual analog scale，VAS)和Oswestry功能障碍指数(oswestry disability index，ODI)评分；在末次随访时对三组患者再次统计VAS评分和ODI评分及其评分改善率，并要求患者在末次随访时完善腰椎MRI检查，各组之间术前与术后终板信号的转归情况对比，随访半年到一年，平均随访7个月。结果出院后末次随访共完成77例，A组26例，B组49例，C组2例。术前三组的VAS评分，A组分别与B、C组相比较差异均有统计学意义（P＜0.05），B组与C组比较差异无统计学意义（P＞0.05）；术前三组ODI评分，三组之间两两比较差异均有统计学意义（P＜0.05）。术后末次随访时三组的VAS评分，三组之间两两比较差异均无统计学意义（P＞0.05）；末次随访时ODI评分，三组之间两两比较差异均有统计学意义（P＜0.05）。三组患者末次随访时的椎间植骨融合位置良好，未见有假关节形成；末次随访复查腰椎MRI发现A组Ⅰ型Modic改变有4例局部转变为Ⅱ型，余22例未见明显变化；B组Ⅱ型Modic改变有1例转变为正常，余48例未见明显变化；C组Ⅲ型Modic改变未见明显变化。结论在对伴有Modic改变的下腰痛患者行腰椎后路椎间融合术后，在研究随访期间，MRI影像结果显示有部分I型Modic改变在向趋于稳定的Ⅱ型转归，Ⅱ型和Ⅲ型Modic改变为较稳定状态，终板信号未见明显转归。

英文摘要:

Objective To perform lumbar posterior interbody fusion in patients with low back pain with Modic changes, and to investigate the patients with low back pain with Modic changes after the lumbar posterior interbody fusion. The effect of the endplate signal of the surgical segment was observed, and the outcome of the postoperative endplate signal was observed. Methods A retrospective analysis of 86 patients with low back pain with Modic changes who visitedour hospital from January 2015 to December 2017 was retrospectively analyzed. Selected subjects of the disease-responsible segments were all L4/5 gaps, grouped according to the preoperative lumbar magnetic resonance imaging (MRI) patients were divided into three types. Type Ⅰ Modic changes has 30 cases, type Ⅱ Modic changes has 52 cases and type Ⅲ Modic changes has 4 cases. All the three groups of patients underwent preoperative related examinations, and all of them were operated by the same group of surgeons. The three groups of patients were divided into a visual analog scale (VAS) and an Oswestry disability index (ODI) score. At the last follow-up, the VAS score and ODI score and their score improvement rate were re-stated for the three groups of patients. Patients were asked to complete the lumbar MRI at the last follow-up. The outcomes of preoperative and postoperative endplate signals were compared between groups, followed up for six months to one year, with an average follow-up of seven months. Results A total of 77 patients were completed at the last follow-up after discharge, there were 26 patients in group A, 49 patients in group B, and 2 patients in group C. The VAS scores of the three groups before operation were significantly different between the A group and the B or C group (P<0.05). There was no significant difference between the B group and the C group (P>0.05).There were significant differences in the ODI scores between the three groups before surgery (P<0.05).At the last follow-up, the VAS scores of the three groups were not significantly different between the three groups (P>0.05). The ODI scores at the last follow-up were statistically significant between the three groups (P<0.05). The intervertebral fusion of the three groups of patients at the last follow-up was in good position. No pseudo joint formation was observed. At the last follow-up review of lumbar spine MRI, 4 cases of type Ⅰ Modic changes in group A were locally converted to type Ⅱ, and the remaining 22 cases showed no significant changes. One group of type Ⅱ Modic changes in group B changed to normal, and the remaining 48 cases showed no significant changes. There was no significant change in type Ⅲ Modic changes in group C. Conclusion During the study of follow-up, after lumbar posterior interbody fusion in patients with low back pain with Modic changes, MRI image results show that some type Ⅰ Modic changes in the trend toward a stable type Ⅱ outcome. Type Ⅱ and type Ⅲ Modic change to a more stable state, the end-plate signal does not show a significant outcome.

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