后路椎间融合术（PLIF）联合经皮椎弓根螺钉内固定治疗 2 型硬化性 Modic 改变：一项回顾性研究。
Type 2 sclerotic Modic change affect fusion result in patients undergoing PLIF with pedicle screw instrumentation: a retrospective study.
机构信息
Guangxi Medical University, 22 Shuangyong Road, Nanning, Guangxi, China.
The Fourth Affiliated Hospital of Guangxi Medical University, 1 Liushi Road, Liuzhou, Guangxi, China.
出版信息
BMC Musculoskelet Disord. 2021 Jun 28;22(1):598. doi: 10.1186/s12891-021-04461-9.
BACKGROUND
Bony fusion rate was significantly lower in patients with type 3 Modic change than patients with normal endplates. It is not known whether there are relevant differences in fusion efficiency among patients with type 2 sclerotic Modic change or non-sclerotic Modic change, or no Modic change.
METHODS
A retrospective study contained 196 lumbar segments in 123 subjects undergoing posterior lumbar interbody fusion (PLIF) with pedicle screw instrumentation (PSI) to assess the effect of type 2 sclerotic Modic change on fusion efficiency. These endplates were allocated into groups A, B, and C, according to their Modic changes. Group A had endplates with type 2 Modic change and endplate sclerosis. Group B had type 2 Modic change without endplate sclerosis. Group C had neither Modic change nor endplate sclerosis. The presence of Modic change was determined by magnetic resonance imaging (MRI). Endplate sclerosis in type 2 Modic change was detected by computed tomography (CT) before the operation. We collected CT data 3 months to more than 24 months after operation in patients to assess bony fusion.
RESULTS
Incidences of bony fusion were 58.8% in group A, 95.0% in group B, 94.3% in group C. The bony fusion rate was significantly lower in group A than in either group B or C. There was no significant difference between groups B and C. Thus, endplates with type 2 sclerotic Modic change had a lower fusion rate in patients undergoing PLIF with PSI.
CONCLUSION
Type 2 sclerotic Modic change could be an important factor that affects solid bony fusion in patients undergoing PLIF with PSI. CT may help diagnose endplate sclerosis in patients with type 2 change and inform the choice of the best site for spinal fusion.
背景
与正常终板相比，3 型 Modic 改变患者的骨融合率明显较低。目前尚不清楚 2 型硬化型 Modic 改变或非硬化型 Modic 改变或无 Modic 改变患者的融合效率是否存在相关差异。
方法
本回顾性研究纳入了 123 例接受后路腰椎椎间融合术（PLIF）和经皮椎弓根螺钉内固定（PSI）治疗的患者的 196 个腰椎节段，以评估 2 型硬化型 Modic 改变对融合效率的影响。这些终板根据 Modic 改变分为 A、B 和 C 组。A 组终板有 2 型 Modic 改变和终板硬化。B 组有 2 型 Modic 改变而无终板硬化。C 组既无 Modic 改变也无终板硬化。磁共振成像（MRI）用于确定 Modic 改变的存在。手术前 CT 检测 2 型 Modic 改变的终板硬化。我们收集了术后 3 个月至 24 个月以上的患者 CT 数据，以评估骨融合情况。
结果
A 组骨融合率为 58.8%，B 组为 95.0%，C 组为 94.3%。A 组的骨融合率明显低于 B 组和 C 组。B 组和 C 组之间无显著差异。因此，在接受 PSI 的 PLIF 治疗的患者中，2 型硬化型 Modic 改变的终板融合率较低。
结论
2 型硬化型 Modic 改变可能是影响 PSI 行 PLIF 患者骨融合的重要因素。CT 有助于诊断 2 型改变患者的终板硬化，并为脊柱融合的最佳部位选择提供信息。
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