• 1. 新疆醫(yī)科大學臨床醫(yī)學院,烏魯木齊,8300542. 新疆醫(yī)科大學第三附屬腫瘤醫(yī)院3. 新疆醫(yī)科大學第二附屬醫(yī)院4. 新疆醫(yī)科大學第―附屬醫(yī)院5. 四川大學華西醫(yī)院循證醫(yī)學與臨床流行病學中心,成都,610041;

目的 　系統(tǒng)評價不同術式治療成人峽部裂型腰椎滑脫的療效.
方法 　計算機檢索Cochrane圖書館(2004年第2期)、Cochrane協(xié)作網(wǎng)專業(yè)試驗數(shù)據(jù)庫(2004年第2期)、MEDLINE(1966～2004),EMBASE(1980～2004)、中國生物醫(yī)學文獻數(shù)據(jù)庫(1980～2004),手工檢索中文文獻(截至2001年6月),收集所有外科治療成人峽部裂型腰椎滑脫的隨機對照試驗(RCT),并對其逐個進行方法學質(zhì)量評價并采用RevMan 4.2軟件進行系統(tǒng)評價.
結果 　共納入4篇RCT,包括277例患者.3篇比較了不同術式治療成人峽部裂型腰椎滑脫,1篇對保守治療與手術治療進行對比.由于納入的研究及病人太少,且結局評價指標差異較大,不能進行Meta分析,只能進行描述性系統(tǒng)評價.所有研究都顯示,外科治療成人峽部裂型腰椎滑脫能夠緩解疼痛和改善臨床結局.其中1個研究認為,后外側融合較保守治療能更有效地緩解疼痛和改善臨床結局;另一個研究認為,器械輔助的后外側融合沒有提高融合率,卻增加了手術并發(fā)癥率,延長了手術時間,增加了術中及術后的失血量;兩個研究討論了椎板減壓對融合率的影響,得出矛盾的結論.
結論 　腰椎后外側融合治療成人峽部裂型腰椎滑脫能夠緩解疼痛和改善臨床結局.內(nèi)固定沒有提高腰椎后外側融合率,腰椎后外側融合治療成人峽部裂型腰椎滑脫有無必要常規(guī)使用內(nèi)固定尚缺乏足夠的證據(jù).尚需更多設計嚴格的研究以增加證據(jù)的強度.

引用本文： 翟 生,白靖平,錫林寶勒日,金格勒,吳泰相,劉關鍵. 外科治療成人峽部裂型腰椎滑脫的系統(tǒng)評價. 中國循證醫(yī)學雜志, 2005, 05(4): 311-316. doi: 復制

1. Kim NH, Lee JW. Anterior Interbody Fusion Versus Posterolateral Fusion With Transpedicula Fixation for Isthmic Spondylolisthesis in Adults: A Comparison of Clinical Results[J]. Spine, 1999; 24(8): 812-817.
2. Beutler WJ, Fredrickson BE, Murtland A, Sweeney CA, Grant WD. Baker D. The Natural History of Spondylolysis and Spondylolisthesis: 45-Year Follow-up Evaluation[J]. Spine, 2003; 28(10): 1 027-1 035.
3. Lim MR, Yoon SC, Green DW. Symptomatic spondylolysis: diagnosis and treatment[J]. Current Opinion in Pediatrics, 2004; (1): 37-46.
4. Sakamaki T, Sairyo K, Katoh S, Endo H, Komatsubara S, Sano T, Yasui N. The Pathogenesis of Slippage and Deformity in the Pediatric Lumbar Spine: A Radiographic and Histologic Study using a New Rat In Vivo Model[J]. Spine, 2003; 28(7): 645-650.
5. Wiltse LL, Widell EH Jr, Jackson DW: Fatigue fracture: the basic lesion is isthmic spondylolisthesis[J]. J Bone Joint Surg Am, 1975; 57(4): 17-22.
6. Ebraheim NA, Lu J, Hao Y, Biyani A, Yeasting RA. Anatomic considerations of the lumbar isthmus[J]. Spine, 1997; 22(9): 941-945.
7. Weiner BK, Walker M, Wiley W. The lateral buttress: an anatomic feature of the lumbar pars interarticularis[J]. Spine, 2002; 27(1): 385-387.
8. Dietrich M, Kurowski P. The importance of mechanical factors in the etiology of spondylolysis: a model analysis of loads and stresses in human lumbar spine[J]. Spine, 1985; 10(6): 532-542.
9. Grobler LJ, Wiltse LL. Classification, non-operative, and operative treatment of spondylolisthesis, in Frymoyer JW (ed): The Adult Spine: Principles and Practice[M]. New York: Raven Press; 1991. Vol 2: 1 655-1 704.
10. Frennered AK, Danielson BI, Nachemson AL. Natural history of symptomatic isthmic low-grade spondylolisthesis in children and adolescents: a seven-year follow-up study[J]. J Pediatr Orthop, 1991; 11(2): 209-213.
11. Saraste H. Long-term clinical and radiological follow-up of spondylolysis and spondylolisthesis[J]. J Pediatr Orthop, 1987; 7(6): 631-638.
12. Blackburne JS, Velikas EP. Spondylolisthesis in children and adolescents[J]. J Bone Joint Surg Br, 1977; 59-B(4): 490-494.
13. Sairyo K, Katoh S, Ikata T, Fujii K, Kajinra K, Goel VK. Development of spondylolytic olisthesis in adolescents[J]. Spine, 2001; 1(3): 171-175.
14. Mihara H. Onari K. Cheng BC. David SM. Zdeblick TA. The biomechanical effects of spondylolysis and its treatment[J]. Spine, 2003; 28(3): 235-238.
15. Gill GG.Mechanism of nerve-root compression and irritation in backache[J]. Clin Orthop, 1955; 5: 66-81.
16. Rubeli MU, Grob D. Fusion of spondylolisthesis[J]. Spine, 1992; 6: 577-592.
17. McNeely ML, Torrance G, Magee DJ.A systematic review of physiotherapy for spondylolysis and spondylolisthesis[J]. Man Ther, 2003; 8: 80-91.
18. Benzel EC. Spine Surgery: Techniques, Complication Avoidance, and Management[M]. Philadelphia, Pa: Churchill Livingstone; 1998.
19. Al-Khawashki H, Wasef AS.Combined Dysplastic and Isthmic Spondylolisthesis: Possible Etiology. [Case Reports][J]. Spine, 2001; 26(23): 542-546.
20. Juni P, Altman DG, Egger M. Assessing the quality of controlled clinical trials[J]. BMJ, 2001; 323(7 303): 42-46.
21. Carragee EJ. Single-level posterolateral arthrodesis, with or without posterior decompression, for the treatment of isthmic spondylolisthesis in adults. A prospective, randomized study[J]. J Bone Joint Surg Am,1997; 79(8): 1 175-1 180.
22. M(o")ller H, Hedlund R. Surgery Versus Conservative Management in Adult Isthmic Spondylolisthesis: A Prospective Randomized Study: Part 1[J]. Spine, 2000; 25(13): 1 711-1 715.
23. M(o")ller H, Hedlund R.Instrumented and Noninstrumented Posterolateral Fusion in Adult Spondylolisthesis: A Prospective Randomized Study: Part 2[J]. Spine, 2000; 25(13): 1 716-1 721.
24. Madan S, Boeree NR. Outcome of Posterior Lumbar Interbody Fusion Versus Posterolateral Fusion for Spondylolytic Spondylolisthesis[J]. Spine, 2002; 27(14): 1 536-1 542.
25. Sinaki M, Lutness MP, Ilstrup DM, Chu CP, Gramse RR. Lumbar spondylolisthesis: retrospective comparison and three-year follow-up of two conservative treatment programs[J]. Arch Phys Med Rehabil, 1989; 70(8): 594-598.
26. Greenough CG. Results of treatment of lumbar spine disorders: Effects of assessment techniques and confounding factors[J]. Acta Orthop Scand, 1993; 64(Suppl 251): s126-s129.
  1. 1. Kim NH, Lee JW. Anterior Interbody Fusion Versus Posterolateral Fusion With Transpedicula Fixation for Isthmic Spondylolisthesis in Adults: A Comparison of Clinical Results[J]. Spine, 1999; 24(8): 812-817.
  2. 2. Beutler WJ, Fredrickson BE, Murtland A, Sweeney CA, Grant WD. Baker D. The Natural History of Spondylolysis and Spondylolisthesis: 45-Year Follow-up Evaluation[J]. Spine, 2003; 28(10): 1 027-1 035.
  3. 3. Lim MR, Yoon SC, Green DW. Symptomatic spondylolysis: diagnosis and treatment[J]. Current Opinion in Pediatrics, 2004; (1): 37-46.
  4. 4. Sakamaki T, Sairyo K, Katoh S, Endo H, Komatsubara S, Sano T, Yasui N. The Pathogenesis of Slippage and Deformity in the Pediatric Lumbar Spine: A Radiographic and Histologic Study using a New Rat In Vivo Model[J]. Spine, 2003; 28(7): 645-650.
  5. 5. Wiltse LL, Widell EH Jr, Jackson DW: Fatigue fracture: the basic lesion is isthmic spondylolisthesis[J]. J Bone Joint Surg Am, 1975; 57(4): 17-22.
  6. 6. Ebraheim NA, Lu J, Hao Y, Biyani A, Yeasting RA. Anatomic considerations of the lumbar isthmus[J]. Spine, 1997; 22(9): 941-945.
  7. 7. Weiner BK, Walker M, Wiley W. The lateral buttress: an anatomic feature of the lumbar pars interarticularis[J]. Spine, 2002; 27(1): 385-387.
  8. 8. Dietrich M, Kurowski P. The importance of mechanical factors in the etiology of spondylolysis: a model analysis of loads and stresses in human lumbar spine[J]. Spine, 1985; 10(6): 532-542.
  9. 9. Grobler LJ, Wiltse LL. Classification, non-operative, and operative treatment of spondylolisthesis, in Frymoyer JW (ed): The Adult Spine: Principles and Practice[M]. New York: Raven Press; 1991. Vol 2: 1 655-1 704.
  10. 10. Frennered AK, Danielson BI, Nachemson AL. Natural history of symptomatic isthmic low-grade spondylolisthesis in children and adolescents: a seven-year follow-up study[J]. J Pediatr Orthop, 1991; 11(2): 209-213.
  11. 11. Saraste H. Long-term clinical and radiological follow-up of spondylolysis and spondylolisthesis[J]. J Pediatr Orthop, 1987; 7(6): 631-638.
  12. 12. Blackburne JS, Velikas EP. Spondylolisthesis in children and adolescents[J]. J Bone Joint Surg Br, 1977; 59-B(4): 490-494.
  13. 13. Sairyo K, Katoh S, Ikata T, Fujii K, Kajinra K, Goel VK. Development of spondylolytic olisthesis in adolescents[J]. Spine, 2001; 1(3): 171-175.
  14. 14. Mihara H. Onari K. Cheng BC. David SM. Zdeblick TA. The biomechanical effects of spondylolysis and its treatment[J]. Spine, 2003; 28(3): 235-238.
  15. 15. Gill GG.Mechanism of nerve-root compression and irritation in backache[J]. Clin Orthop, 1955; 5: 66-81.
  16. 16. Rubeli MU, Grob D. Fusion of spondylolisthesis[J]. Spine, 1992; 6: 577-592.
  17. 17. McNeely ML, Torrance G, Magee DJ.A systematic review of physiotherapy for spondylolysis and spondylolisthesis[J]. Man Ther, 2003; 8: 80-91.
  18. 18. Benzel EC. Spine Surgery: Techniques, Complication Avoidance, and Management[M]. Philadelphia, Pa: Churchill Livingstone; 1998.
  19. 19. Al-Khawashki H, Wasef AS.Combined Dysplastic and Isthmic Spondylolisthesis: Possible Etiology. [Case Reports][J]. Spine, 2001; 26(23): 542-546.
  20. 20. Juni P, Altman DG, Egger M. Assessing the quality of controlled clinical trials[J]. BMJ, 2001; 323(7 303): 42-46.
  21. 21. Carragee EJ. Single-level posterolateral arthrodesis, with or without posterior decompression, for the treatment of isthmic spondylolisthesis in adults. A prospective, randomized study[J]. J Bone Joint Surg Am,1997; 79(8): 1 175-1 180.
  22. 22. M(o")ller H, Hedlund R. Surgery Versus Conservative Management in Adult Isthmic Spondylolisthesis: A Prospective Randomized Study: Part 1[J]. Spine, 2000; 25(13): 1 711-1 715.
  23. 23. M(o")ller H, Hedlund R.Instrumented and Noninstrumented Posterolateral Fusion in Adult Spondylolisthesis: A Prospective Randomized Study: Part 2[J]. Spine, 2000; 25(13): 1 716-1 721.
  24. 24. Madan S, Boeree NR. Outcome of Posterior Lumbar Interbody Fusion Versus Posterolateral Fusion for Spondylolytic Spondylolisthesis[J]. Spine, 2002; 27(14): 1 536-1 542.
  25. 25. Sinaki M, Lutness MP, Ilstrup DM, Chu CP, Gramse RR. Lumbar spondylolisthesis: retrospective comparison and three-year follow-up of two conservative treatment programs[J]. Arch Phys Med Rehabil, 1989; 70(8): 594-598.
  26. 26. Greenough CG. Results of treatment of lumbar spine disorders: Effects of assessment techniques and confounding factors[J]. Acta Orthop Scand, 1993; 64(Suppl 251): s126-s129.