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

目的 　系統(tǒng)評(píng)價(jià)不同術(shù)式治療成人峽部裂型腰椎滑脫的療效.
方法 　計(jì)算機(jī)檢索Cochrane圖書(shū)館(2004年第2期)、Cochrane協(xié)作網(wǎng)專(zhuān)業(yè)試驗(yàn)數(shù)據(jù)庫(kù)(2004年第2期)、MEDLINE(1966～2004),EMBASE(1980～2004)、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)(1980～2004),手工檢索中文文獻(xiàn)(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(jī)對(duì)照試驗(yàn)(RCT),并對(duì)其逐個(gè)進(jìn)行方法學(xué)質(zhì)量評(píng)價(jià)并采用RevMan 4.2軟件進(jìn)行系統(tǒng)評(píng)價(jià).
結(jié)果 　共納入4篇RCT,包括277例患者.3篇比較了不同術(shù)式治療成人峽部裂型腰椎滑脫,1篇對(duì)保守治療與手術(shù)治療進(jìn)行對(duì)比.由于納入的研究及病人太少,且結(jié)局評(píng)價(jià)指標(biāo)差異較大,不能進(jìn)行Meta分析,只能進(jìn)行描述性系統(tǒng)評(píng)價(jià).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(jié)局.其中1個(gè)研究認(rèn)為,后外側(cè)融合較保守治療能更有效地緩解疼痛和改善臨床結(jié)局;另一個(gè)研究認(rèn)為,器械輔助的后外側(cè)融合沒(méi)有提高融合率,卻增加了手術(shù)并發(fā)癥率,延長(zhǎng)了手術(shù)時(shí)間,增加了術(shù)中及術(shù)后的失血量;兩個(gè)研究討論了椎板減壓對(duì)融合率的影響,得出矛盾的結(jié)論.
結(jié)論 　腰椎后外側(cè)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(jié)局.內(nèi)固定沒(méi)有提高腰椎后外側(cè)融合率,腰椎后外側(cè)融合治療成人峽部裂型腰椎滑脫有無(wú)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(shè)計(jì)嚴(yán)格的研究以增加證據(jù)的強(qiáng)度.

引用本文： 翟 生,白靖平,錫林寶勒日,金格勒,吳泰相,劉關(guān)鍵. 外科治療成人峽部裂型腰椎滑脫的系統(tǒng)評(píng)價(jià). 中國(guó)循證醫(yī)學(xué)雜志, 2005, 05(4): 311-316. doi: 復(fù)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.