成人峡部裂性腰椎滑脱症:NASS循证医学指南解读
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摘要
成人峡部裂性腰椎滑脱症是临床上导致下腰痛的常见疾病,为提供最佳、有效的诊断及治疗方案,2014年北美脊柱协会(NASS)制定了成人峡部裂性腰椎滑脱症的诊断与治疗指南(以下称为指南)。指南通过对文献的系统评价,进行循证医学证据分析,确定不同推荐强度,主要从诊断和治疗两个方面的常见问题来进行讨论,确定临床诊治方案。本文对指南进行简要解读,并结合我国的临床实际进行论述,以供临床医生参考。
Objective: Isthmic spondylolisthesis in adults is a common clinical disease that causes lower back pain.In order to provide the best and effective diagnosis and treatment plan, in 2014, the North American Spine Association(NASS) formulated the guidelines for the diagnosis and treatment of isthmic spondylolisthesis in adult(hereinafter referred to as the guideline).Through the systematic review of literature, evidence-based medical evidence analysis was conducted to identify different recommended intensities, to discuss the clinical diagnosis and treatment plan mainly from two aspects of diagnosis and treatment. This article gives a brief explanation of the guidelines and discusses them in combination with the clinical practice in China, so as to provide a reference for clinicians.
Objective: Isthmic spondylolisthesis in adults is a common clinical disease that causes lower back pain.In order to provide the best and effective diagnosis and treatment plan, in 2014, the North American Spine Association(NASS) formulated the guidelines for the diagnosis and treatment of isthmic spondylolisthesis in adult(hereinafter referred to as the guideline).Through the systematic review of literature, evidence-based medical evidence analysis was conducted to identify different recommended intensities, to discuss the clinical diagnosis and treatment plan mainly from two aspects of diagnosis and treatment. This article gives a brief explanation of the guidelines and discusses them in combination with the clinical practice in China, so as to provide a reference for clinicians.
引文
1 Kalichman L, Kim DH, Li L, et al. Spondylolysis and spondylolisthesis: prevalence and association with low back pain in the adult community-based population[J]. Spine, 2009, 34(2): 199-205.
2 王磊, 王伟, 张永兴, 等. 应用保留后方韧带复合体治疗峡部裂型腰椎滑脱症临床观察[J]. 临床军医杂志, 2016,44(2): 190-191.
3 雷礼辉, 李峰, 刘洪. 脊柱-骨盆矢状面参数在峡部裂性腰椎滑脱的临床运用[J]. 中南医学科学杂志, 2015, 43(3): 346-350
4 侯海涛, 邵诗泽, 付松. 应力滑移率在峡部裂型腰椎滑脱症治疗中应用的中期随访[J]. 中国中医骨伤科杂志, 2016,24(4): 26-29.
5 Shin MH, Ryu KS, Rathi NK, et al. Direct pars repair surgery using two different surgical Methods: pedicle screw with universal hook system and direct pars screw fixation in symptomatic lumbar spondylosispatients[J]. J Korean Neurosurg Soc, 2012, 51(1): 14-19.
6 Rizzo T ,Baisden J . Guideline update:diagnosis and treatment of adult Isthmic spondylolisthesis[J]. Spine Journal Official Journal of the North American Spine Society, 2015, 14(50):2-4.
7 孙月钊,强晓军. L5峡部裂椎体上关节突间距与椎体高度的比值[J]. 中国组织工程研究, 2016, 20(35): 5296-5303.
8 王正, 孙天胜. 腰椎峡部裂的治疗进展[J]. 中国组织工程研究, 2017, 21(27): 4423-4428.
9 屈国林,金青松,腾树春,等.腰椎峡部裂X线诊断的新征象-腰椎峡部上下缘连续性中断[J].海南医学,2011,22(6):14-17.
10 龙法余,陈耀武,钟招明,等.脊柱-骨盆矢状面参数与L5峡部裂性滑脱进展的相互作用[J].中国组织工程研究,2018,22(27):4400-4404.
11 徐政,刘艺.青少年L5/S1峡部裂性腰椎滑脱患者脊柱-骨盆矢状面形态分析[J].脊柱外科杂志,2018,16(3):167-173.
12 何守玉,朱锋,孙旭,等.成人腰椎峡部裂性滑脱局部稳定性对脊柱-骨盆矢状面形态的影响[J].中国矫形外科杂志,2015,23(1):77-81.
13 葛晓莉.对比分析X线平片及CT诊断在腰椎滑脱和椎弓峡部裂诊断中的作用[J].西藏医药,2018,39(2):33-35.
14 李文旭,姚欣强,申星,等.腰椎峡部裂诊治的研究进展[J].现代生物医学进展,2016,16(30):5994-5997.
15 尹进,彭宝淦.腰椎峡部裂的治疗策略[J].中国矫形外科杂志,2016,24(2):151-154.
16 赵郭盛,权正学.青少年腰椎峡部裂的诊治进展[J].局解手术学杂志,2016,25(1):53-57.
17 丁金勇,刘涛,周跃,等.微创和开放手术治疗腰椎峡部裂滑脱的疗效分析[J].中国骨与关节损伤杂志,2009,24(8):687-690.
18 梅启元,邵琳.椎弓根内固定联合不同融合方式治疗峡部裂型腰椎滑脱症效果比较[J].解放军医药杂志,2017,29(4):78-81.
19 梁龙,银河,于杰,等.后路环形融合和后外侧融合治疗腰椎滑脱症的Meta分析[J].中国现代手术学杂志,2018,22(2):95-102.
20 许海波,方志祥,李坚.三种入路椎间融合术治疗下腰椎退行性滑脱比较[J].中国现代医生,2012,50(4):44-45.
2 王磊, 王伟, 张永兴, 等. 应用保留后方韧带复合体治疗峡部裂型腰椎滑脱症临床观察[J]. 临床军医杂志, 2016,44(2): 190-191.
3 雷礼辉, 李峰, 刘洪. 脊柱-骨盆矢状面参数在峡部裂性腰椎滑脱的临床运用[J]. 中南医学科学杂志, 2015, 43(3): 346-350
4 侯海涛, 邵诗泽, 付松. 应力滑移率在峡部裂型腰椎滑脱症治疗中应用的中期随访[J]. 中国中医骨伤科杂志, 2016,24(4): 26-29.
5 Shin MH, Ryu KS, Rathi NK, et al. Direct pars repair surgery using two different surgical Methods: pedicle screw with universal hook system and direct pars screw fixation in symptomatic lumbar spondylosispatients[J]. J Korean Neurosurg Soc, 2012, 51(1): 14-19.
6 Rizzo T ,Baisden J . Guideline update:diagnosis and treatment of adult Isthmic spondylolisthesis[J]. Spine Journal Official Journal of the North American Spine Society, 2015, 14(50):2-4.
7 孙月钊,强晓军. L5峡部裂椎体上关节突间距与椎体高度的比值[J]. 中国组织工程研究, 2016, 20(35): 5296-5303.
8 王正, 孙天胜. 腰椎峡部裂的治疗进展[J]. 中国组织工程研究, 2017, 21(27): 4423-4428.
9 屈国林,金青松,腾树春,等.腰椎峡部裂X线诊断的新征象-腰椎峡部上下缘连续性中断[J].海南医学,2011,22(6):14-17.
10 龙法余,陈耀武,钟招明,等.脊柱-骨盆矢状面参数与L5峡部裂性滑脱进展的相互作用[J].中国组织工程研究,2018,22(27):4400-4404.
11 徐政,刘艺.青少年L5/S1峡部裂性腰椎滑脱患者脊柱-骨盆矢状面形态分析[J].脊柱外科杂志,2018,16(3):167-173.
12 何守玉,朱锋,孙旭,等.成人腰椎峡部裂性滑脱局部稳定性对脊柱-骨盆矢状面形态的影响[J].中国矫形外科杂志,2015,23(1):77-81.
13 葛晓莉.对比分析X线平片及CT诊断在腰椎滑脱和椎弓峡部裂诊断中的作用[J].西藏医药,2018,39(2):33-35.
14 李文旭,姚欣强,申星,等.腰椎峡部裂诊治的研究进展[J].现代生物医学进展,2016,16(30):5994-5997.
15 尹进,彭宝淦.腰椎峡部裂的治疗策略[J].中国矫形外科杂志,2016,24(2):151-154.
16 赵郭盛,权正学.青少年腰椎峡部裂的诊治进展[J].局解手术学杂志,2016,25(1):53-57.
17 丁金勇,刘涛,周跃,等.微创和开放手术治疗腰椎峡部裂滑脱的疗效分析[J].中国骨与关节损伤杂志,2009,24(8):687-690.
18 梅启元,邵琳.椎弓根内固定联合不同融合方式治疗峡部裂型腰椎滑脱症效果比较[J].解放军医药杂志,2017,29(4):78-81.
19 梁龙,银河,于杰,等.后路环形融合和后外侧融合治疗腰椎滑脱症的Meta分析[J].中国现代手术学杂志,2018,22(2):95-102.
20 许海波,方志祥,李坚.三种入路椎间融合术治疗下腰椎退行性滑脱比较[J].中国现代医生,2012,50(4):44-45.