應力性腰椎椎弓根骨折研究進展_《中國修復重建外科雜志》

作者：

劉勇 , 渠東 , 三軍 , 振中 , 永軍 , 奎水

無錫市第九人民醫院骨科（江蘇無錫， 214062）;

關鍵詞：

應力性骨折椎弓根腰椎下腰痛治療

DOI：

10.7507/1002-1892.20130052

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目的綜述有關應力性腰椎椎弓根骨折的研究進展。方法廣泛查閱近年應力性腰椎椎弓根骨折的相關文獻，并對其進行綜合分析。結果應力性骨折分疲勞性和結構不良性兩種類型，應力性腰椎椎弓根骨折主要發生在脊柱重復性活動、活動量大的人群和一側峽部崩裂患者或行腰椎手術后患者等。導致應力性腰椎椎弓根骨折的主要應力是剪切力和扭轉力，其次是脊柱突然過屈或過伸。常規X線片檢查應力性腰椎椎弓根骨折極易漏診，需要行XCT、MRI或骨掃描確診。根據應力性骨折不同時期MRI表現，分為應力反應期、不全骨折期、完全骨折期和假關節期四期或四型。對于無神經根刺激癥狀的不全型和完全型應力性腰椎椎弓根骨折以及青少年應力性腰椎椎弓根骨折，多數主張首選保守治療，骨折愈合率較高；對于雙側假關節型、有神經根刺激癥狀的應力性腰椎椎弓根骨折，以及保守治療無效的應力性腰椎椎弓根骨折，均主張手術治療。結論應力性腰椎椎弓根骨折作為引起下腰痛的原因之一，臨床極為少見，且容易漏診，結合骨折類型和患者個體情況綜合考慮采取手術或保守治療，效果較滿意。

引用本文： 劉勇,渠東,三軍,振中,永軍,奎水. 應力性腰椎椎弓根骨折研究進展. 中國修復重建外科雜志, 2013, 27(2): 240-242. doi: 10.7507/1002-1892.20130052 復制

1.	Garber JE, Wright AM. Unilateral spondylolysis with contralateral pedicle fracture. Spine (Phila Pa 1976), 1986, 11(1): 63-66.
2.	Stanley D, Smith TW. Contralateral pedicle stress fracture. An unusual complication of laminectomy. Spine (Phila Pa 1976), 1990, 15(5): 598-599.
3.	Gunzburg R, Fraser RD. Stress fracture of the lumbar pedicle. Case reports of “pediculolysis” and review of literature. Spine (Phila Pa 1976), 1991, 16(2): 185-189.
4.	Traughber PD, Havlina JM. Bilateral pedicle stress fractures: SPECT and CT features. J Comput Assist Tomogr, 1991, 15(2): 338-340.
5.	Weatherley CR, Mehdian H, Berghe LV. Low back pain with fracture of the pedicle and contralateral spondylolysis. A technique of surgical management. J Bone Joint Surg (Br), 1991, 73(6): 990-993.
6.	Araki T, Harata S, Nakano K, et al. Reactive sclerosis of the pedicle associated with contralateral spondylolysis. Spine (Phila Pa 1976), 1992, 17(11): 1424-1426.
7.	Robertson PA, Grobler LJ. Stress fracture of the pedicle. A late complication of posterolateral lumbar fusion. Spine (Phila Pa 1976), 1993, 18(7): 930-932.
8.	Macdessi SJ, Leong AK, Bentivoglio JE. Pedicle fracture after instrumented posterolateral lumbar fusion: a case report. Spine (Phila Pa 1976), 2001, 26(5): 580-582.
9.	Sheehan JP, Helm GA, Sheehan JM, et al. Stress fracture of the pedicle after extensive decompression and contralateral posterior fusion for lumbar stenosis. Report of three cases. Neurosurg Focus, 2002, 13(2): E9.
10.	Ha KY, Kim YH. Bilateral pedicle stress fracture after instrumented posterolateral lumbar fusion: a case report. Spine (Phila Pa 1976), 2003, 28(8): E158-160.
11.	Kim HS, Ju CI, Kim SW. Bilateral pedicle stress fracture accompanying spondylolysis in a patient with ankylosing spondylitis. J Korean Neurosurg Soc, 2010, 48(1): 70-72.
12.	Palmer DK, Inceoglu S, Cheng WK. Stem fracture after total facet replacement in the lumbar spine: a report of two cases and review of the literature. Spine J, 2011, 11(7): e15-19.
13.	Mathew P, Blackman M, Redla S, et al. Bilateral pedicle fractures following anterior dislocation of the polyethylene inlay of a ProDisc artificial disc replacement: a case report of an unusual complication. Spine (Phila Pa 1976), 2005, 30(11): E311-314.
14.	Parvataneni HK, Nicholas SJ, McCance SE. Bilateral pedicle stress fractures in a female athlete: case report and review of the literature. Spine (Phila Pa 1976), 2004, 29(2): E19-21.
15.	Sairyo K, Katoh S, Sasa T, et al. Athletes with unilateral spondylolysis are at risk of stress fracture at the contralateral pedicle and pars interarticularis: a clinical and biomechanical study. Am J Sports Med, 2005, 33(4): 583-590.
16.	Sadiq MZ. Bilateral pedicle stress fracture in the lumbar spine of a sedentary office worker. Eur Spine J, 2006, 15 Suppl 5: 653-655.
17.	Obid P, Richter A, Ubeyli H, et al. Spontane0us bilateral pedicle fracture 30 years after Harrington Instrumentation for idiopathic scoliosis: a case report. J Med Case Rep, 2012, 23, 6(1): 29.
18.	Sirvanci M, Ulusoy L, Duran C. Pedicular stress fracture in lumbar spine. Clin Imaging, 2002, 26(3): 187-193.
19.	Murthy NS. Imaging of stress fractures of the spine. Radiol Clin North Am, 2012, 50(4): 799-821.
20.	Doita M, Shimomura T, Nishida K, et al. Bilateral pedicle stress fracture in a patient with lumbar spinal stenosis: a case report. J Spinal Disord Tech, 2008, 21(7): 531-534.
21.	Ornetti P, Prati C, Fery-Blanco C, et al. Pedicle stress fracture: an unusual complication of pycnodysostosis. Clin Rheumatol, 2008, 27(3): 385-387.
22.	Doita M, Ando Y, Hirata S, et al. Bilateral pedicle stress fracture in a patient with osteoporotic compression fracture. Eur Spine J, 2009, 18(Suppl 2): 206-209.
23.	Jeong IH, Hwang EH, Bae WT. Contralateral Pedicular Fracture with Unilateral Spondylolysis. J Korean Neurosurg Soc, 2009, 46(6): 584-587.
24.	Amari R, Sakai T, Katoh S, et al. Fresh stress fractures of lumbar pedicles in an adolescent male ballet dancer: Case report and literature review. Arch Orthop Trauma Surg, 2009, 129(3): 397-401.
25.	Johnson JN, Wang MY. Stress fracture of the lumbar pedicle bilaterally: surgical repair using a percutaneous minimally invasive technique. J Neurosurg Spine, 2009, 11(6): 724-728.
26.	Hajjioui A, Khazzani H, Sbihi S, et al. Spondylolisthesis on bilateral pedicle stress fracture in the lumbar spine: a case study. Ann Phys Rehabil Med, 2011, 54(1): 53-58.

1. Garber JE, Wright AM. Unilateral spondylolysis with contralateral pedicle fracture. Spine (Phila Pa 1976), 1986, 11(1): 63-66.
2. Stanley D, Smith TW. Contralateral pedicle stress fracture. An unusual complication of laminectomy. Spine (Phila Pa 1976), 1990, 15(5): 598-599.
3. Gunzburg R, Fraser RD. Stress fracture of the lumbar pedicle. Case reports of “pediculolysis” and review of literature. Spine (Phila Pa 1976), 1991, 16(2): 185-189.
4. Traughber PD, Havlina JM. Bilateral pedicle stress fractures: SPECT and CT features. J Comput Assist Tomogr, 1991, 15(2): 338-340.
5. Weatherley CR, Mehdian H, Berghe LV. Low back pain with fracture of the pedicle and contralateral spondylolysis. A technique of surgical management. J Bone Joint Surg (Br), 1991, 73(6): 990-993.
6. Araki T, Harata S, Nakano K, et al. Reactive sclerosis of the pedicle associated with contralateral spondylolysis. Spine (Phila Pa 1976), 1992, 17(11): 1424-1426.
7. Robertson PA, Grobler LJ. Stress fracture of the pedicle. A late complication of posterolateral lumbar fusion. Spine (Phila Pa 1976), 1993, 18(7): 930-932.
8. Macdessi SJ, Leong AK, Bentivoglio JE. Pedicle fracture after instrumented posterolateral lumbar fusion: a case report. Spine (Phila Pa 1976), 2001, 26(5): 580-582.
9. Sheehan JP, Helm GA, Sheehan JM, et al. Stress fracture of the pedicle after extensive decompression and contralateral posterior fusion for lumbar stenosis. Report of three cases. Neurosurg Focus, 2002, 13(2): E9.
10. Ha KY, Kim YH. Bilateral pedicle stress fracture after instrumented posterolateral lumbar fusion: a case report. Spine (Phila Pa 1976), 2003, 28(8): E158-160.
11. Kim HS, Ju CI, Kim SW. Bilateral pedicle stress fracture accompanying spondylolysis in a patient with ankylosing spondylitis. J Korean Neurosurg Soc, 2010, 48(1): 70-72.
12. Palmer DK, Inceoglu S, Cheng WK. Stem fracture after total facet replacement in the lumbar spine: a report of two cases and review of the literature. Spine J, 2011, 11(7): e15-19.
13. Mathew P, Blackman M, Redla S, et al. Bilateral pedicle fractures following anterior dislocation of the polyethylene inlay of a ProDisc artificial disc replacement: a case report of an unusual complication. Spine (Phila Pa 1976), 2005, 30(11): E311-314.
14. Parvataneni HK, Nicholas SJ, McCance SE. Bilateral pedicle stress fractures in a female athlete: case report and review of the literature. Spine (Phila Pa 1976), 2004, 29(2): E19-21.
15. Sairyo K, Katoh S, Sasa T, et al. Athletes with unilateral spondylolysis are at risk of stress fracture at the contralateral pedicle and pars interarticularis: a clinical and biomechanical study. Am J Sports Med, 2005, 33(4): 583-590.
16. Sadiq MZ. Bilateral pedicle stress fracture in the lumbar spine of a sedentary office worker. Eur Spine J, 2006, 15 Suppl 5: 653-655.
17. Obid P, Richter A, Ubeyli H, et al. Spontane0us bilateral pedicle fracture 30 years after Harrington Instrumentation for idiopathic scoliosis: a case report. J Med Case Rep, 2012, 23, 6(1): 29.
18. Sirvanci M, Ulusoy L, Duran C. Pedicular stress fracture in lumbar spine. Clin Imaging, 2002, 26(3): 187-193.
19. Murthy NS. Imaging of stress fractures of the spine. Radiol Clin North Am, 2012, 50(4): 799-821.
20. Doita M, Shimomura T, Nishida K, et al. Bilateral pedicle stress fracture in a patient with lumbar spinal stenosis: a case report. J Spinal Disord Tech, 2008, 21(7): 531-534.
21. Ornetti P, Prati C, Fery-Blanco C, et al. Pedicle stress fracture: an unusual complication of pycnodysostosis. Clin Rheumatol, 2008, 27(3): 385-387.
22. Doita M, Ando Y, Hirata S, et al. Bilateral pedicle stress fracture in a patient with osteoporotic compression fracture. Eur Spine J, 2009, 18(Suppl 2): 206-209.
23. Jeong IH, Hwang EH, Bae WT. Contralateral Pedicular Fracture with Unilateral Spondylolysis. J Korean Neurosurg Soc, 2009, 46(6): 584-587.
24. Amari R, Sakai T, Katoh S, et al. Fresh stress fractures of lumbar pedicles in an adolescent male ballet dancer: Case report and literature review. Arch Orthop Trauma Surg, 2009, 129(3): 397-401.
25. Johnson JN, Wang MY. Stress fracture of the lumbar pedicle bilaterally: surgical repair using a percutaneous minimally invasive technique. J Neurosurg Spine, 2009, 11(6): 724-728.
26. Hajjioui A, Khazzani H, Sbihi S, et al. Spondylolisthesis on bilateral pedicle stress fracture in the lumbar spine: a case study. Ann Phys Rehabil Med, 2011, 54(1): 53-58.

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應力性腰椎椎弓根骨折研究進展

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