一例成人Ⅱ度峽部裂型腰椎滑脫的循證健康咨詢_《中國循證醫學雜志》

作者：

羅稀 ,  李小麟

四川大學華西護理學院（成都 610041）;

關鍵詞：

腰椎滑脫成人峽部裂型手術治療保守治療循證護理

DOI：

10.7507/1672-2531.20130021

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目的　運用循證醫學方法，為1例成人Ⅱ度峽部裂型腰椎滑脫的患者提供選擇治療方案的依據。
方法　在充分評估患者病情的基礎上，根據 PICO 原則，提出臨床問題，檢索 Cochrane 圖書館、DARE、CENTRAL、MEDLINE、EMbase以及CBM，檢索時限截至2011年4月，查找高質量臨床證據，并告知患者相關治療方案的臨床療效及并發癥等情況。患者在充分知曉自身病情及治療方法的情況下，選擇合適的治療方案。
結果　共納入5篇系統評價、1篇Meta分析、3篇RCT及1篇關于本病自然病程的前瞻性研究。證據表明：峽部裂型腰椎滑脫的自然病程預后較好；若保守治療效果不佳、疼痛不緩解、滑脫進展、嚴重影響生活質量時，可實施手術治療；手術治療后癥狀緩解的遠期效果可能較好，但也不能改變本病的自然病程。綜合文獻信息并分析利弊后，患者選擇了保守治療的方法。經過約1年的保守治療，該患者目前情況良好，腿部放射性疼痛有所緩解，CT檢查結果顯示腰椎滑脫無進展。
結論　輕度峽部裂型腰椎滑脫的患者采用保守治療可取得較好療效，但在保守治療的過程中應定期隨訪，監測腰椎滑脫進展情況。

引用本文： 羅稀,李小麟. 一例成人Ⅱ度峽部裂型腰椎滑脫的循證健康咨詢. 中國循證醫學雜志, 2013, 13(1): 121-124. doi: 10.7507/1672-2531.20130021 復制

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4.	Lim MR, Yoon SC, Green DW. Symptomatic spondylolysis: diagnosis and treatment. Current Opinion in Pediatrics, 2004, 16(1): 37-46.
5.	Jacobs WC, Vreeling A, De Kleuver M. Fusion for low-grade adult isthmic spondylolisthesis: a systematic review of the literature. Eur Spine J, 2006, 15(4): 391-402..
6.	Kwon BK, Hilibrand AS, Malloy K, et al. A critical analysis of the literature regarding surgical approach and outcome for adult low-grade isthmic spondylolisthesis. J Spinal Disord Tech, 2005, 18(Suppl): S30-40.
7.	翟生, 白靖平, 錫林寶勒, 等. 外科治療成人峽部裂型腰椎滑脫的系統評價. 中國循證醫學雜志, 2005, 5(4): 311-317.
8.	Bjarke Christensen F, Stender Hansen E, Laursen M, et al. Long-Term Functional Outcome of Pedicle Screw Instrumentation as a Support for Posterolateral spinal Fusion. Spine, 2002, 27(12): 1269-1277.
9.	McNeely ML, Torrance G, Magee DJ. A systematic review of physiotherapy for spondylolysis and spondylolisthesis. Manual Therapy, 2003, 8(2): 80-91.
10.	Wood KB, Fritzell P, Dettori JR, et al. Effectiveness of spinal fusion versus structured rehabilitation in chronic low back pain patients with and without isthmic spondylolisthesis: a systematic review. Spine (Phila Pa 1976). 2011, 36(21 Suppl): S110-119.
11.	Ibrahim T, Tleyjeh IM, Gabbar O. Surgical versus non-surgical treatment of chronic low back pain: a meta-analysis of randomised trials. International orthopaedics, 2008, 32(1): 107-113.
12.	Ekman P, Möller H, Hedlund R. The long-term effect of posterolateral fusion in adult isthmic spondylolisthesis: a randomized controlled study. Spine J, 2005, 5(1): 36-44.
13.	Ekman P, Möller H, Shalabi A, et al. A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration. Eur Spine J, 2009, 18(8): 1175-1186.
14.	Beutler KJ, Freddrickson BE, Murtland A, et al. The natural history of spondylolysis and spondylolisthesis: 45-Year follow-up evaluation. Spine, 2003, 28(10): 1027-1035.

1. 董玉雷, 趙宏. 峽部裂型腰椎滑脫的治療進展. 中國骨與關節外科, 2011, 4(6): 495-500.
2. 趙定麟. 現代脊柱外科學. 第1版. 上海: 上海世界圖書出版公司, 2006: 348.
3. McNeely ML, Torrance G, Magee DJ. A systematic review of physiotherapy for spondylolysis and spondylolisthesis. Manual Therapy, 2003, 8(2): 80-91.
4. Lim MR, Yoon SC, Green DW. Symptomatic spondylolysis: diagnosis and treatment. Current Opinion in Pediatrics, 2004, 16(1): 37-46.
5. Jacobs WC, Vreeling A, De Kleuver M. Fusion for low-grade adult isthmic spondylolisthesis: a systematic review of the literature. Eur Spine J, 2006, 15(4): 391-402..
6. Kwon BK, Hilibrand AS, Malloy K, et al. A critical analysis of the literature regarding surgical approach and outcome for adult low-grade isthmic spondylolisthesis. J Spinal Disord Tech, 2005, 18(Suppl): S30-40.
7. 翟生, 白靖平, 錫林寶勒, 等. 外科治療成人峽部裂型腰椎滑脫的系統評價. 中國循證醫學雜志, 2005, 5(4): 311-317.
8. Bjarke Christensen F, Stender Hansen E, Laursen M, et al. Long-Term Functional Outcome of Pedicle Screw Instrumentation as a Support for Posterolateral spinal Fusion. Spine, 2002, 27(12): 1269-1277.
9. McNeely ML, Torrance G, Magee DJ. A systematic review of physiotherapy for spondylolysis and spondylolisthesis. Manual Therapy, 2003, 8(2): 80-91.
10. Wood KB, Fritzell P, Dettori JR, et al. Effectiveness of spinal fusion versus structured rehabilitation in chronic low back pain patients with and without isthmic spondylolisthesis: a systematic review. Spine (Phila Pa 1976). 2011, 36(21 Suppl): S110-119.
11. Ibrahim T, Tleyjeh IM, Gabbar O. Surgical versus non-surgical treatment of chronic low back pain: a meta-analysis of randomised trials. International orthopaedics, 2008, 32(1): 107-113.
12. Ekman P, Möller H, Hedlund R. The long-term effect of posterolateral fusion in adult isthmic spondylolisthesis: a randomized controlled study. Spine J, 2005, 5(1): 36-44.
13. Ekman P, Möller H, Shalabi A, et al. A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration. Eur Spine J, 2009, 18(8): 1175-1186.
14. Beutler KJ, Freddrickson BE, Murtland A, et al. The natural history of spondylolysis and spondylolisthesis: 45-Year follow-up evaluation. Spine, 2003, 28(10): 1027-1035.

《中國循證醫學雜志》

一例成人Ⅱ度峽部裂型腰椎滑脫的循證健康咨詢

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《中國循證醫學雜志》

一例成人Ⅱ度峽部裂型腰椎滑脫的循證健康咨詢

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