一例成人Ⅱ度峡部裂型腰椎滑脱的循证健康咨询_《中国循证医学杂志》

作者：

罗稀 ,  李小麟

四川大学华西护理学院（成都 610041）;

关键词：

腰椎滑脱成人峡部裂型手术治疗保守治疗循证护理

DOI：

10.7507/1672-2531.20130021

视频：

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目的　运用循证医学方法，为1例成人Ⅱ度峡部裂型腰椎滑脱的患者提供选择治疗方案的依据。
方法　在充分评估患者病情的基础上，根据 PICO 原则，提出临床问题，检索 Cochrane 图书馆、DARE、CENTRAL、MEDLINE、EMbase以及CBM，检索时限截至2011年4月，查找高质量临床证据，并告知患者相关治疗方案的临床疗效及并发症等情况。患者在充分知晓自身病情及治疗方法的情况下，选择合适的治疗方案。
结果　共纳入5篇系统评价、1篇Meta分析、3篇RCT及1篇关于本病自然病程的前瞻性研究。证据表明：峡部裂型腰椎滑脱的自然病程预后较好；若保守治疗效果不佳、疼痛不缓解、滑脱进展、严重影响生活质量时，可实施手术治疗；手术治疗后症状缓解的远期效果可能较好，但也不能改变本病的自然病程。综合文献信息并分析利弊后，患者选择了保守治疗的方法。经过约1年的保守治疗，该患者目前情况良好，腿部放射性疼痛有所缓解，CT检查结果显示腰椎滑脱无进展。
结论　轻度峡部裂型腰椎滑脱的患者采用保守治疗可取得较好疗效，但在保守治疗的过程中应定期随访，监测腰椎滑脱进展情况。

引用本文： 罗稀,李小麟. 一例成人Ⅱ度峡部裂型腰椎滑脱的循证健康咨询. 中国循证医学杂志, 2013, 13(1): 121-124. doi: 10.7507/1672-2531.20130021 复制

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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.
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1. 董玉雷, 赵宏. 峡部裂型腰椎滑脱的治疗进展. 中国骨与关节外科, 2011, 4(6): 495-500.
2. 赵定麟. 现代脊柱外科学. 第1版. 上海: 上海世界图书出版公司, 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, 锡林宝勒, 等. 外科治疗成人峡部裂型腰椎滑脱的系统评价. 中国循证医学杂志, 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.

《中国循证医学杂志》

一例成人Ⅱ度峡部裂型腰椎滑脱的循证健康咨询

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《中国循证医学杂志》

一例成人Ⅱ度峡部裂型腰椎滑脱的循证健康咨询

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