单纯腰椎峡部裂的治疗进展

Progress in Treatment of Simple Lumbar Spondylolysis

单纯腰椎峡部裂是下腰痛的重要病因之一,如治疗不当,病情继续进展后期可导致腰椎滑脱、神经卡压,出现相应的临床症状,严重影响患者生活质量。目前其保守治疗多采用卧床休息、非甾体抗炎药治疗、腰围制动、局部热敷及电疗等方法,早期可获得较好疗效,但中、晚期及先天性峡部裂患者疗效不确切。经严格保守治疗而症状不能缓解甚至加重者可手术治疗,手术方式主要有单纯峡部植骨、螺钉固定、Scott钢丝捆绑、钉-钩固定、记忆合金固定、U型钛棒固定等,其中内固定手术可重建脊柱稳定性并提供坚强固定,愈合率高,且节段内固定能保留运动节段,因此未来寻找相容性更好、操作更简单、更符合生物力学的内固定材料成为研究热点。

Simple lumbar spondylolysis is one of the important causes of low back pain.If the treatment is improper,the disease will continue to progress later,which can lead to lumbar spondylolisthesis,nerve compression,and corresponding clinical symptoms,seriously affecting the quality of life of the patients.At present,conservative treatment mainly adopts bed rest,nonsteroidal anti-inflammatory treatment,waist circumference braking,local hot compress and electrotherapy.Good curative effect can be obtained in the early stage,while the curative effect for the patients with middle,late and congenital isthmus fissure is not definite.Surgical treatment is available if the symptoms cannot be relieved or even aggravated after strict conservative treatment.The main surgical methods are simple isthmus bone graft,screw fixation,Scott wire binding,screw-hook fixation,memory alloy fixation,U-shaped rod fixation,etc.Among them,internal fixation can reconstruct the spinal stability and provide strong fixation with high healing rate,and segmental internal fixation can retain motor segments.Therefore,it has become a research hotspot to find internal fixation materials with better compatibility,simpler operation and better biomechanical conformity in the future.