我国青少年腰椎间盘突出症的荟萃分析  

Meta-analysis of lumbar disc herniation in Chinese adolescents

作　　者：许德荣[1] 宋友东[1] 王海[1] 李书纲[1] 

机构地区：[1]100730,中国医学科学院,北京协和医学院,北京协和医院骨科

出　　处：《中华医学杂志》2013年第45期3606-3609,共4页National Medical Journal of China

摘　　要：目的 为青少年腰椎间盘突出症的诊疗提供循证医学证据.方法检索1990年1月至2012年12月中国知网、万方数据库公开发表的≤21岁青少年腰椎间盘突出症的文献病例,并进行汇总分析.结果共纳入符合标准的文献45篇,报道了1208例患者,其中74.2%为男性,由外伤引起者占65.9%;患者的症状与体征不平行,直腿抬高试验阳性率高（86.8%）;单节段突出占92.0%,其中L4/5突出占54.7%,L5/S1突出占37.6%,腰部侧弯畸形（38.2%）、腰椎生理曲度变直甚至腰椎后凸（41.4%）、椎间隙异常变窄或前窄后宽（33.6%）等影像学改变较成人多见;不同的治疗方案各有其优缺点,椎间盘镜（MED）及开放手术的成功率均在90.0%以上.结论青少年腰椎间盘突出症多发生于男性,外伤是其最常见的病因,主要为L4/5、L5/S1的单节段突出.直腿抬高试验阳性、棘突及椎旁压痛、代偿性脊柱侧弯、腰椎生理曲度改变以及椎间隙异常较成人多见.X线平片、腰椎CT、MR等影像学检查是诊断的重要资料.对绝大多数患者而言,保守治疗是首要的,微创介入手术、MED及开放手术在保守治疗无效时也可以取得比较理想的疗效.Objective To provide evidence-based medicine rationales for the diagnosis and treatment of lumbar disc herniation （LDH） in Chinese adolescents. Methods The related medical literature of pediatric LDH between January 1990 and December 2012 was collected by retrospective searches of WANGFANG and CNKI databases. The data concerning mechanism, clinical manifestations, diagnosis and treatment were recorded and analyzed. Results A total of 1208 cases of LDH in adolescents were retrieved from 45 articles. Most of them were males （74. 2% ）. And the primary cause was trauma （65.9%）. Their clinical presentations were characterized by mild symptoms and serious physical signs. And 87.0% of them had a positive straight-leg raising test. Single-level intervertebral disk protrusion accounted for 92%. And the levels were at IA-L5 （54. 7% ） and LS-S1 （37.6%）. There was a higher incidence of lumbar scoliosis deformity （ 38.2% ）, lumbar spine physiological curvature change （41.4%） and loss of vertebral height （33.6%） in adolescents than adults. There were many different treatments for pediatric LDH. Each method had its own advantages and disadvantages. The success rates of micro endoscopic discectomy （MED） and open discectomy were more than 90%. Conclusion Trauma is a common cause of pediatric LDH. Males are more frequently affected. The single-level protrusion of L4/5 or LS/S1 has a much higher incidence. Positive straight-leg raising test and imaging findings of lumbar scoliosis deformity, lumbar spine physiological curvature change and a loss of vertebral height may aid the diagnosis. Normally conservative treatment is offered. And chemonucleolysis, MED and open discectomy are alternative options.

关 键 词：青少年 椎间盘移位 综合分析 

分 类 号：R681.53[医药卫生—骨科学]