【摘要】 目的　系统评价不同术式治疗成人峡部裂型腰椎滑脱的疗效。方法　计算机检索Cochrane图书馆(2004年第2期)、Cochrane协作网专业试验数据库( 2004年第2期)、MEDLINE( 1966 ~2004 ),EMBASE( 1980 ~2004)、中国生物医学文献数据库(1980~2004),手工检索中文文献(截至2001年6月),收集所有外科治疗成人峡部裂型腰椎滑脱的随机对照试验(RCT),并对其逐个进行方法学质量评价并采用RevMan4. 2软件进行系统评价。结果　共纳入4篇RCT,包括277例患者。3篇比较了不同术式治疗成人峡部裂型腰椎滑脱, 1篇对保守治疗与手术治疗进行对比。由于纳入的研究及病人太少,且结局评价指标差异较大,不能进行Meta分析,只能进行描述性系统评价。所有研究都显示,外科治疗成人峡部裂型腰椎滑脱能够缓解疼痛和改善临床结局。其中1个研究认为,后外侧融合较保守治疗能更有效地缓解疼痛和改善临床结局;另一个研究认为,器械辅助的后外侧融合没有提高融合率,却增加了手术并发症率,延长了手术时间,增加了术中及术后的失血量;两个研究讨论了椎板减压对融合率的影响,得出矛盾的结论。结论　腰椎后外侧融合治疗成人峡部裂型腰椎滑脱能够缓解疼痛和改善临床结局。内固定没有提高腰椎后外侧融合率,腰椎后外侧融合治疗成人峡部裂型腰椎滑脱有无必要?更多还原

【Abstract】 Objective To assess the effectiveness of surgical interventions for lumbar isthmic spondylolisthesis in adults. Methods RCTs of surgical treatment for adult lumbar isthmic spondylolisthesis were identified from specialized trials registered in Cochrane Back Group, The Cochrane Library(Issue 2, 2004),additional electronic search (including MEDLINE(19662004),EMBASE(19802004) and CBM), handsearching for Chinese journals. Two reviewers assessed the quality of the trials and extracted data independently. Meta analysis was conducted using RevMan 4.2. Results Four published trials including a total of 277 patients were included. Three trials compared different operative procedures and one trial considered conservative versus surgical treatment for lumbar isthmic spondylolisthesis in adults. Two trials had limitations of trial design which at times gave considerable potential for bias. As very few studies and patients were included, and different score criteria were used to assess the clinical outcomes in the review, we decided to provide a descriptive summary only. All trials drew a conclusion that lumbar posterolateral fusion for adult isthmic spondylolisthesis could relieve pain and improve clinical outcome. There was no significant difference in fusion rate and improvement of clinical outcomes between different operative procedures. One trial showed that the lumbar posterolateral fusion could improve function and relieve pain more efficiently than an exercise program. Three trials indicated there was no difference in fusion rate and improvement of clinical outcomes between different operative methods. One trial suggested that instrumented posterolateral fusion did not improve fusion rate but increased complication rates, operation time and bleeding loss. Two trials considered the role of decompressive laminectomy and reached a conflicting conclusion. Conclusions There is no adequate evidence about the most effective technique of treatment for adult lumbar isthmic spondylolisthesis. There is limited evidence that the lumbar posterolateral fusion for adult isthmic spondylolisthesis can efficiently relieve pain and improve clinical outcome. There is no evidence that the use of pedicle screw fixation can improve the fusion rate or the clinical outcome. At present, there is no enough evidence available from randomised trials to support the routine clinical use of instrumented fusion for lumbar isthmic spondylolisthesis in adults. As very few studies and patients were included in the review, it was cautious to draw any conclusions from the review. More trials with high quality on methodology are needed.更多还原