查看更多>>摘要：目的 总结腰椎峡部裂性滑脱分型和分期的研究进展。 方法 在中国知网、万方数据库以及Pubmed等中、英文数据库，检索2000年1月—2022年7月发表的有关腰椎峡部裂性滑脱分型和分期的文献共570篇，剔除无法获取全文、内容不符以及重复性研究等文献，最终纳入38篇文献，对腰椎峡部裂性滑脱的分型及分期进行归纳总结。 结果 由于X线易受髂骨遮挡的影响，基于X线的腰椎峡部裂性滑脱分期研究较少：根据峡部裂缝特征分为3期，但较为笼统；根据真性滑脱值和L5发育情况分型较为精确，可分为2型，但应用价值有限。CT较X线能更准确地评估腰椎峡部裂的程度，在显示腰椎峡部裂性滑脱方面优于X线。根据CT显示的峡部裂缝特征分为早期、进展期、终末期，根据此分期可在早期发现腰椎峡部裂性滑脱，但无法对峡部的细微形态变化进行评估。按照椎弓根峡部特征，在X线评估的基础上进行CT的分期，可分为极早期、晚期早期、进展期和晚期，其中早期是保守治疗的最佳时机，但研究存在局限；在此基础上重新分期，可分为非滑脱期、极早期、晚期早期、进展期及终末期，可以更准确地反映腰椎峡部裂性滑脱的严重程度。MRI在显露骨髓水肿以及其他软组织病变方面具有优势。根据腰椎峡部裂性滑脱MRI影像特征将其分为0~5级，但是此分型方法在显示2级腰椎峡部裂性滑脱时效果不佳，可能导致漏诊。根据峡部裂及周围组织在MRI中的表现，可将腰椎峡部裂性滑脱分为A型和BⅠ、BⅡ、BⅢ型，但疾病的进展中并不是每种分型均会出现。联合应用X线、CT及MRI进行腰椎峡部裂性滑脱分期，可分为早期阶段、进展阶段以及晚期阶段，早期阶段及进展期阶段应积极保守治疗。而按手术方式对腰椎峡部裂性滑脱进行的分型，对临床决策更具指导意义。 结论 目前，针对腰椎峡部裂性滑脱分型的相关研究主要集中在基于X线、CT、MRI等影像学表现，以及基于不同手术方式进行的分型与分期研究，不同的分型及分期可指导脊柱外科医师更好地了解该病的形成机制、预测进展及制定恰当的治疗方案。 Objective To summarize the research progress on the classification of lumbar spondylolisthesis. Methods A total of 570 articles on the classification and staging of lumbar spondylolisthesis published from January 2000 to July 2022 were retrieved from Chinese and English databases such as CNKI, Wanfang Database, and Pubmed. Articles for which the full text could not be obtained or had inconsistent content and repetitive studies were excluded. A total of 38 articles were finally included. The types and stages of spondylolisthmia were summarized. Results Given that X-ray is easily affected by iliac occlusion, few X-ray-based staging methods exist. X-ray-based staging methods can be divided into three types in accordance with the characteristics of isthmus cracks. However, they are general. Classification in accordance with the true slip value and L5 development is accurate and can be divided into two types but has limited application value. Compared with X-ray, CT can evaluate the degree of lumbar spondylolysis more accurately and is superior in showing spondylolisthesis. CT stages can be divided into early, advanced, and terminal in accordance with the features of isthmic fissures shown by CT. Although the CT staging method can be used to detect lumbar isthmic spondylolisthesis at an early stage, it cannot be used to evaluate the subtle morphological changes presented by isthmic fissures. CT staging based on X-ray evaluation can be divided into very early, late early, advanced, and late stages in accordance with the characteristics of the isthmus of the vertebral pedicle. Among these stages, the early stage is the best time for conservative treatment. However, research on this staging method has limitations. CT staging based on X-ray evaluation can be divided into the nonslip, very early, late early, advanced, and terminal stages. This staging system can reflect the severity of spondylolisthesis accurately. MRI has advantages in revealing bone marrow edema and other soft tissue lesions. Lumbar isthmic spondylolisthesis can be classified into grades 0-5 in accordance with MRI imaging features. However, this classification method is ineffective in showing grade 2 spondylolisthmic spondylolisthesis. This situation may lead to missed diagnosis. The isthmus is divided into types A, BⅠ, BⅡ, and BⅢ on the basis of the appearance of the isthmus and its surrounding tissue on MRI. However, not every type is observed in disease progression. Staging based on the simultaneous use of X-ray, CT, and MRI can be divided into early, progressive, and advanced stages, and patients in the early and progressive stages should actively receive conservative treatment. The surgical classification of spondylolisthmia is important for clinical decision making. Conclusion Relevant research on the classification and staging of lumbar spondylolisthesis is mainly based on imaging techniques, such as X-ray, CT, and MRI, and different surgical methods. Different classification and staging systems can guide spinal surgeons to understand the formation mechanism of lumbar spondylolisthesis, predict progress, and develop treatment plans.
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