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首页> 外文期刊>Journal of pediatric orthopaedics >Nonoperative treatment of spondylolysis and grade I spondylolisthesis in children and young adults: a meta-analysis of observational studies.
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Nonoperative treatment of spondylolysis and grade I spondylolisthesis in children and young adults: a meta-analysis of observational studies.

机译：儿童和年轻人的非手术治疗椎体溶解和I级椎体滑脱：一项观察性研究的荟萃分析。

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BACKGROUND: The incidence of spondylolysis is at least 6% by the end of childhood, and painful lesions are not infrequent. The most common treatments for spondylolysis are nonoperative in nature and include bracing, activity restriction, and therapeutic exercises. These treatments have been used either alone or in concert. The aim of this meta-analysis was to identify and summarize the evidence from the literature on the effectiveness of nonoperative treatment for spondylolysis (including those with up to 25% spondylolisthesis) in children and young adults. METHODS: A comprehensive literature search identified articles meeting the following inclusion criteria: (1) the target population was children and young adults with spondylolysis (including those with up to 25% spondylolisthesis); (2) the treatment intervention was nonoperative; (3) minimum follow-up was 1 year in studies using clinical parameters as the primary outcome; and (4) the studies included at least 10 subjects. Outcome data from eligible studies were pooled into 1 of 2 groups: clinical outcome or radiographic evidence of a union of the pars defects. RESULTS: Fifteen observational studies measuring the clinical outcome had a weighted and pooled success rate of 83.9% in 665 patients. A subgroup analysis comparing the clinical outcome of patients treated with a brace to patients treated without a brace was not significantly different (P=0.75). Ten studies evaluating radiographic healing of the defects had a pooled success rate of 28.0% (n=847). A subgroup analysis showed that unilateral defects healed at a pooled and weighted rate of 71% (n=92), significantly more than bilateral defects at 18.1% (n=446, P<0.0001). An additional subgroup analysis showed acute defects healed at a rate of 68.1% (n=236), significantly more than progressive lesions (28.3%, n=224, P<0.0001) and terminal lesions (n=217, P<0.0001), of which not one defect healed. CONCLUSIONS: A meta-analysis of observational studies suggests that 83.9% of patients treated nonoperativelywill have a successful clinical outcome after at least 1 year. Bracing does not seem to influence this outcome. In contrast to the high rate of success with clinical parameters, most defects did not heal with nonoperative treatment suggesting that a successful clinical outcome does not depend on healing of the lesion. Lesions diagnosed at the acute stage were more likely to heal after nonoperative treatment as were unilateral defects when compared with bilateral defects. LEVEL OF EVIDENCE: Meta-analysis of level IV studies. Therapeutic level IV.
机译：背景：到儿童期末，椎骨峡部裂的发生率至少为6％，并且疼痛的病变并不罕见。脊椎溶解的最常见治疗方法实际上是非手术性的，包括支撑，活动受限和治疗性锻炼。这些治疗方法已经单独使用或一起使用。这项荟萃分析的目的是从文献中鉴定和总结有关儿童和年轻人中非手术治疗椎体溶解症（包括那些合并椎体滑脱不超过25％的患者）有效性的证据。方法：全面的文献检索确定了符合以下入选标准的文章：（1）目标人群是儿童和青少年患有腰椎滑脱症（包括腰椎滑脱症占25％的儿童）; （2）治疗干预无效。 （3）以临床参数为主要结果的研究最少随访1年; （4）研究包括至少10名受试者。来自合格研究的结果数据分为2组中的1组：临床结果或pars缺陷并集的放射学证据。结果：十五项观察结果评估了665例患者的临床结局，加权和合并成功率为83.9％。比较使用支架治疗的患者和不使用支架治疗的患者的临床结局的亚组分析无显着差异（P = 0.75）。十项评估放射线愈合缺陷的研究的综合成功率为28.0％（n = 847）。亚组分析显示，单侧缺损的愈合率和加权率分别为71％（n = 92），明显高于双边缺损的18.1％（n = 446，P <0.0001）。进一步的亚组分析显示，急性缺损的治愈率为68.1％（n = 236），明显高于进行性病变（28.3％，n = 224，P <0.0001）和末期病变（n = 217，P <0.0001），其中没有一个缺陷可以治愈。结论：一项观察性研究的荟萃分析表明，非手术治疗的患者中，有83.9％的患者在至少一年后会获得成功的临床结局。支撑似乎并没有影响这一结果。与临床参数的高成功率相比，大多数缺陷在非手术治疗后无法治愈，这表明成功的临床结果并不取决于病变的愈合。与双侧缺损相比，在急性期被诊断出的病变与单侧缺损相比，非手术治疗后更容易愈合。证据级别：第四级研究的荟萃分析。治疗级别IV。

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