Spinal Department, Oxford University Hospitals, Headley Way, Oxford, United Kingdom.
Orthopaedic Department, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, United Kingdom; Division of Medical Sciences, Oxford University Clinical Academic Graduate School, Headley Way, Oxford, United Kingdom.
Global Spine J. 2016 Sep;6(6):615-25. doi: 10.1055/s-0036-1586743. Epub 2016 Aug 10.
Narrative review.
The study aims to critically review the outcomes associated with the surgical repair or conservative management of spondylolysis in athletes.
The English literature listed in MEDLINE/PubMed was reviewed to identify related articles using the term "spondylolysis AND athlete." The criteria for studies to be included were management of spondylolysis in athletes, English text, and no year, follow-up, or study design restrictions. The references of the retrieved articles were also evaluated. The primary outcome was time to return to sport. This search yielded 180 citations, and 25 publications were included in the review.
Treatment methods were dichotomized as operative and nonoperative. In the nonoperative group, 390 athletes were included. A combination of bracing with physical therapy and restriction of activities was used. Conservative measures allowed athletes to return to sport in 3.7 months (weighted mean). One hundred seventy-four patients were treated surgically. The most common technique was Buck's, using a compression screw (91/174). All authors reported satisfactory outcomes. Time to return to play was 7.9 months (weighted mean). There were insufficient studies with suitably homogenous subgroups to conduct a meta-analysis.
There is no gold standard approach for the management of spondylolysis in the athletic population. The existing literature suggests initial therapy should be a course of conservative management with thoracolumbosacral orthosis brace, physiotherapy, and activity modification. If conservative management fails, surgical intervention should be considered. Two-sided clinical studies are needed to determine an optimal pathway for the management of athletes with spondylolysis.
叙述性回顾。
本研究旨在批判性地回顾与运动员峡部裂的手术治疗或保守治疗相关的结果。
在 MEDLINE/PubMed 中检索英文文献，使用“spondylolysis AND athlete”这一术语来确定相关文章。纳入研究的标准为：运动员峡部裂的治疗、英文文本、无年限、随访或研究设计限制。还评估了检索到的文章的参考文献。主要结局是重返运动的时间。该检索产生了 180 个引文，有 25 篇出版物被纳入综述。
治疗方法分为手术和非手术。在非手术组中，纳入了 390 名运动员。采用支具与物理治疗相结合并限制活动的方法。保守治疗可使运动员在 3.7 个月（加权平均值）重返运动。174 例患者接受了手术治疗。最常见的技术是 Buck's 法，使用压缩螺钉（91/174）。所有作者均报告了满意的结果。重返运动的时间为 7.9 个月（加权平均值）。由于没有足够的研究具有适当的同质亚组，因此无法进行荟萃分析。
对于运动员峡部裂的治疗，目前尚无金标准方法。现有文献表明，初始治疗应是保守治疗，包括胸腰骶支具、物理治疗和活动调整。如果保守治疗失败，应考虑手术干预。需要进行双盲临床试验来确定治疗运动员峡部裂的最佳方案。
