应力性腰椎椎弓根骨折研究进展_《中国修复重建外科杂志》

作者：

刘勇 , 渠东 , 三军 , 振中 , 永军 , 奎水

无锡市第九人民医院骨科（江苏无锡， 214062）;

关键词：

应力性骨折椎弓根腰椎下腰痛治疗

DOI：

10.7507/1002-1892.20130052

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的综述有关应力性腰椎椎弓根骨折的研究进展。方法广泛查阅近年应力性腰椎椎弓根骨折的相关文献，并对其进行综合分析。结果应力性骨折分疲劳性和结构不良性两种类型，应力性腰椎椎弓根骨折主要发生在脊柱重复性活动、活动量大的人群和一侧峡部崩裂患者或行腰椎手术后患者等。导致应力性腰椎椎弓根骨折的主要应力是剪切力和扭转力，其次是脊柱突然过屈或过伸。常规X线片检查应力性腰椎椎弓根骨折极易漏诊，需要行XCT、MRI或骨扫描确诊。根据应力性骨折不同时期MRI表现，分为应力反应期、不全骨折期、完全骨折期和假关节期四期或四型。对于无神经根刺激症状的不全型和完全型应力性腰椎椎弓根骨折以及青少年应力性腰椎椎弓根骨折，多数主张首选保守治疗，骨折愈合率较高；对于双侧假关节型、有神经根刺激症状的应力性腰椎椎弓根骨折，以及保守治疗无效的应力性腰椎椎弓根骨折，均主张手术治疗。结论应力性腰椎椎弓根骨折作为引起下腰痛的原因之一，临床极为少见，且容易漏诊，结合骨折类型和患者个体情况综合考虑采取手术或保守治疗，效果较满意。

引用本文： 刘勇,渠东,三军,振中,永军,奎水. 应力性腰椎椎弓根骨折研究进展. 中国修复重建外科杂志, 2013, 27(2): 240-242. doi: 10.7507/1002-1892.20130052 复制

1.	Garber JE, Wright AM. Unilateral spondylolysis with contralateral pedicle fracture. Spine (Phila Pa 1976), 1986, 11(1): 63-66.
2.	Stanley D, Smith TW. Contralateral pedicle stress fracture. An unusual complication of laminectomy. Spine (Phila Pa 1976), 1990, 15(5): 598-599.
3.	Gunzburg R, Fraser RD. Stress fracture of the lumbar pedicle. Case reports of “pediculolysis” and review of literature. Spine (Phila Pa 1976), 1991, 16(2): 185-189.
4.	Traughber PD, Havlina JM. Bilateral pedicle stress fractures: SPECT and CT features. J Comput Assist Tomogr, 1991, 15(2): 338-340.
5.	Weatherley CR, Mehdian H, Berghe LV. Low back pain with fracture of the pedicle and contralateral spondylolysis. A technique of surgical management. J Bone Joint Surg (Br), 1991, 73(6): 990-993.
6.	Araki T, Harata S, Nakano K, et al. Reactive sclerosis of the pedicle associated with contralateral spondylolysis. Spine (Phila Pa 1976), 1992, 17(11): 1424-1426.
7.	Robertson PA, Grobler LJ. Stress fracture of the pedicle. A late complication of posterolateral lumbar fusion. Spine (Phila Pa 1976), 1993, 18(7): 930-932.
8.	Macdessi SJ, Leong AK, Bentivoglio JE. Pedicle fracture after instrumented posterolateral lumbar fusion: a case report. Spine (Phila Pa 1976), 2001, 26(5): 580-582.
9.	Sheehan JP, Helm GA, Sheehan JM, et al. Stress fracture of the pedicle after extensive decompression and contralateral posterior fusion for lumbar stenosis. Report of three cases. Neurosurg Focus, 2002, 13(2): E9.
10.	Ha KY, Kim YH. Bilateral pedicle stress fracture after instrumented posterolateral lumbar fusion: a case report. Spine (Phila Pa 1976), 2003, 28(8): E158-160.
11.	Kim HS, Ju CI, Kim SW. Bilateral pedicle stress fracture accompanying spondylolysis in a patient with ankylosing spondylitis. J Korean Neurosurg Soc, 2010, 48(1): 70-72.
12.	Palmer DK, Inceoglu S, Cheng WK. Stem fracture after total facet replacement in the lumbar spine: a report of two cases and review of the literature. Spine J, 2011, 11(7): e15-19.
13.	Mathew P, Blackman M, Redla S, et al. Bilateral pedicle fractures following anterior dislocation of the polyethylene inlay of a ProDisc artificial disc replacement: a case report of an unusual complication. Spine (Phila Pa 1976), 2005, 30(11): E311-314.
14.	Parvataneni HK, Nicholas SJ, McCance SE. Bilateral pedicle stress fractures in a female athlete: case report and review of the literature. Spine (Phila Pa 1976), 2004, 29(2): E19-21.
15.	Sairyo K, Katoh S, Sasa T, et al. Athletes with unilateral spondylolysis are at risk of stress fracture at the contralateral pedicle and pars interarticularis: a clinical and biomechanical study. Am J Sports Med, 2005, 33(4): 583-590.
16.	Sadiq MZ. Bilateral pedicle stress fracture in the lumbar spine of a sedentary office worker. Eur Spine J, 2006, 15 Suppl 5: 653-655.
17.	Obid P, Richter A, Ubeyli H, et al. Spontane0us bilateral pedicle fracture 30 years after Harrington Instrumentation for idiopathic scoliosis: a case report. J Med Case Rep, 2012, 23, 6(1): 29.
18.	Sirvanci M, Ulusoy L, Duran C. Pedicular stress fracture in lumbar spine. Clin Imaging, 2002, 26(3): 187-193.
19.	Murthy NS. Imaging of stress fractures of the spine. Radiol Clin North Am, 2012, 50(4): 799-821.
20.	Doita M, Shimomura T, Nishida K, et al. Bilateral pedicle stress fracture in a patient with lumbar spinal stenosis: a case report. J Spinal Disord Tech, 2008, 21(7): 531-534.
21.	Ornetti P, Prati C, Fery-Blanco C, et al. Pedicle stress fracture: an unusual complication of pycnodysostosis. Clin Rheumatol, 2008, 27(3): 385-387.
22.	Doita M, Ando Y, Hirata S, et al. Bilateral pedicle stress fracture in a patient with osteoporotic compression fracture. Eur Spine J, 2009, 18(Suppl 2): 206-209.
23.	Jeong IH, Hwang EH, Bae WT. Contralateral Pedicular Fracture with Unilateral Spondylolysis. J Korean Neurosurg Soc, 2009, 46(6): 584-587.
24.	Amari R, Sakai T, Katoh S, et al. Fresh stress fractures of lumbar pedicles in an adolescent male ballet dancer: Case report and literature review. Arch Orthop Trauma Surg, 2009, 129(3): 397-401.
25.	Johnson JN, Wang MY. Stress fracture of the lumbar pedicle bilaterally: surgical repair using a percutaneous minimally invasive technique. J Neurosurg Spine, 2009, 11(6): 724-728.
26.	Hajjioui A, Khazzani H, Sbihi S, et al. Spondylolisthesis on bilateral pedicle stress fracture in the lumbar spine: a case study. Ann Phys Rehabil Med, 2011, 54(1): 53-58.

1. Garber JE, Wright AM. Unilateral spondylolysis with contralateral pedicle fracture. Spine (Phila Pa 1976), 1986, 11(1): 63-66.
2. Stanley D, Smith TW. Contralateral pedicle stress fracture. An unusual complication of laminectomy. Spine (Phila Pa 1976), 1990, 15(5): 598-599.
3. Gunzburg R, Fraser RD. Stress fracture of the lumbar pedicle. Case reports of “pediculolysis” and review of literature. Spine (Phila Pa 1976), 1991, 16(2): 185-189.
4. Traughber PD, Havlina JM. Bilateral pedicle stress fractures: SPECT and CT features. J Comput Assist Tomogr, 1991, 15(2): 338-340.
5. Weatherley CR, Mehdian H, Berghe LV. Low back pain with fracture of the pedicle and contralateral spondylolysis. A technique of surgical management. J Bone Joint Surg (Br), 1991, 73(6): 990-993.
6. Araki T, Harata S, Nakano K, et al. Reactive sclerosis of the pedicle associated with contralateral spondylolysis. Spine (Phila Pa 1976), 1992, 17(11): 1424-1426.
7. Robertson PA, Grobler LJ. Stress fracture of the pedicle. A late complication of posterolateral lumbar fusion. Spine (Phila Pa 1976), 1993, 18(7): 930-932.
8. Macdessi SJ, Leong AK, Bentivoglio JE. Pedicle fracture after instrumented posterolateral lumbar fusion: a case report. Spine (Phila Pa 1976), 2001, 26(5): 580-582.
9. Sheehan JP, Helm GA, Sheehan JM, et al. Stress fracture of the pedicle after extensive decompression and contralateral posterior fusion for lumbar stenosis. Report of three cases. Neurosurg Focus, 2002, 13(2): E9.
10. Ha KY, Kim YH. Bilateral pedicle stress fracture after instrumented posterolateral lumbar fusion: a case report. Spine (Phila Pa 1976), 2003, 28(8): E158-160.
11. Kim HS, Ju CI, Kim SW. Bilateral pedicle stress fracture accompanying spondylolysis in a patient with ankylosing spondylitis. J Korean Neurosurg Soc, 2010, 48(1): 70-72.
12. Palmer DK, Inceoglu S, Cheng WK. Stem fracture after total facet replacement in the lumbar spine: a report of two cases and review of the literature. Spine J, 2011, 11(7): e15-19.
13. Mathew P, Blackman M, Redla S, et al. Bilateral pedicle fractures following anterior dislocation of the polyethylene inlay of a ProDisc artificial disc replacement: a case report of an unusual complication. Spine (Phila Pa 1976), 2005, 30(11): E311-314.
14. Parvataneni HK, Nicholas SJ, McCance SE. Bilateral pedicle stress fractures in a female athlete: case report and review of the literature. Spine (Phila Pa 1976), 2004, 29(2): E19-21.
15. Sairyo K, Katoh S, Sasa T, et al. Athletes with unilateral spondylolysis are at risk of stress fracture at the contralateral pedicle and pars interarticularis: a clinical and biomechanical study. Am J Sports Med, 2005, 33(4): 583-590.
16. Sadiq MZ. Bilateral pedicle stress fracture in the lumbar spine of a sedentary office worker. Eur Spine J, 2006, 15 Suppl 5: 653-655.
17. Obid P, Richter A, Ubeyli H, et al. Spontane0us bilateral pedicle fracture 30 years after Harrington Instrumentation for idiopathic scoliosis: a case report. J Med Case Rep, 2012, 23, 6(1): 29.
18. Sirvanci M, Ulusoy L, Duran C. Pedicular stress fracture in lumbar spine. Clin Imaging, 2002, 26(3): 187-193.
19. Murthy NS. Imaging of stress fractures of the spine. Radiol Clin North Am, 2012, 50(4): 799-821.
20. Doita M, Shimomura T, Nishida K, et al. Bilateral pedicle stress fracture in a patient with lumbar spinal stenosis: a case report. J Spinal Disord Tech, 2008, 21(7): 531-534.
21. Ornetti P, Prati C, Fery-Blanco C, et al. Pedicle stress fracture: an unusual complication of pycnodysostosis. Clin Rheumatol, 2008, 27(3): 385-387.
22. Doita M, Ando Y, Hirata S, et al. Bilateral pedicle stress fracture in a patient with osteoporotic compression fracture. Eur Spine J, 2009, 18(Suppl 2): 206-209.
23. Jeong IH, Hwang EH, Bae WT. Contralateral Pedicular Fracture with Unilateral Spondylolysis. J Korean Neurosurg Soc, 2009, 46(6): 584-587.
24. Amari R, Sakai T, Katoh S, et al. Fresh stress fractures of lumbar pedicles in an adolescent male ballet dancer: Case report and literature review. Arch Orthop Trauma Surg, 2009, 129(3): 397-401.
25. Johnson JN, Wang MY. Stress fracture of the lumbar pedicle bilaterally: surgical repair using a percutaneous minimally invasive technique. J Neurosurg Spine, 2009, 11(6): 724-728.
26. Hajjioui A, Khazzani H, Sbihi S, et al. Spondylolisthesis on bilateral pedicle stress fracture in the lumbar spine: a case study. Ann Phys Rehabil Med, 2011, 54(1): 53-58.

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应力性腰椎椎弓根骨折研究进展

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