腰椎管狭窄症诊断与治疗的研究进展

姚俊杰; 齐伟; 张馨心; 刘畅; 庞婷婷; 栗嘉徽; 商强强

doi:10.7619/jcmp.20214841

腰椎管狭窄症诊断与治疗的研究进展

1.
长春中医药大学, 吉林长春, 130117
2.
长春中医药大学附属医院, 吉林长春, 130021

基金项目:

国家自然科学基金委员会资助项目 82074570

详细信息

通讯作者:
商强强, E-mail: 470396919@qq.com

中图分类号: R681.5;R274.9
计量
- 文章访问数: 389
- HTML全文浏览量: 278
- PDF下载量: 51
出版历程
- 收稿日期: 2021-12-07
- 网络出版日期: 2022-03-21

Research progress in diagnosis and treatment of lumbar spinal stenosis

1.
Changchun University of Chinese Medicine, Changchun, Jilin, 130117
2.
the Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, Jilin, 130021

摘要

摘要:
腰椎管狭窄症(LSS)是临床常见的脊柱疾病, 手术为LSS患者首选的治疗方法，传统的中医药保守治疗对轻、中度狭窄的患者也有显著疗效，但临床中对该病的诊疗始终存在分歧。本文通过疏理腰椎管狭窄症最新文献，从症状体征、影像学诊断与全基因组关联分析等方面为临床提供新的补充，为治疗提供新的证据，并为保守治疗的研究与开展提供新思路。
- 腰椎管狭窄症 /
- 椎旁肌肉异常 /
- 全基因组关联分析 /
- 影像学 /
- 老龄化
Abstract:
Lumbar spinal stenosis (LSS) is a common clinical spinal disease, surgery is the first choice for patients with LSS, and conservative treatment with traditional Chinese medicine also has a significant effect for patients with mild and moderate stenosis. However, there are always differences in diagnosis and treatment of LSS in clinic. By sorting out the latest literatures on lumbar spinal stenosis, this paper provided new supplements for clinical practice from the aspects of symptoms and signs, imaging diagnosis and genome-wide association analysis, gave new evidence for treatment, new ideas for the study and development of conservative treatment.
- lumbar spinal stenosis /
- paravertebral muscle abnormalities /
- genome-wide association analysis /
- imaging /
- aging

HTML全文

参考文献(50)

[1]	腰椎管狭窄症手术治疗规范中国专家共识组. 腰椎管狭窄症手术治疗规范中国专家共识(2014年)[J]. 中华医学杂志, 2014, 94(35): 2724-2725. doi: 10.3760/cma.j.issn.0376-2491.2014.35.002
[2]	KNUTSSON B, MUKKA S, WAHLSTRÖM J, et al. The association between tobacco smoking and surgical intervention for lumbar spinal Stenosis: cohort study of 331, 941 workers[J]. Spine J, 2018, 18(8): 1313-1317. doi: 10.1016/j.spinee.2017.11.018
[3]	LIU X, ZHAO X D, LONG Y W, et al. Facet sagittal orientation: possible role in the pathology of degenerative lumbar spinal Stenosis[J]. Spine, 2018, 43(14): 955-958. doi: 10.1097/BRS.0000000000002493
[4]	OTANI K, KIKUCHI S, YABUKI S, et al. Lumbar spinal Stenosis has a negative impact on quality of life compared with other comorbidities: an epidemiological cross-sectional study of 1862 community-dwelling individuals[J]. Sci World J, 2013, 2013: 590652. http://www.ncbi.nlm.nih.gov/pubmed/24453878
[5]	KITAB S, LEE B S, BENZEL E C. Redefining lumbar spinal Stenosis as a developmental syndrome: an MRI-based multivariate analysis of findings in 709 patients throughout the 16- to 82-year age spectrum[J]. J Neurosurg Spine, 2018, 29(6): 654-660. doi: 10.3171/2018.5.SPINE18100
[6]	ZILELI M, CROSTELLI M, GRIMALDI M, et al. Natural course and diagnosis of lumbar spinal Stenosis: WFNS spine committee recommendations[J]. World Neurosurg X, 2020, 7: 100073. doi: 10.1016/j.wnsx.2020.100073
[7]	王波, 王宸, 王运涛, 等. 腰椎管狭窄症诊断和治疗的不确定性[J]. 东南大学学报: 医学版, 2013, 32(1): 121-124. doi: 10.3969/j.issn.1671-6264.2013.01.029
[8]	徐燕笑, 武凯, 廖立青, 等. 腰椎弓根长度与椎管大小的相关性[J]. 解剖学杂志, 2019, 42(5): 473-476. doi: 10.3969/j.issn.1001-1633.2019.05.009
[9]	JIANG H, MORO A, LIU Y, et al. Two GWAS-identified variants are associated with lumbar spinal Stenosis and Gasdermin-C expression in Chinese population[J]. Sci Rep, 2020, 10(1): 21069. doi: 10.1038/s41598-020-78249-7
[10]	JIANG X, CHEN D. The identification of novel gene mutations for degenerative lumbar spinal Stenosis using whole-exome sequencing in a Chinese cohort[J]. BMC Med Genomics, 2021, 14(1): 134. doi: 10.1186/s12920-021-00981-4
[11]	SURI P, STANAWAY I B, ZHANG Y F, et al. Genome-wide association studies of low back pain and lumbar spinal disorders using electronic health record data identify a locus associated with lumbar spinal Stenosis[J]. Pain, 2021, 162(8): 2263-2272. http://journals.lww.com/pain/Abstract/9000/Genome_wide_association_studies_of_low_back_pain.98125.aspx
[12]	JIANG J Y, WANG H B, WANG L, et al. Multifidus degeneration, A new risk factor for lumbar spinal Stenosis: a case-control study[J]. World Neurosurg, 2017, 99: 226-231. doi: 10.1016/j.wneu.2016.11.142
[13]	MIKI T, NAOKI F, TAKASHIMA H, et al. Associations between paraspinal muscle morphology, disc degeneration, and clinical features in patients with lumbar spinal Stenosis[J]. Prog Rehabil Med, 2020, 5: 20200015. http://www.researchgate.net/publication/342933719_Associations_between_Paraspinal_Muscle_Morphology_Disc_Degeneration_and_Clinical_Features_in_Patients_with_Lumbar_Spinal_Stenosis
[14]	FORTIN M, LAZÁRY Á, VARGA P P, et al. Association between paraspinal muscle morphology, clinical symptoms and functional status in patients with lumbar spinal Stenosis[J]. Eur Spine J, 2017, 26(10): 2543-2551. doi: 10.1007/s00586-017-5228-y
[15]	TOMKINS-LANE C, MELLOH M, WONG A. Diagnostic tests in the clinical diagnosis of lumbar spinal Stenosis: consensus and Results of an International Delphi Study[J]. Eur Spine J, 2020, 29(9): 2188-2197. doi: 10.1007/s00586-020-06481-w
[16]	COOK C J, COOK C E, REIMAN M P, et al. Systematic review of diagnostic accuracy of patient history, clinical findings, and physical tests in the diagnosis of lumbar spinal Stenosis[J]. Eur Spine J, 2020, 29(1): 93-112. doi: 10.1007/s00586-019-06048-4
[17]	ISHIHARA S, FUJITA N, AZUMA K, et al. Spinal epidural lipomatosis is a previously unrecognized manifestation of metabolic syndrome[J]. Spine J, 2019, 19(3): 493-500. doi: 10.1016/j.spinee.2018.07.022
[18]	KIM K, MENDELIS J, CHO W. Spinal epidural lipomatosis: a review of pathogenesis, characteristics, clinical presentation, and management[J]. Global Spine J, 2019, 9(6): 658-665. doi: 10.1177/2192568218793617
[19]	MALONE J B, BEVAN P J, LEWIS T J, et al. Incidence of spinal epidural lipomatosis in patients with spinal Stenosis[J]. J Orthop, 2018, 15(1): 36-39. doi: 10.1016/j.jor.2017.11.001
[20]	SPINNATO P, LOTRECCHIANO L, PONTI F. "Y" sign in spinal epidural lipomatosis[J]. Joint Bone Spine, 2021, 88(1): 105056. doi: 10.1016/j.jbspin.2020.07.005
[21]	PAPAVERO L, EBERT S, MARQUES C J. The prevalence of redundant nerve roots in patients with lumbar spinal Stenosis is body position dependent: a retrospective observational study with repeated measures design in an upright MRI scanner[J]. Neuroradiology, 2020, 62(8): 979-985. doi: 10.1007/s00234-020-02423-x
[22]	CONG L, ZHU Y, YAN Q, et al. A meta-analysis on the clinical significance of redundant nerve roots in symptomatic lumbar spinal Stenosis[J]. World Neurosurg, 2017, 105: 95-101. doi: 10.1016/j.wneu.2017.05.103
[23]	MARQUES C J, HILLEBRAND H, PAPAVERO L. The clinical significance of redundant nerve roots of the cauda equina in lumbar spinal Stenosis patients: a systematic literature review and meta-analysis[J]. Clin Neurol Neurosurg, 2018, 174: 40-47. doi: 10.1016/j.clineuro.2018.09.001
[24]	任涛, 郑明辉, 王翔, 等. 伴与不伴马尾神经冗余征腰椎管狭窄症的手术疗效比较[J]. 中国矫形外科杂志, 2019, 27(1): 42-46. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJXS201901013.htm
[25]	BARZ T, MELLOH M, STAUB L P, et al. Increased intraoperative epidural pressure in lumbar spinal Stenosis patients with a positive nerve root sedimentation sign[J]. Eur Spine J, 2014, 23(5): 985-990. doi: 10.1007/s00586-013-3071-3
[26]	WANG G Y, PENG Z, LI J, et al. Diagnostic performance of the nerve root sedimentation sign in lumbar spinal Stenosis: a systematic review and meta-analysis[J]. Neuroradiology, 2019, 61(10): 1111-1121. doi: 10.1007/s00234-019-02248-3
[27]	KO S. Correlations between sedimentation sign, dural sac cross-sectional area, and clinical symptoms of degenerative lumbar spinal Stenosis[J]. Eur Spine J, 2018, 27(7): 1623-1628. doi: 10.1007/s00586-017-5374-2
[28]	ZHANG L M, CHEN R Q, LIU B, et al. The nerve root sedimentation sign for differential diagnosis of lumbar spinal Stenosis: a retrospective, consecutive cohort study[J]. Eur Spine J, 2017, 26(10): 2512-2519. doi: 10.1007/s00586-016-4435-2
[29]	陈延超, 余作冲, 曹蓉, 等. MRI显示神经根沉降征在腰椎管狭窄症中的应用价值[J]. 中国组织工程研究, 2017, 21(31): 5042-5047. doi: 10.3969/j.issn.2095-4344.2017.31.021
[30]	ANDERSON D B, LUCA K, JENSEN R K, et al. A critical appraisal of clinical practice guidelines for the treatment of lumbar spinal Stenosis[J]. Spine J, 2021, 21(3): 455-464. doi: 10.1016/j.spinee.2020.10.022
[31]	FORNARI M, ROBERTSON S C, PEREIRA P, et al. Conservative treatment and percutaneous pain relief techniques in patients with lumbar spinal Stenosis: WFNS spine committee recommendations[J]. World Neurosurg X, 2020, 7: 100079. doi: 10.1016/j.wnsx.2020.100079
[32]	JANG S H, CHANG M C. At least 5-year follow-up after transforaminal epidural steroid injection due to lumbar radicular pain caused by spinal Stenosis[J]. Pain Pract, 2020, 20(7): 748-751. doi: 10.1111/papr.12905
[33]	谢瑞, 于杰, 梁龙, 等. 腰椎管狭窄患者的手术和非手术治疗: 丹麦国家临床指南解读[J]. 天津中医药, 2020, 37(1): 33-37. https://www.cnki.com.cn/Article/CJFDTOTAL-TJZY202001009.htm
[34]	SHEN J, WANG Q, WANG Y M, et al. Comparison between fusion and non-fusion surgery for lumbar spinal Stenosis: a meta-analysis[J]. Adv Ther, 2021, 38(3): 1404-1414. doi: 10.1007/s12325-020-01604-7
[35]	HERMANSEN E, AUSTEVOLL I M, HELLUM C, et al. Comparable increases in dural sac area after three different posterior decompression techniques for lumbar spinal Stenosis: radiological results from a randomized controlled trial in the NORDSTEN study[J]. Eur Spine J, 2020, 29(9): 2254-2261. doi: 10.1007/s00586-020-06499-0
[36]	MACHADO G C, FERREIRA P H, YOO R I, et al. Surgical options for lumbar spinal Stenosis[J]. Cochrane Database Syst Rev, 2016, 11: CD012421. http://www.researchgate.net/profile/Gustavo_Machado4/publication/309613794_Surgical_options_for_lumbar_spinal_stenosis/links/59e165b2aca2724cbfdb79e0/Surgical-options-for-lumbar-spinal-stenosis.pdf
[37]	FÖRSTH P, ÓLAFSSON G, CARLSSON T, et al. A randomized, controlled trial of fusion surgery for lumbar spinal Stenosis[J]. N Engl J Med, 2016, 374(15): 1413-1423. doi: 10.1056/NEJMoa1513721
[38]	WEI F L, ZHOU C P, LIU R, et al. Management for lumbar spinal Stenosis: a network meta-analysis and systematic review[J]. Int J Surg, 2021, 85: 19-28. doi: 10.1016/j.ijsu.2020.11.014
[39]	MASI A T, BETTS S. Surgery versus nonsurgical treatment of lumbar spinal Stenosis[J]. Ann Intern Med, 2015, 163(5): 397. doi: 10.7326/L15-5129-4
[40]	ZAINA F, TOMKINS-LANE C, CARRAGEE E, et al. Surgical versus non-surgical treatment for lumbar spinal Stenosis[J]. Cochrane Database Syst Rev, 2016(1): CD010264. doi: 10.1002/14651858.CD010264.pub2/media/CDSR/CD010264/CD010264.pdf
[41]	ILYAS H, GOLUBOVSKY J L, CHEN J X, et al. Risk factors for 90-day reoperation and readmission after lumbar surgery for lumbar spinal Stenosis[J]. J Neurosurg Spine, 2019, 31(1): 20-26. doi: 10.3171/2019.1.SPINE18878
[42]	MOOJEN W A, ARTS M P, JACOBS W C H, et al. Interspinous process device versus standard conventional surgical decompression for lumbar spinal Stenosis: randomized controlled trial[J]. BMJ, 2013, 347: f6415. doi: 10.1136/bmj.f6415
[43]	COSTA F, INNOCENZI G, GUIDA F, et al. Degenerative lumbar spine Stenosis consensus conference: the Italian job. recommendations of the spinal section of the Italian society of neurosurgery[J]. J Neurosurg Sci, 2021, 65(2): 91-100.
[44]	MACHADO G C, FERREIRA M L. No clinically important benefits of surgery over rehabilitation for lumbar spinal Stenosis (PEDro synthesis)[J]. Br J Sports Med, 2017, 51(6): 541-542. doi: 10.1136/bjsports-2016-097238
[45]	DELITTO A, PIVA S R, MOORE C G, et al. Surgery versus nonsurgical treatment of lumbar spinal Stenosis: a randomized trial[J]. Ann Intern Med, 2015, 162(7): 465-473. doi: 10.7326/M14-1420
[46]	NETZER C, URECH K, HVGLE T, et al. Characterization of subchondral bone histopathology of facet joint osteoarthritis in lumbar spinal Stenosis[J]. J Orthop Res, 2016, 34(8): 1475-1480. doi: 10.1002/jor.23281
[47]	QIN Z S, DING Y L, XU C, et al. Acupuncture vs noninsertive sham acupuncture in aging patients with degenerative lumbar spinal Stenosis: a randomized controlled trial[J]. Am J Med, 2020, 133(4): 500-507, e20. doi: 10.1016/j.amjmed.2019.08.038
[48]	OKA H, MATSUDAIRA K, TAKANO Y, et al. A comparative study of three conservative treatments in patients with lumbar spinal Stenosis: lumbar spinal Stenosis with acupuncture and physical therapy study (LAP study)[J]. BMC Complement Altern Med, 2018, 18(1): 19. doi: 10.1186/s12906-018-2087-y
[49]	雍晨, 谭龙旺. 中医药疗法促进腰椎间盘突出后重吸收的作用研究[J]. 湖北中医药大学学报, 2021, 23(1): 118-121. https://www.cnki.com.cn/Article/CJFDTOTAL-HZXX202101033.htm
[50]	KWON C Y, YOON S H, LEE B, et al. Acupotomy for the treatment of lumbar spinal Stenosis: a systematic review and meta-analysis[J]. Medicine, 2019, 98(32): e16662. doi: 10.1097/MD.0000000000016662

施引文献(11)

期刊类型引用(9)

1.	黄琳，粟胜勇. 基于JAK/STAT信号通路探讨针刺治疗脑出血机制研究进展. 中国中医药信息杂志. 2024(02): 186-190 . 百度学术
2.	马学淼，杜晔，程光宇，程为平. 针刺对急性颅内出血大鼠的神经功能及损伤的影响. 中国医药导报. 2023(17): 14-18 . 百度学术
3.	韩光远，宋丽娟，丁智斌，安俊，柴智，王青，黄建军，马存根. 星形胶质细胞在脑缺血诱导的炎症反应中的作用及其机制. 中国免疫学杂志. 2022(01): 118-123 . 百度学术
4.	孔妍，邹伟，关睿骞，刘双岭，陈奥，崔乃松. 基于GFAP/STAT3通路探讨针康法对脑缺血再灌注大鼠神经功能和星形胶质细胞的影响. 环球中医药. 2022(05): 731-737 . 百度学术
5.	许文婷，薛玉满，王策，孔莹，邹伟. 百会透曲鬓调控EGFR/STAT3通路抑制脑出血大鼠神经功能损伤的机制研究. 针灸临床杂志. 2022(07): 70-75 . 百度学术
6.	彭华，唐晓平，张涛，孙浩耕，杨彬彬，熊平. 蛛网膜下腔出血大鼠血清中EGFR、FABP、Glu和Asp的表达水平及意义. 河北医药. 2019(09): 1317-1320 . 百度学术
7.	孙晓玲，张晓娟，张清泉，邱雷，王林娜，侯素平. TP53、EGFR、PDGF在星形胶质细胞瘤进展中的表达及意义. 广东医学. 2019(12): 1750-1753 . 百度学术
8.	魏珍珍，方晓艳，白明，苗明三. 基于星形胶质细胞的脑缺血损伤治疗研究进展. 神经药理学报. 2019(01): 36-43 . 百度学术
9.	何佳鑫，赵晖，张秋霞，齐放，李君玲，张楠，樊永平，李明，王蕾. 补肾益髓方及其拆方对星形胶质细胞胶质瘢痕中GFAP与CSPGs表达的影响. 中国中医急症. 2018(01): 1-4 . 百度学术