The mechanical etiology of spondylolysis and spondylolisthesis.
The mechanical etiology of spondylolysis and spondylolisthesis.
复制标题
脊椎峡部裂和脊椎滑脱的机械病因学。
DOI：
10.1097/00003086-197606000-00005
复制
发表时间：
1976
影响因子：
4.2
通讯作者：
C. Eng
中科院分区：
文献类型：
--
作者：
H. Farfan;V. Osteria;C. Eng
有3种机制可能导致神经弓失效，伴有或不伴有病理椎体椎体移位：屈曲超载、不平衡剪切力和强制旋转。应当理解，所有类型的过载可以同时并且以各种组合来应用。在作用于腰椎的所有力中，扭转暴力对神经弓的破坏性最大。除了引起滑脱之外，它还能够产生部位的溶解，特别是当背脊柱在后韧带系统中受到高拉应力的额外限制时。在正常情况下，L5-S1椎间关节承受的力最大，因此最先受到损伤。然而，在存在反逆过程的情况下，破坏性应力会出现在下一个较高的关节中。虽然抗扭转大横突可以保护 L5-S1 关节免受扭转，但它可能无法保护 L5 椎骨免受过度弯曲应变的影响，过度弯曲应变可能导致椎骨骨折。虽然这两种情况都可能发生松解，但矛盾的是，脊椎峡部裂和脊椎滑脱是相互排斥的情况。长期以来，人们一直认为剪切力不平衡是滑脱的原因。这种机制仍然不令人信服，除非存在影响骨骼组织的病理状况。
There are 3 mechanisms that may result in failure of the neural arch with or without displacement of the vertebral body of the pathological vertebral: flexion overload, unbalanced shear forces and forced rotation. It is understood that all types of overload may be applied simultaneously and in various combinations. Of all the forces acting on the lumbar spine torsional violence is the most disruptive of the neural arch. Besides causing olisthesis, it is also capable of producing lysis of the pars especially if the dorsal spine has the added restraint of high tensile stresses in the posterior ligamentous system. Under normal conditions, the L5-S1 intervertebral joint is subject to the highest forces and it therefore receives the first damage. However, in the presence of antiverse process, damaging stress occurs in the next higher joint. While the antitorsional large transverse process may protect the L5-S1 joint from torsion, it may not protect the L5 vertebra from excessive flexional strains that may fracture the pars. Though lysis may occur in both instances, paradoxically spondylolysis and spondylolisthesis are mutually exclusive conditions. It has long been thought that shear force imbalance was the causative agent in olisthesis. This mechanism remains unconvincing except possibly in instances where there is a pathological condition affecting the skeletal tissue.