Stretch R A, Botha T, Chandler S, Pretorius P
Sport Bureau, University of Port Elizabeth, PO Box 1600, Port Elizabeth, 6000.
S Afr Med J. 2003 Aug;93(8):611-6.
To demonstrate the efficacy of various radiological diagnostic modalities in assessing lower back pain in young fast bowlers.
Ten cricketers who presented to either a physiotherapist or a doctor with suspected spondylolysis underwent an X-ray, a single photon emission computed tomography (SPECT) bone scan and a computed tomography (CT) scan to assess the severity of the injury. Three and 12 months after the initial CT scan, second and third CT scans were performed in order to assess whether healing had taken place. After the initial radiological investigation the subjects diagnosed with spondylolysis or pedicle sclerosis underwent prescribed intervention and rehabilitation which included physiotherapy modalities, postural correction, and specific individually graded flexibility, stabilisation, strengthening and cardiovascular programmes.
Radiographs were normal in 8 subjects, while 2 had evidence of sclerosis. The isotope scan showed increased uptake in all of the subjects. The CT scans showed no fracture (N = 3), partial fractures (N = 3), complete fractures (N = 2) and old fractures bilaterally (N = 2). When the follow-up CT scan was carried out at 3 months, 1 of the subjects had developed a partial fracture of the left pars interarticularis on the inferior border, which showed complete union when CT scanned at 12 months. At 3 months the partial and complete fractures showed progressive healing in 2 subjects, with complete healing in all the other cases. Complete healing was achieved in all subjects at 12 months, with the exception of 1 subject who showed near-complete union, with a small area of fibrous union on the inferior border and 2 old bilateral fractures that remained un-united.
From the results it is evident that when a young fast bowler presents with backache after bowling, it would be appropriate to do an X-ray, a bone scan and a CT scan to make the diagnosis. Discontinuing the fast bowling and following an active rehabilitation programme should result in spontaneous resolution and healing of the fractures. If it is not detected early a fibrous or non-union fracture could result.
证明各种放射学诊断方法在评估年轻快速投球手下背部疼痛方面的疗效。
10名因疑似椎弓崩裂而就诊于物理治疗师或医生处的板球运动员接受了X线、单光子发射计算机断层扫描（SPECT）骨扫描和计算机断层扫描（CT），以评估损伤的严重程度。在初次CT扫描后的3个月和12个月，进行了第二次和第三次CT扫描，以评估是否已愈合。在初次放射学检查后，被诊断为椎弓崩裂或椎弓根硬化的受试者接受了规定的干预和康复治疗，包括物理治疗方法、姿势矫正以及特定的个体化分级柔韧性、稳定性、强化和心血管训练计划。
8名受试者的X线片正常，2名有硬化迹象。同位素扫描显示所有受试者摄取增加。CT扫描显示无骨折（n = 3）、部分骨折（n = 3）、完全骨折（n = 2）和双侧陈旧性骨折（n = 2）。在3个月时进行随访CT扫描时，1名受试者在下缘出现了左侧关节突间部的部分骨折，在12个月时CT扫描显示完全愈合。在3个月时，2名受试者的部分和完全骨折显示出逐渐愈合，其他所有病例均完全愈合。除1名受试者显示近乎完全愈合，在下缘有一小片纤维性愈合区域，以及2例双侧陈旧性骨折未愈合外，所有受试者在12个月时均实现了完全愈合。
从结果可以明显看出，当一名年轻快速投球手在投球后出现背痛时，进行X线、骨扫描和CT扫描以做出诊断是合适的。停止快速投球并遵循积极的康复计划应能使骨折自发消退和愈合。如果早期未被发现，可能会导致纤维性或不愈合骨折。
