Chang Chia-Hsieh, Lee Zhon-Liao, Chen Wen-Jer, Tan Chih-Feng, Chen Lih-Huei
Department of Orthopedics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
Spine (Phila Pa 1976). 2008 Jul 15;33(16):1750-4. doi: 10.1097/BRS.0b013e31817d1d12.
Retrospective review and post-test-only control group design.
To study the incidence and associated factors of ring apophysis fracture in adolescent lumbar disc herniation and to evaluate the long-term morbidity of untreated apophyseal fracture.
Ring apophysis fracture is a feature in adolescent disc herniation, but the incidence and prognosis are unknown. It is still controversial whether to remove the apophyseal fragment at time of discectomy.
We studied 96 adolescents (mean age, 14.7 years) with clinical diagnosis of disc herniation proved by computerized tomography (CT). In CT scan ring, apophyseal fracture is classified by the size (large/small) and the location (central/lateral). We used modified Oswestry classification in the nonoperative patients for pain and functional evaluation. Patients with and without apophyseal fracture were compared to define the significance of the lesion.
Twenty-seven of the 96 CT studies (28%) demonstrated apophyseal fractures. All but 2 were at the level of the herniated disc. Large-central fragments were the most common in 16 patients (48%), large-lateral fragments in 2, small-central fragments in 6, and small-lateral fragment in 6. Rate of surgery was significantly higher in the disc herniation patients with apophyseal fractures. Sixty-four nonoperative patients were evaluated 6.6 years (range, 2.3-14.3) after the CT study and questionnaires were completed in 54 patients (84%). Patients with large apophyseal fragments had more chance of chronic back pain and limitation of daily activities than the patients with small fragments and patients without apophyseal fracture.
Apophyseal fracture is not uncommon in adolescent lumbar disc herniation. The surgical decision must depend on clinical symptoms instead of radiologic findings, but disc herniation with apophyseal fracture may exhibit more severe symptoms. Patients with large apophyseal fragments must be informed of a greater chance of chronic back pain later on. Small apophyseal fragments had no clinical significance.
回顾性研究及仅设后测的对照组设计。
研究青少年腰椎间盘突出症中环突骨折的发生率及相关因素，并评估未治疗的突骨折的长期发病率。
环突骨折是青少年椎间盘突出症的一个特征，但发生率及预后尚不清楚。椎间盘切除术时是否切除突碎片仍存在争议。
我们研究了96例临床诊断为椎间盘突出症的青少年（平均年龄14.7岁），其诊断经计算机断层扫描（CT）证实。在CT扫描中，根据环突骨折的大小（大/小）和位置（中央/外侧）进行分类。我们对非手术患者采用改良的奥斯维斯特里分类法进行疼痛和功能评估。比较有和没有突骨折的患者，以确定该病变的意义。
96例CT研究中有27例（28%）显示有突骨折。除2例外，所有骨折均发生在椎间盘突出的节段。大的中央碎片最为常见，有16例患者（48%）；大的外侧碎片2例；小的中央碎片6例；小的外侧碎片6例。有环突骨折的椎间盘突出症患者的手术率明显更高。64例非手术患者在CT检查后6.6年（范围2.3 - 14.3年）接受评估，54例患者（84%）完成了问卷调查。有大的突碎片的患者比有小碎片的患者和没有突骨折的患者患慢性背痛和日常活动受限的可能性更大。
环突骨折在青少年腰椎间盘突出症中并不少见。手术决策必须取决于临床症状而非影像学表现，但伴有环突骨折的椎间盘突出症可能表现出更严重的症状。必须告知有大的突碎片的患者日后患慢性背痛的可能性更大。小的突碎片无临床意义。
