Sairyo K, Sakai T, Yasui N
Department of Orthopaedics, University of Tokushima School of Medicine, 3-18-15, Kuramoto, Tokushima 770-8503, Japan.
J Bone Joint Surg Br. 2009 Feb;91(2):206-9. doi: 10.1302/0301-620X.91B2.21256.
It has been noted that bony union of a pars defect can be achieved in children if they wear a trunk brace. Our aim was to evaluate how the stage of the defect on CT and the presence or absence of high signal change in the adjacent pedicle on T2-weighted MRI were related to bony healing. We treated 23 children conservatively for at least three months. There were 19 boys and four girls with a mean age of 13.5 years (7 to 17). They were asked to refrain from sporting activity and to wear a Damen soft thoracolumbosacral type brace. There were 41 pars defects in 23 patients. These were classified as an early, progressive or terminal stage on CT. The early-stage lesions had a hairline crack in the pars interarticularis, which became a gap in the progressive stage. A terminal-stage defect was equivalent to a pseudarthrosis. On the T2-weighted MR scan the presence or absence of high signal change in the adjacent pedicle was assessed and on this basis the defects were divided into high signal change-positive or -negative. Healing of the defect was assessed by CT. In all, 13 (87%) of the 15 early defects healed. Of 19 progressive defects, only six (32%) healed. None of the seven terminal defects healed. Of the 26 high signal change-positive defects 20 (77%) healed after conservative treatment whereas none of the high signal change-negative defects did so. We concluded that an early-stage defect on CT and high signal change in the adjacent pedicle on a T2-weighted MR scan are useful predictors of bony healing of a pars defect in children after conservative treatment.
已经注意到，如果儿童佩戴躯干支具，峡部缺损可以实现骨性愈合。我们的目的是评估CT上缺损的阶段以及T2加权MRI上相邻椎弓根高信号改变的有无与骨愈合的关系。我们对23名儿童进行了至少三个月的保守治疗。有19名男孩和4名女孩，平均年龄13.5岁（7至17岁）。要求他们避免体育活动并佩戴达门软式胸腰骶型支具。23例患者中有41处峡部缺损。这些在CT上被分类为早期、进展期或终末期。早期病变在关节突间有一条细裂缝，在进展期变成一个间隙。终末期缺损相当于假关节。在T2加权MR扫描上评估相邻椎弓根高信号改变的有无，并在此基础上将缺损分为高信号改变阳性或阴性。通过CT评估缺损的愈合情况。15处早期缺损中有13处（87%）愈合。19处进展期缺损中只有6处（32%）愈合。7处终末期缺损均未愈合。26处高信号改变阳性缺损中有20处（77%）在保守治疗后愈合，而高信号改变阴性缺损无一愈合。我们得出结论，CT上的早期缺损和T2加权MR扫描上相邻椎弓根的高信号改变是儿童峡部缺损保守治疗后骨愈合的有用预测指标。
