用单光子发射计算机断层扫描（SPECT）检测10岁以下腰痛患者的椎弓根损伤。
Detection of pars injury by SPECT in patients younger than age 10 with low back pain.
作者信息
Spencer Hillard T, Sokol Levi O, Glotzbecker Michael P, Grant Frederick D, d'Hemecourt Pierre A, Micheli Lyle J, Treves S Ted
机构信息
Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
出版信息
J Pediatr Orthop. 2013 Jun;33(4):383-8. doi: 10.1097/BPO.0b013e318285c3be.
BACKGROUND
Evaluation of extension-based low back pain in young athletes with suspected pars injury may include a referral for skeletal single photon emission computed tomography (SPECT). However, the diagnostic yield of this technique in children with low back pain before the age of 10 years remains uncertain. We examined a series of consecutive SPECT scans to address this question.
MATERIALS AND METHODS
A retrospective review of department databases revealed 107 consecutive skeletal Tc-99m MDP SPECT scans performed between January 1, 2007 and December 31, 2009 in children less than 10 years of age. Of these, 72 studies were performed for a referral diagnosis of back pain. There were 43 girls (44 studies) and 28 boys (28 studies). The mean age was 7.2 years (range, 1.9 to 9.9 y). All SPECT scans were reviewed and positive findings documented. In addition, all available anatomic imaging, imaging reports (computed tomography, magnetic resonance, and x-ray) and clinical notes were reviewed, and results were compared with those of SPECT studies.
RESULTS
Of the 72 SPECT studies, 35 (49%) identified a focal area in the spine of abnormal increased uptake, with 17 in the region of the pars interarticularis. With additional imaging, 1 case was demonstrated not to be a pars injury (computed tomography showed a transverse process fracture) and 2 patients with negative SPECT scans were shown to have pars injuries that SPECT scan had not detected, for a total of 18 pars injuries (25%) in this cohort. Reported participation in gymnastics or football was related to pars injury (odds ratio 4.3, P=0.04).
CONCLUSIONS
Pars injury was found in 25% of children referred for SPECT scan with back pain below 10 years of age. SPECT scan was highly sensitive for this injury as well as in identifying other potential sites of pathology, and should be considered in the workup of persistent low back pain in young children.
LEVEL OF EVIDENCE
Level II, diagnostic study.
背景
对于怀疑椎弓根损伤的年轻运动员，评估基于伸展的下背痛可能包括转诊进行骨骼单光子发射计算机断层扫描（SPECT）。然而，该技术在10岁以下下背痛儿童中的诊断率仍不确定。我们检查了一系列连续的SPECT扫描以解决这个问题。
材料与方法
对科室数据库进行回顾性研究，发现2007年1月1日至2009年12月31日期间对10岁以下儿童进行了107次连续的骨骼Tc-99m MDP SPECT扫描。其中，72项研究是为了转诊诊断背痛而进行的。有43名女孩（44项研究）和28名男孩（28项研究）。平均年龄为7.2岁（范围1.9至9.9岁）。对所有SPECT扫描进行了回顾并记录了阳性结果。此外，还回顾了所有可用的解剖学成像、成像报告（计算机断层扫描、磁共振成像和X线）以及临床记录，并将结果与SPECT研究结果进行了比较。
结果
在72项SPECT研究中，35项（49%）在脊柱中发现了摄取异常增加的局灶性区域，其中17项位于关节突间区域。通过额外的成像检查，1例被证明不是椎弓根损伤（计算机断层扫描显示横突骨折），2例SPECT扫描阴性的患者被证明存在SPECT扫描未检测到的椎弓根损伤，该队列中共有18例椎弓根损伤（25%）。报告参与体操或足球运动与椎弓根损伤有关（优势比4.3，P = 0.04）。
结论
在因背痛接受SPECT扫描的10岁以下儿童中，25%发现有椎弓根损伤。SPECT扫描对这种损伤以及识别其他潜在病理部位高度敏感，在幼儿持续性下背痛的检查中应予以考虑。
证据水平
二级，诊断性研究。
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