Singhal Ash, Mitra Anish, Cochrane Doug, Steinbok Paul
Division of Pediatric Neurosurgery, Department of Surgery, University of British Columbia and B.C. Children's Hospital, Vancouver, B.C., Canada.
Pediatr Neurosurg. 2013;49(1):16-20. doi: 10.1159/000355127. Epub 2013 Oct 30.
BACKGROUND/AIMS: Lumbar disc herniation (LDH) can be associated with ring apophysis fracture (RAF), which is found in 6% of adult cases. However, the incidence and management of RAF in pediatric LDH is not well documented. The purpose of this study is to determine the prevalence of RAF in pediatric LDH, identify risk factors and explore the influence of RAF on the surgical management and outcome of LDH patients.
Hospital records and images were retrospectively reviewed for all pediatric patients (<18 years old) who underwent CT scanning for LDH at BC Children's Hospital from 1985 to 2010.
Forty-two patients met the study inclusion criteria. RAF was present in 38% of the pediatric patients with LDH. There was a significant correlation with gender (p = 0.021; 55% of the males had RAF, and 20% of the females) and association with central herniations (p = 0.003). At the last follow-up, 58% of the patients with RAF were symptom free, compared with 68% of the patients with no RAF.
RAF is more frequently associated with LDH in children than in adults. Gender and central disc herniation are associated with RAF. Given the frequency of RAF, to properly identify these fractures and anticipate their treatment, preoperative CT would be necessary.
背景/目的：腰椎间盘突出症（LDH）可能与环状骨骺骨折（RAF）相关，在成人病例中，该骨折的发生率为6%。然而，小儿LDH中RAF的发生率及处理方法尚无充分文献记载。本研究旨在确定小儿LDH中RAF的患病率，识别危险因素，并探讨RAF对LDH患者手术治疗及预后的影响。
对1985年至2010年在卑诗省儿童医院因LDH接受CT扫描的所有小儿患者（<18岁）的医院记录和影像进行回顾性分析。
42例患者符合研究纳入标准。小儿LDH患者中38%存在RAF。RAF与性别有显著相关性（p = 0.021；55%的男性有RAF，20%的女性有RAF），且与中央型突出相关（p = 0.003）。在末次随访时，有RAF的患者中58%无症状，而无RAF的患者中这一比例为68%。
与成人相比，RAF在小儿LDH中更为常见。性别及中央型椎间盘突出与RAF相关。鉴于RAF的发生率，为准确识别这些骨折并预期其治疗方法，术前CT检查是必要的。
