Moley Peter J, Gribbin Caitlin K, Vargas Elizabeth, Kelly Bryan T
Department of Physiatry, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA.
Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA.
J Hip Preserv Surg. 2018 Nov 27;5(4):393-398. doi: 10.1093/jhps/hny040. eCollection 2018 Dec.
Locating the source of lumbopelvic-hip pain requires the consideration of multiple clinical pathways. Although low back pain has an incidence of 50% in the adolescent population, the pathophysiology in this population typically differs from that of other age groups. Dynamic mechanical impairments of the hip, such as femoroacetabular impingement, may contribute to the pathogenesis of adolescent low back pain. Eight adolescent male athletes who presented to a single provider with a primary complaint of low back pain with hip pain or motion loss on exam and were ultimately diagnosed with lumbar spondylolysis and dynamic mechanical hip issues between 2009 and 2011 were included. The age at spondylolysis diagnosis ranged from 15 to 19 years (mean ± standard deviation: 16.3 ± 1.3 years). Seven patients had cam-type impingement, whereas one presented with pincer-type impingement. All patients demonstrated either decreased internal rotation at 90 degrees of hip flexion and neutral abduction or pain on the Flexion Adduction Internal Rotation test on at least one of hip. All eight patients were treated initially with 6 weeks of physical therapy consisting of attempted restoration of hip motion and the graduated progression of hip and spine stabilization exercises. Five patients (62.5%) returned to sport at an average of 11.2 weeks (range: 6-16 weeks). For three patients (37.5%), hip pain and motion loss persisted, thus requiring surgery. All subjects had symptoms for at least 6 weeks, with 6 months as the longest duration. This report is the first documented series of adolescent athletes with co-diagnoses of spondylolysis and femoroacetabular impingement. This retrospective case series was approved by the Institutional Review Board at Hospital for Special Surgery.
确定腰骨盆-髋部疼痛的来源需要考虑多种临床途径。虽然青少年人群中腰痛的发病率为50%，但该人群的病理生理学通常与其他年龄组不同。髋部的动态机械损伤，如股骨髋臼撞击，可能导致青少年腰痛的发病机制。纳入了8名青少年男性运动员，他们于2009年至2011年间因主要抱怨腰痛伴髋部疼痛或检查时髋部活动受限而就诊于同一医疗服务提供者处，最终被诊断为腰椎峡部裂和动态机械性髋部问题。峡部裂诊断时的年龄范围为15至19岁（平均±标准差：16.3±1.3岁）。7例患者为凸轮型撞击，而1例为钳夹型撞击。所有患者在髋关节屈曲90度和中立外展位时均表现为内旋减少，或至少在一侧髋关节的屈曲内收内旋试验中出现疼痛。所有8例患者最初均接受了6周的物理治疗，包括尝试恢复髋关节活动以及逐步进行髋关节和脊柱稳定练习。5例患者（62.5%）平均在11.2周（范围：6 - 16周）后恢复运动。3例患者（37.5%）髋部疼痛和活动受限持续存在，因此需要手术治疗。所有受试者的症状至少持续了6周，最长持续时间为6个月。本报告是首例记录的同时诊断为腰椎峡部裂和股骨髋臼撞击的青少年运动员系列病例。本回顾性病例系列已获得特种外科医院机构审查委员会的批准。
