Fortius Clinic, 17 Fitzhardinge Street, London, W1H 6EQ, UK.
Research Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
Skeletal Radiol. 2024 Mar;53(3):489-497. doi: 10.1007/s00256-023-04437-x. Epub 2023 Aug 31.
To assess how pars interarticularis fracture characteristics on T1-VIBE and STIR MRI relate to healing and identify anatomical parameters that may impact healing.
A retrospective review of an MRI series of lumbar pars interarticularis injuries in elite athletes over a 3-year period. Fracture configurations, signal intensities and anatomical parameters were recorded by two radiologists. Statistical analysis employed multilevel mixed-effects linear regressions, adjusted for repeated measures and baseline covariates.
Forty-seven lumbar pars interarticularis injuries among 31 athletes were assessed. On final scans for each athlete, 15% (7/47) injuries had worsened, 23% (11/47) remained stable, 43% (20/47) partially healed and 19% (9/47) healed completely. Healing times varied, quickest was 49 days for a chronic fracture in a footballer. Bone marrow oedema signal was highest in worsened fractures, followed by improved, and lowest in stable fractures. As healing progressed, T1-VIBE signal at the fracture line decreased. Bone marrow oedema and fracture line signal peaked at 90-120 days before decreasing until 210-240 days. Fractures with smaller dimensions, more vertical orientation and a longer superior articular facet beneath were significantly associated with better healing (p < 0.05).
Most diagnosed athletic pars interarticularis injuries improve. Normalising T1-VIBE signal at the fracture line is a novel measurable indicator of bony healing. Contrastingly, bone marrow oedema signal is higher in active fractures irrespective of healing or deterioration. Injuries initially perceived as worsening may be exhibiting the normal osteoclastic phase of healing. Better outcomes favour smaller, vertical fractures with a longer superior articular facet beneath.
评估 T1-VIBE 和 STIR MRI 上的椎间关节突骨折特征与愈合的关系，并确定可能影响愈合的解剖学参数。
对 3 年内精英运动员的腰椎椎间关节突损伤的 MRI 系列进行回顾性研究。两位放射科医生记录了骨折形态、信号强度和解剖学参数。采用多级混合效应线性回归进行统计分析，调整了重复测量和基线协变量。
评估了 31 名运动员的 47 个腰椎椎间关节突损伤。在每位运动员的最终扫描中，15%（7/47）的损伤恶化，23%（11/47）稳定，43%（20/47）部分愈合，19%（9/47）完全愈合。愈合时间不同，足球运动员的慢性骨折最快为 49 天。骨髓水肿信号在恶化的骨折中最高，其次是改善的，稳定的骨折中最低。随着愈合的进展，骨折线上的 T1-VIBE 信号减少。骨髓水肿和骨折线信号在 90-120 天达到峰值，然后下降直到 210-240 天。尺寸较小、垂直方向和上方关节突下较长的骨折与更好的愈合显著相关（p<0.05）。
大多数诊断为运动性椎间关节突损伤都会改善。骨折线上 T1-VIBE 信号的正常化是骨愈合的一个新的可测量指标。相反，骨髓水肿信号在活跃的骨折中无论愈合还是恶化都更高。最初被认为恶化的损伤可能正在经历正常的破骨愈合阶段。更好的结果有利于较小、垂直的骨折，上方关节突下较长。
