Congeni J, McCulloch J, Swanson K
Sports Medicine Center, Children's Hospital Medical Center, Akron, Ohio, USA.
Am J Sports Med. 1997 Mar-Apr;25(2):248-53. doi: 10.1177/036354659702500220.
We examined the natural course of athletically active young people with back pain and a diagnosis of spondylolysis (stress fracture of the pars interarticularis of the facet joint of the lumbar spine). We limited the study to those with "subtle" fractures (normal radiographs and positive bone scans) and used computed tomography scanning to further characterize this lesion and to determine whether we could demonstrate healing in this population. The study group included 40 patients with low back pain and a diagnosis of spondylolysis by nuclear medicine study. Computed tomography scans were performed with both traditional cuts and reverse-gantry angled cuts to help determine long-term treatment and prognosis. Forty-five percent of patients (18) demonstrated chronic nonhealing fractures, 40% (16) demonstrated acute fractures in various stages of healing, and 15% (6) demonstrated no obvious fractures. With the diagnosis of spondylolysis being fairly common in young athletes with low back pain, primary care physicians need to have a high index of suspicion in making the diagnosis. Computed tomography scans can play a very important role in diagnosis, assessment of the defect, short-term and long-term management decisions, and in determining prognosis.
我们研究了患有背痛且被诊断为椎弓崩裂（腰椎小关节突关节峡部应力性骨折）的体育活动活跃的年轻人的自然病程。我们将研究局限于那些有“隐匿性”骨折（X线平片正常但骨扫描阳性）的患者，并使用计算机断层扫描来进一步描述这种病变，以及确定我们是否能在该人群中证实骨折愈合情况。研究组包括40例因核医学检查诊断为椎弓崩裂的腰痛患者。采用传统层面扫描和反向机架倾斜扫描进行计算机断层扫描，以帮助确定长期治疗方案和预后。45%的患者（18例）显示为慢性不愈合骨折，40%（16例）显示处于不同愈合阶段的急性骨折，15%（6例）未显示明显骨折。鉴于椎弓崩裂在患有腰痛的年轻运动员中相当常见，基层医疗医生在做出诊断时需要有高度的怀疑指数。计算机断层扫描在诊断、缺损评估、短期和长期管理决策以及确定预后方面可发挥非常重要的作用。
