背景:脊椎滑脱是椎骨关节间部的缺陷,最常见于L5和L4。脊椎滑脱和峡部裂性脊椎滑脱的病因通常被认为是对椎骨薄弱部分的重复机械应力的结果。在年轻运动员中观察到脊椎裂的发生率较高。症状性峡部裂可以成功保守治疗,但目前对治疗方式的共识有限,且缺乏大规模的临床试验.
目的:本研究的目的是研究青少年运动员症状性峡部裂的最佳治疗方法,并评估非手术治疗者的功能结局。
方法:回顾性综述。
方法:200名年龄在10至19岁之间的青少年患者参与了运动结局指标:伤害特征(年龄,机制,时间),运动,骨刺激器的使用,在计算机断层扫描(CT)扫描3个月时骨愈合,回到运动,皮质类固醇注射使用。
方法:回顾性分析了2007年至2019年间诊断为脊椎裂的200名青少年运动员患者(62名女性和139名男性)。诊断基于X线平片,然后进行磁共振成像。所有患者均保守治疗,停止体育活动,胸腰骶矫形器,诊断后三个月和外部骨刺激器。对3个月的随访进行CT扫描,以评估骨愈合情况。随后,患者接受了6周的康复治疗,重点是核心强化。治疗后有症状的患者被转介接受类固醇注射,并继续接受康复方案。
结果:最常见的受伤年龄是15岁,服从强正态分布。最常见的运动是足球,其次是棒球/垒球。受伤的主要机制是举重训练,其次是足球受伤。日历年的第一季度受伤发生率最高,3月受伤最多,12月受伤最少。一百五十二名运动员报告使用规定的骨刺激器,与未使用骨刺激器的患者相比,这些患者在随访CT扫描中显示出骨愈合率明显更高。97名患者(98%)恢复了运动或类似水平的活动。37名患者(18%)由于持续疼痛而接受了小关节或硬膜外类固醇注射,一名患者接受了外科手术。随访CT扫描显示骨愈合率为49.8%。
结论:保守治疗停止运动的青少年运动员脊椎裂,胸腰骶矫形器,在恢复运动方面,骨刺激器和随后的康复与出色的结果相关。
BACKGROUND: Spondylolysis is a defect of the pars interarticularis of vertebrae, most commonly seen at L5 and L4. The etiology of spondylolysis and isthmic spondylolisthesis is generally considered to be a result of repetitive mechanical stress to the weak portion of the vertebrae. A higher incidence of spondylolysis is observed in young athletes. Symptomatic spondylolysis can be successfully treated conservatively, but there is currently a limited consensus on treatment modalities and a lack of large-scale clinical trials.
OBJECTIVE: The purpose of the present study was to investigate the optimal treatment algorithm for symptomatic spondylolysis in adolescent athletes and evaluate the functional outcomes of those undergoing the nonoperative treatment.
METHODS: A retrospective review.
METHODS: Two hundred one adolescent patients ranging from age 10 to 19 involved in athletics OUTCOME MEASURES: Injury characteristics (age, mechanism, time), sports played, bone stimulator use, bony healing at 3 months on computed tomography (CT) scans, return to sports, corticosteroid injection use.
METHODS: Two hundred one adolescent athlete patients (62 females and 139 males) diagnosed with spondylolysis between 2007 and 2019 were retrospectively reviewed. Diagnosis was based on plain radiography followed by magnetic resonance imaging. All patients were treated conservatively with cessation of sports activity, thoracolumbosacral orthosis, and external bone stimulator for three months after diagnosis. CT scans were obtained for the 3-month follow-up visits to assess bony healing. Subsequently the patients received 6 weeks of rehabilitation focused on core strengthening. Symptomatic patients after the treatment were referred for steroid injections and continued with the rehabilitation protocol.
RESULTS: The most common age of injury was 15 years old, following a strong normal distribution. The most commonly played sport was football, followed by baseball/softball. The primary mechanism of injury was weight training closely followed by a football injury. The first quarter of the calendar year had the highest incidence of injuries with the most injuries occurring in March and the least occurring in December. One hundred fifty-two athletes reported using bone stimulators as prescribed, and these patients showed a significantly higher rate of bony healing on follow-up CT scans than those who did not use bone stimulators. One hundred ninety-seven patients (98%) returned to sports or similar level of activities. Thirty-seven patients (18%) received facet or epidural steroid injections due to continued pain and one patient underwent a surgical procedure. Follow-up CT scans showed 49.8% bony healing.
CONCLUSIONS: Conservative treatment of spondylolysis in adolescent athletes with cessation of sports, thoracolumbosacral orthosis, and bone stimulator followed by rehabilitation was associated with excellent outcomes in terms of return to sports.