Đang chuẩn bị liên kết để tải về tài liệu:
Musculoskeletal problems and injuries - part 6

Hình 7.10. Spondylolysis, và trượt đốt sống (bên phải). (A) đại diện chụp ảnh phóng xạ của một kéo dài bất thường (Greyhound ký)-đoạn interarticularis, hoặc "cổ" của một con chó Scotty (mũi tên). Khuyết tật khác, chẳng hạn như xơ cứng hoặc ly giải trong-đoạn hiển thị tốt nhất trong này (B) "Scotty con chó." Một quá trình khớp cấp trên (tai) "cổ" (Từ Lillegard và Kruse, 50 với sự cho phép) | 7. Musculoskeletal Problems of Children 173 A SEVERITY OF SLIP ANGLE SPONDYLOLISTHESIS B C Fig. 7.10. Spondylolysis and spondylolisthesis right . A Radiographic representation of an abnormal elongation greyhound sign of the pars interarticularis or the neck of a scotty dog arrow . Other defects such as sclerosis or lysis in the pars are best visualized in this neck. From Lillegard and Kruse 50 with permission. B Scotty dog. A superior articular process ear B pedicle eye C pars interarticularis neck D lamina body E inferior articular process front leg . C Severity of spondylolisthesis and slip angle. 174 Mark D. Bracker et al. interarticularis of L5. Sclerosis of the opposite pars may be present. A standing spot lateral view of L5-S1 allows accurate assessment of a possible slip. Scoliosis is commonly associated with spondylolisthesis. Bone scans show increased activity on one or both sides in symptomatic spondylolysis but are not routinely required. If asymptomatic no treatment is required and there is no need to limit contact sports. For a mildly symptomatic patient temporary reduction of activity is all that is needed. If symptoms are alleviated progressive activity is permitted. Symptoms that are sudden in onset traumatically induced or do not resolve with rest do heal much as any fracture would heal after 10 to 12 weeks of immobilization in a plastic body jacket or a Boston-type spinal orthosis. In general once symptoms resolve the child can resume normal activities although advice regarding return to rigorous spine-bending athletic events gymnastics diving downed lineman in football is controversial see Chapter 10 . With spondylolisthesis if slippage is less than 30 and symptoms are minimal treatment is conservative. With persistent pain unresponsive to treatment or slippage more than 30 to 50 spinal fusion is recommended. Such fusion is generally at the L5-S1 level and includes L4 if slippage is more than 50 .44 Idiopathic Scoliosis Idiopathic scoliosis is .