Background:Sacral fatigue fractures are a rare injury but should be considered as a differential diagnosis for low back and buttock pain in young adults. Collective reports are limited, most of which have focused on long-distance runners.Purpose:To investigate the characteristics of sacral fatigue fractures in adolescents.Study Design:Case series; Level of evidence, 4.Methods:We analyzed patient background characteristics, physical examination and imaging findings, and treatment courses of those diagnosed with sacral fatigue fractures using magnetic resonance imaging.Results:Among 34 patients with sacral fatigue fractures, 15 and 19 were male and female patients, respectively, with an age range of 11 to 19 years (mean age, 15.0 years). Almost all patients were athletes, and 29 patients performed their sport ≥5 times a week. Long-distance runners were the most commonly affected, comprising 7 patients, and participants in other common sports such as baseball (6 patients), basketball (4 patients), and soccer (3 patients) were also affected. Physical examination revealed tension sign (Lasègue test) on the affected side in 6 patients and tight hamstrings in 24 patients. Imaging findings included 18 patients with right-side involvement, 12 with left-side involvement, and 4 with involvement on both sides. In 11 patients, spina bifida occulta was observed at S1 and 8 patients had a history of lumbar spondylolysis with 4 patients having concurrent sacral fatigue fractures. Physical therapy was performed concurrently with the cessation of exercise, and return to exercise was permitted if the pain had been relieved after 1 month. All patients returned to sports at a median of 48 days (range, 20-226 days) after symptom onset. However, 2 patients experienced recurrence (1 patient on the ipsilateral side and 1 patient on the contralateral side).Conclusion:Sacral stress fractures are not limited to long-distance runners in this population and can manifest as lower back pain or buttock pain in athletes participating in a variety of sports. Although the course of treatment was generally good, the possibility of recurrence must always be considered.

中文翻译：

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青少年骶骨疲劳性骨折的临床特点及治疗过程


背景：骶骨疲劳骨折是一种罕见的损伤，但应被视为年轻人腰痛和臀部疼痛的鉴别诊断。集体报道有限，大多集中于长跑运动员。目的：探讨青少年骶骨疲劳骨折的特点。研究设计：病例系列；证据级别，4。方法：我们通过磁共振成像分析诊断为骶骨疲劳骨折的患者的背景特征、体格检查和影像学表现以及治疗疗程。结果：34 例骶骨疲劳骨折患者中，男性 15 例，男性 19 例。分别为女性患者和女性患者，年龄范围为11至19岁（平均年龄15.0岁）。几乎所有患者都是运动员，29 名患者每周进行运动≥5 次。长跑运动员是最常见的受影响者，共有 7 名患者，其他常见运动项目如棒球（6 名患者）、篮球（4 名患者）和足球（3 名患者）的参与者也受到影响。体格检查发现6名患者患侧紧张征（拉塞格试验），24名患者腿筋紧张。影像学结果包括 18 例右侧受累患者，12 例左侧受累，4 例双侧受累。 11例患者在S1时出现隐性脊柱裂，8例有腰椎峡部裂史，4例并发骶骨疲劳性骨折。停止运动的同时进行物理治疗，1个月后疼痛缓解即可恢复运动。所有患者在症状出现后平均 48 天（范围为 20-226 天）恢复运动。 然而，有2例患者出现复发（同侧1例，对侧1例）。结论：骶骨应力性骨折并不局限于该人群中的长跑运动员，在运动员中可表现为腰痛或臀部疼痛参加各种体育运动。尽管治疗过程总体良好，但必须始终考虑复发的可能性。