骨应力性塑形改建的研究及其对新兵基础训练的指导意义

分组模拟训练的２８８只兔股骨标本病理观察及扭断试验结果表明，较大强度和时限训练的主导作用是加速骨塑形改建，增强抗骨折能力。分３组经３种方法训练的１８０只大鼠的股骨上段病理切片及电镜观察表明，强化循环训练组的改建完成率高于其它两组，而应力性骨折发生率则低于其它两组。对１１２９名新兵１２周基础训练的前瞻性流行病学调查证实，下肢长管状骨经历约９周的应力性塑形改建期，训练的第２，７周出现的应力性骨折高发的     

"强化循环训练"法加速骨塑形改建的形态计量学观察及其现场人群干预研究

目的观察强化循环训练对骨塑形改建的影响,探讨其作为一种新的训练模式的科学性。方法雄性大鼠48只,随机均分为对照组和强化循环训练组(循环组)。每组分别于1、2、3、4、5、6周切取大鼠胫骨上段,进行皮质骨厚度(CT)、骨小梁平均骨壁厚度(MRT)、骨小梁类骨质表面(Sos)及骨小梁吸收表面(Sr)的百分比等骨形态学分析和比较。随机将某部新兵1303人分为对照组和实验组进行现场人群干预试验,实验组以“强化循环训练法”代替传统的“循序渐进”训练模式训练,以应力性骨折发生率为观察指标,进行组间比较。结果第4、5、6周,循环组反映骨形成情况的指标CT(1·37±0·09,1·86±0·14,1·94±0·23)、Sos(12·29±1·17,14·61±1·84,15·51±1·13)、MWT(56·37±2·52,57·28±3·01,58·23±2·93)明显高于对照组(P<0·05),反映骨破坏吸收情况的指标Sr在循环组第4周升高后持续降低,而对照组则持续增加。实验组新兵连的应力性骨折发生率(6·1%)低于对照组(12·9%),骨应力性改建时限(2~6周)亦较对照组缩短(3~8周),训练成绩则显著提高。结论“强化循环训练”能缩短骨塑形改建时限。     

强化训练对狗关节软骨的组织学影响

目的研究强化训练下狗膝关节软骨的组织学变化，以了解不同运动训练模式对膝关节软骨早期塑形改建的影响。方法20只实验用狗随机分为一般训练组（训练组，n=8）、强化训练组（强化组，n=8）和对照组（n=4），训练组与强化组分别以不同的训练方式进行训练。训练10周后所有实验动物均被施行安乐死，膝关节软骨行组织学检查。结果训练组和强化组训练10周时膝关节软骨有明显损伤及修复迹象，强化组关节软骨塑形改建情况优于训练组，但代表损伤程度的Mankin评分两组无明显差别。结论长时间大强度运动易产生软骨运动性损伤，修复过程也随之发生；强化训练较一般训练能更好地促进关节软骨的塑形改建。     

强化循环训练促进跟腱组织塑形改建的实验研究

目的考察耐力运动训练过程中大鼠跟腱组织结构与生化成分的变化及不同训练模式与大鼠跟腱塑形改建规律的对应关系。方法120只8周龄雄性Wistar大鼠按训练方式、训练时间两因素析因设计以体重区组进行随机分组，训练方式有自由活动、中等负荷训练、强化训练、强化循环训练4个水平，训练时间有1、2、3、4、6、8周6个水平，共24组，每组5只。训练结束后切取跟腱组织，通过扫描电镜及透射电镜观察其超微结构，并应用碱解法测定强化循环训练组大鼠跟腱中羟脯氨酸的含量，以其代表胶原蛋白总量的变化；通过免疫组织化学染色的方法对该训练组大鼠跟腱组织中Ⅲ型胶原蛋白含量的动态变化进行半定量分析。结果在训练过程中，跟腱的组织结构出现由以损伤为主到修复重建占主导的动态变化，循环训练模式下损伤表现出现早，程度轻，持续时间最短。跟腱胶原蛋白总量在训练过程中保持不变，而Ⅲ型胶原的表达呈现训练早期增强，随塑形改建的进行又逐渐减弱的规律。在运动训练下肌腱组织的塑形改建过程中，胶原的新生与破坏，合成与降解是相平衡的过程。训练早期Ⅲ型胶原的含量增加提示应力作用下胶原代谢活动加速，促进组织结构发生改建。结论肌腱在运动训练中的塑形改建是通过其内部结构的重塑而非组织肥大来完成的。训练中负荷重复的次数较之单次负荷的大小对肌腱的塑形改建更具积极意义，强化循环训练可以加速跟腱的塑形改建。     

强化循环训练对大鼠骨骼肌有氧能力影响的研究

目的比较跑步训练、游泳训练和强化循环训练对发展骨骼肌有氧能力的作用。方法25只雄性Wistar大鼠分为对照组1、对照组2、跑步组、游泳组和强化循环训练组（n=5），运用组织形态计量学的方法观察各组大鼠比目鱼肌有氧代谢能力的变化。结果3种耐力性训练都能有效地提高大鼠骨骼肌的有氧代谢能力。其中，强化循环训练较单纯游泳与跑步训练能更好地促进骨骼肌的塑形改建及提高骨骼肌的功能。结论强化循环训练能缩短骨骼肌塑形的过程，并且有利于发展骨骼肌的有氧代谢能力。     

下肢骨应力性骨折的早期影像学诊断

采用骨闪烁显像术，对１００例接受新兵军事训练９周期间发生下肢骨应力性骨折症状的患者，进行早期影像学诊断。共检出８６例２１７个病变，其中Ⅰ～Ⅱ级的轻度病变占９６．３％，无症状病变占３２．７％。以骨闪烁显像作为早期诊断应力性骨折的金标准，对比观察同批患者１３４处骨折病变同期的Ｘ线摄片诊断结果。采用的常规Ｘ线摄片法仅发现１３处病变，阳性率９．７％。对８６例患者每例的病变数、病变等级及好发部位等指标也进行     

家兔经皮自体骨髓移植在骨缺损瘢痕组织内成骨的X线表现

目的：观察家兔经皮自体骨髓移植在骨缺损瘢痕组织内成骨的Ｘ线特征。材料方法：选健康家兔１８只，于双侧桡骨建立１ｃｍ的骨缺损模型，６周后，于右侧骨缺损瘢痕组织内注射自体骨髓２ｍｌ，左侧注射外周血２ｍｌ。于注射前及注射后１、２、３、４、１２周行双侧桡骨骨缺损部位的Ｘ线检查。结果：骨缺损注射组，在注射后２周有新骨形成，３～４周时骨缺损间隙只残留１．５ｍｍ（１．２～２．３ｍｍ）。外周血注射组骨缺损间隙依然存在，骨缺损间隙平均７．５ｍｍ（７．０～９．３ｍｍ）。结论：经皮注射自体骨髓于骨缺损瘢痕组织内有成骨作用，外周血在骨缺损瘢痕组织内不能成骨     

加速新兵下肢骨塑形改建的现场干预研究

加速新兵下肢骨塑形改建的现场干预研究４７１０３１洛阳解放军第１５０医院李祖国，黄昌林，韩西，张莉关键词骨折，预防学，新兵中国图书资料分类号Ｒ６８１．７应力性骨折（ＳＦ）是新兵基础训练中最常见的骨伤之一，各国军队对此高度重视，进行了多方面研究，报道ＳＦ...     

新兵应力性骨折的群组研究

目的：描述新兵基础训练期间应力性骨折（ＳＦ）的发生率与分布特征，探讨致伤因素和评价预防措施效果．方法：于１９９２～１９９４年三个年度对驻陕某部队３２０９名新兵进行群组研究，从１９９３年度起限制每周５ｋｍ跑次数．结果：三个年度ＳＦ的发生率依次为３６．２％、３１．６％和２６．７％，与１９９２年度比较，１９９３与１９９４年度均有明显下降（Ｐ＜０．０１）．步兵分队平均发生率为３６．９％，明显高于炮兵与勤务分队（１７．３％）．结论：结果表明新兵基础训练期间ＳＦ发生率高，５ｋｍ跑是主要致伤因素，预防效果明显．     

陆海空新兵基础训练期间军事训练伤的流行病学调查

目的：了解我军各军种训练伤的流行病学特征,初步分析致伤原因。方法：选取陆海空三军参加１９９８年度基础训练的２４４７名新兵,统一进行流行病学调查。结果：陆海空三军总发生率２９．４％,陆军为３２．８％,海军为;２８．２％,空军为２５．０％。陆军与海军和空军有显著性差异,海军与空军无显著性差异。支队间发生率有显著性差异。陆军与海军开训后第７周为发生高峰,海军的高峰期略晚;各部位损伤中以下肢２５．１％的发生率为最高（构成比为８５．４％）;各类型损伤中以过劳性损伤１７．３％的发生率为最高（构成比为５８．９％）。结论：加大训练强度可导致训练伤发生人数的增加,训练伤发生的部位与主要受训部位相一致;训练内容与安排不同,训练伤的发生率不同。     

The effect of leg strength on the incidence of lower extremity overuse injuries during military training

This study examined the effects of strength, aerobic fitness, and activity profile on the incidence of overuse injuries, particularly stress fractures, during military training. A total of 136 military recruits were followed during 9 weeks of basic training. Maximal strength and aerobic fitness were determined by a one-repetition maximum leg press and a 2,000-m run, respectively. An activity profile was determined by the recruit's activity history. Twelve recruits (8.8%) were diagnosed with stress fractures. Recruits who were 1 SD below the population mean in both absolute (98.4 +/- 36.6 kg) and relative strength (1.72 +/- 0.61 kg/kg of body weight) had a five times greater risk for stress fracture (p < 0.05) than stronger recruits. Poor aerobic fitness did not appear to be related to any increased incidence of stress fracture. It appears that recruits with lower body strength levels, within 1 SD of the population mean, have a reduced incidence of stress fractures during military training.     

The long-term followup of soldiers with stress fractures

A group of 295 Israeli infantry recruits was evaluated in a prospective study of stress fractures which began in basic training. On the basis of scintigraphy, 91 of the recruits (31%) were found to have sustained stress fractures during basic training. Sixty-six of the 91 recruits with stress fractures (72%) were followed for a minimum of 1 year after basic training to determine the natural history of a soldier who sustains a stress fracture and resumes training after a period of rest. Five clinical patterns were observed: (1) uneventful recovery (47%); (2) protracted recovery (13.6%); (3) symptoms consistent with recurrent stress fractures in new sites (19.6%); (4) intermittent nonstress fracture bone pain (16.7%); and (5) chronic stress fractures (3%). The incidence of recurrent stress fractures was 10.6%. A control group of 60 recruits who sustained no stress fractures in basic training had a 1.7% incidence of stress fractures after basic training. Recruits who sustained stress fractures in basic training continued to be a higher risk for stress fractures during subsequent training.     

Physical and psychological stressors linked with stress fractures in recruit training

This study aimed to measure ambulation in infantry army basic training, and to evaluate if covering more distance can explain stress fractures in a stressor–stress model. Forty‐four male combat recruits (18.7 ± 0.7 years) participated in a 6‐month rigorous high intensity combat training program. Baseline data included anthropometric measurements, VO₂max, and psychological questionnaires. Actual distance covered was measured using a pedometer over an 11‐week training period. Psychological questionnaires were repeated after 2 months. Sixteen recruits were diagnosed with stress fractures by imaging (SFi = 36.4%). Statistical analysis included comparing measured variables between SFi and those without stress fractures (NSF). The recruits covered 796 ± 157 km, twofold the distance planned of 378 km (P < 0.001). The SFi group covered a distance 16.4% greater than that of the NSF group (866 ± 136 and 744 ± 161 km, respectively, P < 0.01), and also demonstrated greater psychological stress. These data reveal the importance of adherence to or enforcement of military training programs. In the light of these data, the Israeli Defense Forces program needs reappraisal. A stressor–stress response might explain the susceptibility of certain recruits for injury. Using advanced technology, monitoring ambulation may prevent stress fracture development by limiting subjects exceeding a certain level. Psychological profile may also play a role in predicting stress fracture development.     

Prevention of common overuse injuries by the use of shock absorbing insoles. A prospective study

Sedentary individuals, particularly new military recruits, who start a physical training program have a substantial risk of developing an overuse injury of the lower limb. In this study we investigated the effect of neoprene insoles on the incidence of overuse injuries during 9 weeks of basic military training. The experimental group consisted of 237 randomly selected new recruits, while 1151 recruits were the control group. Insoles were given to the experimental group and compliance was monitored. A panel of doctors documented and classified all injuries occurring during the 9 week period. A total of 54 (22.8%) and 237 (31.9%) injuries were reported in the experimental and control groups, respectively. In both groups, the majority of injuries were overuse (experimental group, 90.7%; control group, 86.4%). The mean weekly incidence of total overuse injuries and tibial stress syndrome was significantly lower (P less than 0.05) in the experimental group. The mean incidence of stress fractures was lower in the experimental group but not significantly so (0.05 less than P less than 0.1). This study shows that the incidence of total overuse injuries and tibial stress syndrome during 9 weeks of basic military training can be reduced by wearing insoles.     

新兵基础训练应力性骨折61例

目的探讨由军事训练导致的应力性骨折的发病因素、早期诊断及预防措施。方法对61例新兵基础训练应力性骨折进行病因调查及分析,并下部队了解训练计划及方法。结果下肢(59例)发病高峰期在训练的第2、3周,上肢(2)例。41例经休息理疗治愈,8例完全骨折无移位者经石膏固定治愈。3例骨折并移位经骨牵引治愈,9例骨折并移位者经手术内固定治愈。结论发病因素为个体内在因素及缺乏科学训练方法。开训的2~4周是预防的重点时期,早期诊断与合理练兵是预防的关键。     

Clinical value of grading the scintigraphic appearances of tibial stress fractures in military recruits.

PURPOSE: This study evaluated the relation between the scintigraphic appearances of tibial stress fracture in military recruits and the likelihood that they would complete basic military training. MATERIALS AND METHODS: The authors retrospectively reviewed 58 Tc-99m MDP scans of recruits referred for possible tibial stress fracture and graded them according to the criteria of Zwas et al. (1987). Stress fracture appearances were correlated with clinical information such as the duration of rehabilitation and final outcome with regard to completion of the initial basic military training program. RESULTS: Thirty-seven of the 58 patients (64%) had tibial stress fractures, all of which were located in the tibial diaphysis, with most occurring in the middle and lower thirds. Most (23 of 37) patients had stress fractures of grade I or II, and the others had grade III or IV stress fractures. There was no statistical difference in the proportion of patients with bilateral fractures between grades I-II and III-IV. There was no significant difference in the duration of rehabilitation for recruits successfully recovering from grade III-IV fractures compared with grade I-II fracture. There was a greater proportion of patients with lower grade fractures than higher grade fractures (P = 0.0006) who, despite rehabilitation, could not continue training because of unremitting or recurring pain at the fracture site and were medically discharged from military service. CONCLUSIONS: Contrary to expectation, recruits with higher-grade stress fractures were not less likely to complete basic military training compared with recruits with lower grade stress fractures.     

Comparison of stress fractures of male and female recruits during basic training in the Israeli anti-aircraft forces

BACKGROUND: In military basic training, stress fractures are a common orthopedic problem. Female recruits have a significantly higher incidence of stress fractures than do male recruits. Because the Israeli Defense Forces opened traditionally male roles in combat units to female recruits, their high risk for stress fractures is of concern. OBJECTIVE: To compare the prevalence of stress fractures during Israeli Defense Forces anti-aircraft basic training among otherwise healthy young male and female recruits, in terms of anatomic distribution and severity. DESIGN: Ten mixed gender batteries, including 375 male recruits and 138 female recruits, carried out basic training in the Israeli anti-aircraft corps between November 1999 and January 2003. Each battery was monitored prospectively for 10 weeks of a basic training course. During that time, recruits who were suspected of having an overuse injury went through a protocol that included an orthopedic specialist physical examination followed by a radionuclide technetium bone scan, which was assessed by consultant nuclear medicine experts. The assessment included the anatomic site and the severity of the fractures, labeled as either high severity or low severity. RESULTS: Stress fractures were significantly more common among female recruits than among male recruits. A total of 42 male (11.2%) and 33 female (23.91%) recruits had positive bone scans for stress fractures (female:male relative ratio, 2.13; p < 0.001). Pelvic, femur, and tibia fractures were significantly more common among female recruits than among male recruits (p < 0.005). Female recruits had significantly more severe fractures in the tibia (p < 0.05). However, there was no significant difference in the severity of stress fractures in the femur or metatarsals between male and female recruits, as assessed by radionuclide uptake. CONCLUSIONS: We recommend that different training programs be assigned according to gender, in which female recruits would have a lower level of target strain or a more moderate incline of strain in the training program throughout basic training.     

Stress fractures of the pelvis in female navy recruits: an analysis of possible mechanisms of injury

The purpose of our study was to investigate possible risk factors and mechanisms for the development of pelvic stress fractures in female Navy recruits. We used a case-control retrospective study of female Navy recruits undergoing basic military training. We compared anthropometric and activity data between recruits with pelvic stress fractures (N = 25) and female recruits who completed training without injury (N = 61). Recruits developing pelvic stress fractures were significantly (p < 0.05) shorter and lighter and were more frequently Asian or Hispanic than recruits without stress fractures. In addition, recruits with pelvic stress fractures reported marching in the back of their training division, were road guards, and felt that their stride was too long during training activities more often than recruits without injury. Self-reported fitness, activities before recruit training, or a history of amenorrhea was not found to be associated with the development of a pelvic stress fracture in our population.     

Factors associated with discharge during marine corps basic training

This prospective study assessed risk factors for discharge from basic training (BT) among 2,137 male Marine Corps recruits between February and April 2003. Physical and demographic characteristics, exercise, and previous lower extremity injuries before arrival at Marine Corps Recruit Depot were assessed by questionnaire during intake processing. Stress fractures were confirmed by x-ray, triple-phase bone scan, or magnetic resonance imaging. Overall, 223 (10.4%) participants were discharged from training. In addition to the occurrence of a stress fracture during BT, older age (>23 years), non-Hispanic race, poor incoming self-rated physical fitness, no history of competitive exercise, and an incoming lower extremity injury with incomplete recovery were independent risk factors for discharge. Strategies to identify and allow the proper healing time for pre-BT lower extremity injuries, including interventions to improve the physical fitness of recruits before BT and reduce stress fractures during BT, may be indicated to lower attrition.