胫骨应力性骨折62例的骨折部位分析

目的探讨胫骨应力性骨折的致伤原因与骨折部位的关系及防治。方法对我院骨科自1996年以来收治62例胫骨应力性骨折的空降兵战士在不同致伤组中胫骨骨折部位进行统计学分析。结果跳跃致伤组和跑步致伤组中胫骨骨折部位的分布 X~2检验为 P<0.01。结论发生在中下段的胫骨应力性骨折多与跳跃致伤相关:发生在中上段的胫骨应力性骨折多于跑步致伤相关,提出穿插训练、循序渐进、增强认识等针对性的预防措施。     

股骨中下段应力骨折（附7例报告）

股骨中下段应力骨折（附７例报告）解放军第８１医院骨科（南京２１０００２）赵红军既往报道应力骨折多见于胫骨，股骨干甚少见。我院自１９９１年４月至１９９３年２月共收治了７例股骨干应力骨折，均为入伍不久的新战士。骨折部位以股骨下段为多，其次为中段，现报告如...     

士兵胫骨应力骨折的病因与生物力学

我院在对某部４００名士兵的训练伤调查中发现，该部应力骨折的发病率为９．５％，其中胫骨应力骨折较多，占全部应力骨折的７８％。发病部位多发生于胫骨上中１／３水平的后侧、内侧。此部位与文献报道长跑运动员应力骨折的部位不一样。为探讨士兵应力骨折的发病机理，我...     

军训致下肢应力骨折１３２例

军训致下肢应力骨折多发生于新兵 ,且多见于频繁的下肢重复、超负荷训练 ,如跑步、正步、行军等 ,尤以胫骨、股骨、跖骨骨折为多。为防治此类骨折 ,我们对 19871999年下肢应力骨折 132例的发生机制、诱因、临床特点等进行分析 ,供同行参考。1　临床资料1 1　一般情况　本组 132例应力骨折均为新兵 ,年龄 182 1岁。骨折部位 :股骨干 12例 ,其中中段 4例 ,下段 8例 ;胫骨干 12 0例 ,其中上段 14例 ,中段98例 ,下段 8例。股骨干应力骨折均因剧痛并伴肢体功能活动障碍就诊 ,而胫骨骨折病人因早期只有轻微疼痛 ,且不影响肢体活动 ,故平均骨折后 3…     

骨外固定技术不植骨治疗复杂性骨不连与骨缺损

目的 探讨应力促进骨愈合的机制及骨外固定技术不植骨治疗复杂性骨不连与骨缺损的临床疗效。方法 （1）5例10根新鲜尸体完整胫骨及安装外固定器后测定骨表面应变、应力值。再制成胫骨中段骨折进行等体重加压，测定压力衰减情况。60只兔胫骨干制成骨折模型并施行骨外固定器三维立体固定，分别施加兔自身体重0倍（A组，对照组）、1／2倍（B组）、等体重（C组）、1．5倍（D组）的压力加压固定，测定术后即刻及1，2，4，6周骨折断端应力电位，并取骨折处标本行HE染色，光镜下观察。术后6周摄X线片，并取胫骨行扭转试验，测定骨愈合强度。（2）1978—2005年共收治195例复杂性骨不连、骨缺损患者，通过骨外固定施加1／2至等体重的压应力不植骨治疗，观察骨愈合及伤肢负重情况。结果（1）胫骨表面不同点应变、应力值相差显著；各点上架前后差异无统计学意义。加压固定后5h内骨断端压力以每小时5％～10％的速度衰减，24h后不到初始值的60％。兔胫骨骨折后应力电位变为负电位，A组及加压组（B、C、D组）分别于术后2周、6周恢复正电位。X线片、组织学及力学试验表明，加压组骨愈合速度及强度均好于对照组，但1．5倍体重加压量会造成骨坏死。（2）临床观察194例获得骨性愈合，愈合率99．5％。骨断端愈合时间3～7个月，平均5个月，骨延长区愈合时间4～11个月，骨愈合指数平均为37．8d／cm。全部患者取外固定器后伤肢可负重行走，无一例再骨折及截肢。结论 应力产生的负电荷可促进骨愈合，最佳生理性加压量应以自身体重为标准，经皮穿针骨外固定不植骨方法在复杂性骨不连与骨缺损的治疗中可视为一种疗效确切的微创生物学治疗技术。     

新兵应力性骨折的发生与防治

应力性骨折（siress fracture SF）亦称疲劳性骨折，是军事训练、运动员训练中的常见损伤。其发病率各家报道不同，美国海军陆战队新兵发病率为2．9％，以色列新兵高达31％。国内报道新兵应力性骨折发病率为9．5％～16．9％，个别报道甚至高达32．5％。应力性骨折好发于下肢，不同运动引起的应力性骨折部位各异，比如，篮球运动员的跗、跖骨发病率较高，田径运动员多发于胫骨、腓骨或跖骨，足球运动员好发第5跖骨。部队军事训练中，以负重行军和长跑训练引起的胫骨应力性骨折最为多见（50％-80％）；其次为跖骨（20％～40％）。     

应力骨折

应力骨折是体育运动和军事训练中常见的损伤,属于过度使用性损伤的一种,亦称疲劳骨折。与暴力引起的急性骨折不同,应力骨折是阈下损伤积累的结果,其特征是骨的破坏和修复同时进行。应力骨折好发于下肢,但各种运动引起的应力骨折部位各异。蓝球运动员跗、跖骨应力骨折发病率较高,田径运动员多发于胫骨、腓骨或跖骨,足球运动员好发于第5跖骨,军事训练以胫骨骨折为最多见,占50%～80%。1　损伤机制和病理改变当力作用于骨时,不论是压力还是张力,骨内均受到应力作用。应力作用使骨的形状产生变化称为应变。在一定范围内,应力越大则应变越大。当应…     

双下肢骨干多处骨折伴双股骨颈骨折一例

患者男，４０岁。因车祸伤后１５分钟入院。检查：意识恍惚，ＢＰ８／６ｋＰａ，Ｐ１４０次／分钟，Ｒ３０次／分钟，右小腿上段前侧重度开放伤。诊断为：创伤性失血性休克；双股骨颈头下型骨折（ＧａｒｄｅｎⅣ型）；右股骨干中下段骨折；右胫骨近侧干骺端与胫骨干上段粉...     

应力性骨折的影像学诊断进展

应力性骨折（stress fracture SF）亦称疲劳性骨折，是军事训练、运动员训练中常见的损伤。其发病率各家报道不同，美国海军陆战队新兵的发病率为2．9％，以色列新兵高达31％。国内报道，新兵应力性骨折发病率为9．5％～16．9％，个别报道高达32．5％。应力性骨折好发于下肢，不同运动引起的应力性骨折部位各异，比如，篮球运动员的跗、跖骨发病率较高，田径运动员多发于胫骨、腓骨或跖骨，足球运动员好发于第5跖骨。部队军事训练中，以负重行军和长跑训练引起的胫骨应力性骨折最为多见（50．0％～80．0％），其次为跖骨（20．0％～40．0％）。     

核素心肌灌注显像和CT冠状动脉造影检测冠状动脉心肌桥所致心肌血液供应异常

目的利用SPECT／CT完成同机核素MPI和CTCA,探讨冠状动脉（简称冠脉）心肌桥（MB）对心肌血液供应的影响。方法回顾性分析2008年3月至2013年3月间294例以胸闷、胸痛或心悸为主要症状、接受MPI及同机CTCA检查的患者资料,筛选出冠脉MB患者49例[男26例,女23例,年龄32～85（55．4±16．6）岁]。统计MB和缺血发生部位;将MPI和CTCA图像进行融合,对融合图像上MB．壁冠脉穿行心肌缺血区域、且CAG证实该区域供血冠脉不存在粥样斑块所致管腔狭窄者,判定心肌缺血为MB所致。利用z。检验比较不同部位MB引发心肌缺血改变的发生率差异。结果49例冠脉MB患者中,MB位于前降支近段3例,前降支中段34例,前降支远段4例,间隔支3例,回旋支远段2例,中间支I例,右冠脉近中段2例;MPI显示心肌缺血41例（缺血部位46处）,其中心尖部3例,前壁心尖部5例,前壁中部17例,间隔心尖部4例,前间隔中部3例,前侧壁中部2例,下侧壁中部2例,下侧壁基底段4例,下壁近心尖部3例,下壁基底段3例;融合图像示MB引发的心肌缺血有32例,其中23例由前降支中段MB所致。MB位于好发部位组（前降支中段,34例）与非好发部位组（15例）的心肌缺血发生率分别为67．6％（23／34）和60．0％（9／15）,差异无统计学意义（x2=0．27,P〉0．05）。结论左冠脉前降支中段是MB的好发部位,不同部位的MB引发心肌缺血的发生率无显著差异。MPI／CTCA融合影像可同时探测心肌缺血和冠脉MB的部位,判断MB对心肌血液供应的影响。     

'Sports anemia'--a real or apparent phenomenon in endurance-trained athletes?

In order to critically define the apparently widespread condition 'sports anemia', the red cell indices and iron status of male distance runners and triathletes, and female distance runners and ballet dancers were compared to non-exercising controls of both sexes. The mean hemoglobin (Hb) levels of all groups were within the normal ranges and there was no difference between the athletic and control groups of each sex. The mean serum ferritin (SF) concentration of the male distance runners (79.8 micrograms/l) was significantly lower than that of the triathletes (123.5 micrograms/l) and controls (138.3 micrograms/l). Iron deficiency (SF less than 12 micrograms/l, % saturation less than 18%) was evident in 3.3% and 5% of the male and female runners respectively, and 3.3% of the ballet dancers. Iron deficiency anemia (abnormal red cell indices and iron status) occurred in only 1.7% and 3.3% of the male and female distance runners respectively, and 3.3% of the dancers. However, 7 (11.7%) each of the male and female distance runners and 6 (20.0%) of the ballet dancers recorded hemoglobin values lower than the normal range of 140 g/l and 120 g/l for males and females respectively. This anomaly can be explained by a significantly expanded plasma volume in endurance-trained individuals, causing a 'pseudoanemia'. We conclude therefore that athletes are at no greater risk for developing a frank anemia than the non-exercising population, and that the term 'sports anemia' is misleading, as it does not describe a specific clinical entity.     

Stress fractures in ballet dancers.

We surveyed 54 female dancers in two professional ballet companies. A total of 27 fractures were reported in 17 dancers. Metatarsal fractures were the most common (63%), followed by fractures of the tibia (22%) and spine (7%). Dancers who danced greater than 5 hours per day were significantly more likely to have a stress fracture than those dancing less than 5 hours per day. Dancers in the stress fracture group also had a significantly longer duration of amenorrhea than those in the group with no stress fractures. No significant difference was found between the dancers who had stress fractures and those who did not with regard to any of the other variables examined. These data suggest that prolonged amenorrheic intervals and heavy training schedules may predispose ballet dancers to stress fractures. Of the 17 dancers with stress fractures, only 1 had neither of these risk factors.     

Anterior bony ankle impingement

Anterior bony ankle impingement results from osteophyte formation on the anterior edge of the distal tibia and/or neck of the talus, secondary to direct trauma during extreme or repetitive ankle dorsiflexion. It is common in ballet dancers, gymnasts, soccer players, football players, runners, and high jumpers. Typically, patients will complain of painful limitation of dorsiflexion, catching, and swelling in the ankle. These symptoms can be debilitating and considerably limit their athletic performance. The suspected diagnosis is confirmed with a plain lateral ankle radiograph that shows the anterior osteophytes. Initial treatment includes rest, an internal or external heel lift, rubber-sole wedge shoes, nonsteroidal anti-inflammatory drugs, physical therapy, and intra-articular steroid injections. If nonoperative treatment fails, removal of the anterior osteophytes by open or arthroscopic technique offers symptomatic relief of pain in most patients.     

National survey to evaluate musuloskeletal health in retired professional ballet dancers in the United Kingdom

ObjectivesTo explore the musculoskeletal health of retired professional ballet dancers in the United Kingdom (UK).DesignOnline national survey.ParticipantsRetired professional ballet dancers living in the UK.MethodsThe survey explored: what musculoskeletal injuries or diseases are experienced by retired professional ballet dancers; which anatomical regions were affected by musculoskeletal injuries or diseases in retired professional ballet dancers; whether ballet dancers were forced to retire from professional ballet due to musculoskeletal injuries or disease.ResultsForty-six retired ballet dancers responded. Thirty-six percent (n = 17) of respondents reported retiring from ballet due to musculoskeletal injury. The median age when respondents retired from professional ballet was 29 years. The most common issues that caused people to retire were hip and back pain (25%; n = 9 respectively), followed by hamstring injuries, ankle injuries, cervical spine injuries, and anterior knee pain (13% respectively; n = 5). Ninety-one percent (n = 42) reported experiencing muscle and joint pain post-retirement.ConclusionsMusculoskeletal pain and disease was a problem for respondents in this study. Further investigation is needed to define the problem, so management can be examined. Comparing performance and training regimes to injury rates in professional dancers, and then following these cohorts into retirement, would increase knowledge on this population.     

The injury panorama in a Swedish professional ballet company

We performed a combined retro- and prospective study of injuries in a Swedish professional, classical ballet company during 5 consecutive years. There were 390 injuries incurred by 98 dancers over a 5-year period, i.e., 0.6 injuries/1000 dance hours. Most injuries were considered to be due to overuse. The median sick leave was 2.3 weeks per injury. The foot and ankle region is vulnerable in classical ballet dancers, and overuse injuries can result in long periods of sick leave. Of the dancers employed for more than 1 year 95% were suffered injuries during the study period. We found considerable differences in the injury profile between male and female and between younger and older dancers. Male dancers suffered more frequently from acute injuries to the knee joint. Traumatic injuries were seen most frequently in male soloists. Female dancers more often suffered overuse injuries, especially to the foot and ankle region. The younger dancers more often suffered traumatic injuries, for example, ankle sprain, and also stress fractures.     

Os trigonum impingement in dancers.

Sixteen patients underwent surgical excision of an impinging ossicle through a posterior lateral approach. Twelve of these patients (15 ankles) were available for followup and were retrospectively surveyed at an average of 28 months after surgery. There were 9 women and 3 men. Nine were professional ballet dancers and 3 were students of advanced ballet schools. Preoperative symptoms included pain localized to the posterior ankle, limitation of motion, weakness, swelling, or neurologic changes associated with dance activities. All patients were severely hampered in their dance participation and had failed nonsurgical therapies. Postoperatively, all patients followed an aggressive rehabilitation protocol. All had improvement in their impingement symptoms; eight (67%) still had occasional discomfort. All professional dancers returned to unrestricted dance activity. The mean time to full activity was 3 months. One patient had a superficial wound infection requiring antibiotic treatment and another suffered a transient tibial nerve neurapraxia. Both of these complications resolved without sequelae. We conclude that posterior ankle impingement in ballet dancers, caused by an os trigonum and resistant to nonsurgical therapies, is effectively treated with simple excision of the offending structure.     

Bone stress lesions in ballet dancers: scintigraphic assessment

Ballet dancers are athletes susceptible to ligamentous and bony injury. We reviewed retrospectively the bone scans (technetium-99m methylene diphosphonate) of 23 ballet dancers with pain in the back and/or lower extremities to determine the usefulness of scintigraphy in the detection of stress lesions of bone. The scintigraphic studies in 19 dancers identified multiple areas of stress injury in both symptomatic and asymptomatic locations. Thirteen dancers had 22 stress fractures (microfractures of trabeculae with associated bone repair) manifested by an intense focus of increased uptake of radiopharmaceutical, and 19 dancers had stress reactions (areas of accelerated remodeling and resorption of bone) demonstrated by diffusely increased uptake of radiotracer. Ten of the 13 dancers with stress fractures were symptomatic and six of the 19 dancers with stress reactions were symptomatic. The radiographs of 10 dancers with positive bone scans were normal or showed no distinction between acute and chronic injuries. Stress fractures were most prevalent in the feet, and stress reactions were most prevalent in the tibiae. The study confirmed that ballet dancers sustain significant bone stress in their legs and feet. Our results show that scintigraphy can be used to detect stress fractures and stress reactions at both symptomatic and asymptomatic sites in this population.     

Effect of Mulligan's and Kinesio knee taping on adolescent ballet dancers knee and hip biomechanics during landing

Taping is often used to manage the high rate of knee injuries in ballet dancers; however, little is known about the effect of taping on lower‐limb biomechanics during ballet landings in the turnout position. This study investigated the effects of Kinesiotape (KT), Mulligan's tape (MT) and no tape (NT) on knee and hip kinetics during landing in three turnout positions. The effect of taping on the esthetic execution of ballet jumps was also assessed. Eighteen pain‐free 12–15‐year‐old female ballet dancers performed ballet jumps in three turnout positions, under the three knee taping conditions. A Vicon Motion Analysis system (Vicon Oxford, Oxford, UK) and Advanced Mechanical Technology, Inc. (Watertown, Massa chusetts, USA) force plate collected lower‐limb mechanics. The results demonstrated that MT significantly reduced peak posterior knee shear forces (P = 0.025) and peak posterior (P = 0.005), medial (P = 0.022) and lateral (P = 0.014) hip shear forces compared with NT when landing in first position. KT had no effect on knee or hip forces. No significant differences existed between taping conditions in all landing positions for the esthetic measures. MT was able to reduce knee and the hip forces without affecting the esthetic performance of ballet jumps, which may have implications for preventing and managing knee injuries in ballet dancers.     

Prevalence and profile of musculoskeletal injuries in ballet dancers: A systematic review and meta-analysis

AimTo determine the prevalence of musculoskeletal disorders and anatomical regions which are most frequently injured in ballet dancers.MethodsPublished (AMED, CiNAHL, EMBASE, SPORTDiscus, psycINFO, MEDLINE, the Cochrane Library) and grey literature databases (OpenGrey, the WHO International Clinical Trials Registry Platform, Current Controlled Trials and the UK National Research Register Archive) were searched from their inception to 25th May 2015 for papers presenting data on injury prevalence in ballet dancers. Two reviewers independently identified all eligible papers, data extracted and critically appraised studies. Study appraisal was conducted using the CASP appraisal tool. Pooled prevalence data with 95% confidence intervals were estimated to determine period prevalence of musculoskeletal disorders and anatomical regions affected.ResultsNineteen studies were eligible, reporting 7332 injuries in 2617 ballet dancers. The evidence was moderate in quality. Period prevalence of musculoskeletal injury was 280% (95% CI: 217–343%). The most prevalent musculoskeletal disorders included: hamstring strain (51%), ankle tendinopathy (19%) and generalized low back pain (14%). No papers explored musculoskeletal disorders in retired ballet dancers.ConclusionsWhilst we have identified which regions and what musculoskeletal disorders are commonly seen ballet dancers. The long-term injury impact of musculoskeletal disorders in retired ballet dancers remains unknown.     

Injury epidemiology in pre-professional ballet dancers: A 5-year prospective cohort study

IntroductionPre-professional ballet dancers are at high-risk for injury, with injury rates ranging from 1.4 to 4.7 injuries/1000 dance-hours. In dance injury epidemiology, multi-year studies are limited, and findings are inconsistent. Thus, the extent to which injury estimates range from year to year in a pre-professional ballet program is currently unknown.ObjectiveThe aim of this study was to establish the extent and characteristics of injuries in pre-professional adolescent ballet dancers across five academic training years.Methods452 female and male pre-professional ballet dancers (median age, 15 years; range, 11–20 years) participated across five academic years at a vocational ballet school. Participants completed an online weekly injury questionnaire (OSTRC-Q) and self-reported dance hours questionnaire.ResultsQuestionnaire response was 91.4%. Depending on the definition of injury, yearly injury prevalence ranged from 32.1% (145/452; time-loss) to 67.4% (305/452; all-complaints) across the 5 years. Yearly injury rates ranged from 0.76 (95%CI: 0.66, 0.86; time-loss) to 2.54 (95%CI: 2.37, 2.73; all-complaints) per 1000 dance-hours. The ankle was the most reported injury location (range: 16–33%).ConclusionsInjury prevalence and injury rate estimates remained high across five academic years in a pre-professional ballet population. Injury estimates were highest when an all-complaints definition was employed.Level of evidenceTherapy/Prevention, Aetiology/Harm, level 2b.