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1.
目的应用电子束CT(EBCT)观察Amplatzer房间隔缺损封堵器(ASO)置人后形态变化。方法11例继发孔型房间隔缺损(ASD)患者,于封堵术后第1d,3、6及12个月时行心电门控单层容积扫描,依据心脏解剖和ASO形态,选择3个观察层面,分别测量ASO左、右心房盘横径、腰部厚度和横径等指标;同时观察ASO的形态和位置随时间的变化。结果术后3、6和12个月时,分别有8、8和4例完成复查。ASO在术后3或6个月时形态变化较大,与术后次日相比,主要是腰部厚度显著缩小(10例),术后1d、3、6和12个月时ASO腰部厚度分别为(13.79±4.63)、(7.02±3.17)、(6.65±2.76)和(5.08±2.82)mm(P〈0.05);左心房盘横径术后1d、3、6和12个月时分别为(40.91±8.55)、(39.04±13.10)、(39.45±13.20)和(44.79±5.27)mm,右心房盘横径术后1d、3、6和12个月时分别为(37.24±4.98)、(36.54±4.83)、(37.01±4.73)和(39.56±5.88)mm,腰部横径术后1d.3、6和12个月时分别为(21.55±5.82)、(22.80±4.88)、(20.52±5.82)和(27.72±4.53)mm,左、右心房盘和腰部横径变化不显著(P〉0.05)。术后3、6和12个月时,分别有6、7和4例患者的ASO形态为优或良。在形态变化的同时,ASO位置发生变化。结论EBCT能够直观、准确观察ASO各径线、形态和空间位置的变化过程。  相似文献   

2.
131I治疗Graves甲亢中动态监测血清TRAb的临床价值   总被引:1,自引:0,他引:1  
目的 探讨^131I治疗Graves甲状腺功能亢进症(简称甲亢)中动态监测血清促甲状腺激素受体抗体(TRAb)水平变化的临床价值。方法 130例Graves甲亢患者和50名健康对照者分别于^131I治疗前及治疗后3,6,12和24个月采用放射受体分析法(RRA)测定其血清TRAb水平。数据用x^-±s表示,组间差异用方差分析与t检验。结果 130例Graves甲亢患者在^131I治疗前血清TRAb水平[(92.93±68.99)U/L]高于健康对照组(P〈0.01)。在^131I治疗后3个月血清TRAb水平[(139.04±77.19)U/L]明显高于治疗前(P〈0.01),治疗后6个月患者血清TRAb水平[(65.87±54.86)U/L]开始降低,但与对照组比较差异仍有统计学意义(P〈0.01),在^131I治疗12个月后血清TRAb水平[(14.16±12.35)U/L]明显降低(P〈0.01),到24个月患者血清TRAb水平[(12.99±5.52)U/L]与对照组比较差异无统计学意义(P〉0.05)。结论 在^131I治疗前检测血清TRAb水平可指导^131I的用量;在^131I治疗后检测Graves甲亢患者的TRAb水平有助于随访监测及疗效评价,还可了解治疗后的免疫反应状态。  相似文献   

3.
目的应用多层螺旋CT血管成像(CTA),探讨髂总静脉汇合部的解剖与髂静脉压迫综合征的关系。方法对无下肢血管闭塞性病变主诉和体征的80例患者行多层螺旋CT腹部增强扫描,采用多平面重组显示髂总静脉汇合部,测量右髂总动脉跨越处左髂总静脉前后径、两侧髂总静脉汇入下腔静脉的角度、横断面及正交断面上两侧髂总静脉的内径和面积,并对测量结果进行统计分析。结果横断面上两侧髂总静脉的平均内径、面积及其比值[右、左侧内径分别为(14.8±2.7)、(19.1±5.3)mm,面积分别为(171±61)、(244±112)mm^2,与下腔静脉内径比分别为0.79±0.12和1.03±0.30,与下腔静脉面积比分别为0.65±0.20和0.93±0.47]均大于正交断面[右、左侧内径分别为(14.1±2.3)、(15.6±3.5)mm,面积分别为(157±51)、(182±74)mm^2,与下腔静脉内径比分别为0.75±0.10和0.83±0.16,与下腔静脉面积比分别为0.59±0.19和0.68±0.25]相应数值(t=3.525—7.979,P均〈0.01)。正交断面左侧髂总静脉与下腔静脉内径比和面积比均大于右侧(t值分别为13.030和10.942,P均〈0.01)。右侧髂总静脉汇入下腔静脉的夹角小于左侧(P〈0.01)。在非老年(年龄〈65岁)患者中,男性在右髂总动脉跨越处测量的左髂总静脉前后径及正交断面上的面积[分别为(9.2±3.5)mm和(209±63)mm^2]大于女性[分别为(6.0±3.1)mm和(150±74)mm^2](t值分别为3.120和2.880,P〈0.01)。在老年(年龄≥65岁)患者中,男性左髂总静脉正交断面面积及其与下腔静脉面积的比值[分别为(207±90)mm^2和(0.80±0.34)]大于女性[分别为(138±38)mm^2和(0.59±0.14)](t值分别为2.811和2.245,P〈0.05)。结论CTA能多平面显示髂总静脉汇合部的解剖,并可进行多方位准确测量,对髂静脉压迫综合征的诊断有临床应用价值。  相似文献   

4.
目的研究抑制素(INH)在体条件下能否通过大鼠的血脑屏障及在垂体或下丘脑的分布。方法采用颈静脉灌流和放射自显影技术,将20只SD大鼠分为4组,每组5只,第1~3组(实验组)颈静脉注射^125 I-INH50μl,第4(对照)组注射等量的生理盐水。第1,2,3组分别于注射后30,60和120min断头处死,取出垂体、下丘脑,以生理盐水洗涤,测量放射性计数,取放射性最大组的垂体与下丘脑组织行放射自显影分析。结果第1组垂体的放射性最高[(1008.00±5.78)Bq],而第2和3组分别为(723.00±4.95)和(491.00±4.90)Bq;1~3组的下丘脑放射性分别为(20.00±1.01),(22.00±0.95)与(19.00±0.73)Bq。第4组垂体与下丘脑的放射性分别为(16.00±1.40),(15.00±0.98)Bq。各实验组大鼠垂体的放射性与对照组差异有统计学意义(P〈0.01),且在注射后30min放射性最大(第1组),60和120min后逐渐降低;而实验组与对照组大鼠的下丘脑放射性差异无统计学意义(P〉0.05);放射自显影结果示,实验组大鼠的垂体组织上有明显的银颗粒,而对照组没有;实验组和对照组大鼠的下丘脑组织上均未见明显的银颗粒。结论^125I-INH能通过大鼠血脑屏障,垂体在注射后30min放射性最大,在大鼠垂体上有INH结合位点或受体,而在其下丘脑没有。  相似文献   

5.
复发性视神经脊髓炎脑扩散张量成像研究   总被引:1,自引:1,他引:0  
目的利用扩散张量成像(DTI)探讨复发性视神经脊髓炎(RNMO)患者是否存在隐匿性脑组织损伤及其发生机制。方法对16例RNMO患者和16例性别和年龄匹配的正常志愿者脑组织的平均扩散系数(ND)和部分各向异性(FA)进行直方图和感兴趣区(ROI)分析,以P≤0.005为差异有统计学意义。结果与志愿者比较,RNMO患者脑的平均MD升高[脑组织:RNMO患者(0.95±0.02)×10^-3mm^2/s,志愿者(0.91±0.03)×10^-3mm^2,t=3.940,P〈0.001;脑白质:RNMO患者(0.82±0.02)×10^-3mm^2/s,志愿者(0.80±0.02)×10^-3mm^2/s,t=3.117,P=0.004;脑灰质:RNMO患者(1.06±0.04)×10^-3mm^2/s,志愿者(0.88±0.05)×10^-3mm^2/s,t=4.031,P〈0.001]、脑白质的FA直方图峰高抬高[RNMO患者(2.61±0.18)‰,志愿者(2.38±0.18)‰,t=3.627,P=0.001]及脑灰质的MD直方图峰高降低[RNMO患者(7.37±0.89)‰,志愿者(8.91±1.71)‰,t=3.210,P=0.003]和峰位置抬高[RNMO患者(0.83±0.02)×10^-3mm^2/s,志愿者(0.81±0.02)×10^-3mm^2/s,t=4.373,P〈0.001];与脊髓和视神经有直接联系ROI的平均MD升高[延髓:RNMO患者(1.27±0.11)×10^-3mm^2/s,志愿者(1.11±0.10)×10^-3mm^2/s,t=4.260,P〈0.001;大脑脚:RNMO患者(1.01±0.11)×10^-3mm^2/s,志愿者(0.87±0.05)×10^-3mm^2/s,t=4.391,P〈0.001;内囊:RNMO患者(0.74±0.01)×10^-3mm^2/s,志愿者(0.72±0.01)×10^-3mm^2/s,t=4.683,P〈0.001;视放射:RNMO患者(0.88±0.03)×10^-3mm^2/s,志愿者(0.82±0.03)×10^-3mm^2/s,t=4.619,P〈0.001)、平均FA降低(延髓:RNMO患者0.27±0.01,志愿者0.29±0.03,t=2.996,P=0.005;大脑脚:RNMO患者0.49±0.04,志愿者0.54±0.03,t=4.280,P〈0.001;内囊:RNMO患者0.66±0.02,志愿者0.69±0.02,t=3.953,P〈0.001;视放射:RNMO患者0.53±0.04,志愿者0.59±0.03,t=4.705,P〈0.001);而与脊髓和视神经无直接联系的胼胝体的平均MD[膝部:RNMO患者(0.76±0.04)×10^-3mm^2/s,志愿者(0.73±0.03)×10^-3mm^2/s;压部:RNMO患者(0.77±0.05)×10^-3mm^2/s,志愿者(0.73±0.04)×10^-3mm^2/s]和FA值(膝部:RNMO患者0.82±0.03,志愿者0.82±0.03;压部:RNMO患者0.83±0.03,志愿者0.83±0.02)差异无统计学意义(P值均〉0.005)。结论RNMO患者存在隐匿性脑组织损伤,这可能与继发于脊髓和视神经病灶的顺行和逆行性变性有关。  相似文献   

6.
目的:探讨阻塞性睡眠呼吸暂停综合征(OSAS)患者和正常人在清醒状态下咽部多层螺旋CT(MSCT)综合测量值及其在临床中的应用价值。方法:选择由多导睡眠图确诊为OSAS的患者68例,健康对照组56例,分别进行清醒状态下平和呼吸MSCT扫描,比较各测量值及比值,并将上述指标代人判别分析方程。结果:在63个自变量指标中,49个指标2组差异有统计学意义(P〈0.05)。将所有指标分别代人判别分析方程,其中软腭后区(RP)左右径(LR)[OSAS组为(9.4±3.7)mm,对照组为(20.1±5.0)mm;t=-13.820,P=0.000]及最小横截面积(XSA)[OSAS组为(54±27)mm^2,对照组为(164±77)mm^2;t=10.944,P=0.000]、舌高[OSAS组为(75.4±8.3)mm,对照组为(58.4±9.8)mm;t=10.476,P=0.000)、悬雍垂长/气道长(OSAS组为0.139±0.039,对照组为0.154±0.048,t=-1.983,P=0.050)4项指标被选人判别分析方程式。OSAS组阳性66例(97.1%),对照组阴性52例(92.9%)。结论:多项测量值及比值的比较显示2组间差异有统计学意义,但数值有重叠。判别分析方程式的引入有助于MSCT对OSAS的诊断。  相似文献   

7.
苏州市水中放射性水平调查及其质量评价   总被引:1,自引:1,他引:0       下载免费PDF全文
目的对苏州市水源的放射性水平进行调查和评价。方法采用BH1216型低本地α、β放射性测量装置,用^241Am和优质纯KCl分别作为总α、总β放射性测量的标准源,采用中等厚度相对测量法测定样品中的总α、总口放射性活度。结果苏州市各种水样的总α放射性水平为(2.62±0.17)×10^-2~(8.48±2.80)×10^-2 Bq/L;总β放射性水平为(0.77±0.47)×10^-1~(3.75±0.26)×10^-1 Bq/L;β/α的平均值为1.6—7.2。结论苏州市水源没有受到人工放射性核素的污染,其水源水质量均为优良水平;所有水源中浅井水的总放射性水平最高。  相似文献   

8.
目的研究定量门控心肌断层显像(QGS)、爱莫瑞心脏工具箱(ECToolbox)和四维模型心肌断层显像(4D-MSPECT)3种定量分析软件所测左心室射血分数(LVEF)、舒张末期容积(EDV)和收缩末期容积(ESV)的相关性以及与左心室造影之间的相关性。方法临床疑诊或确诊冠心病患者212例均行99^Tc^m-MIBI门控心肌SPECT显像,并分别以QGS、ECToolbox和4D-MSPECT软件处理得LVEF1、EDV1、ESV1。其中106例患者行左心室造影,分别测得LVEF2、EDV2、ESV2。比较3种软件之间及其与左心室造影之间的相关性。结果3种软件所测LVEF1、EDV1、ESV1的相关性好,所测LVEF1值的r值为0.89~0.91(P均〈0.001),EDV1、ESV1值的r值为0.97~0.98(P均〈0.001)。对于LVEF1和EDV1,QGS、ECToolbox、4D-MSPECT所测值间的差异具有统计学意义(P〈0.001)。QGS所测值[LVEF1:(59.2±11.4)%、EDV1:(88.8±35.5)ml]低于4D-MSPECT所测值[LVEF1:(64.2±12.6)%、EDV1:(98.1±39.5)ml],4D—MSPECT所测值又低于ECToolbox所测值[LVEF1:(68.3±12.8)%、EDV1:(108.2±39.0)ml];而对于ESV1,QGS[(39.0±27.0)ml]、ECToolbox[(37.9±31.4)ml]与4D—MSPECT[(38.7±31.3)ml]所测值之间差异无统计学意义(P=0.92)。门控心肌SPECT显像与左心室造影所测LVEF2、EDV2、ESV2的相关性好,r值分别为0.70~0.80,0.57~0.61和0.87—0.89(P均〈0.001)。结论3种门控SPECT定量分析软件所测值之间及与左心室造影的相关性均较好。  相似文献   

9.
头颈部病变MR扩散成像的初步研究   总被引:4,自引:0,他引:4  
目的探讨MR扩散加权成像(DWI)在头颈部病变中的诊断价值。方法回顾性分析57例头颈部病变共85个病灶,其中恶性肿瘤22个(22例),良性肿瘤13个(13例),囊性或液性病灶13例共17个病灶,包括囊肿12个(8例),肿瘤坏死4个(4例),脓肿1个(1例);淋巴结病灶33个。所有患者均经临床追踪或手术病理证实。分析各病灶在扩散敏感因子(b值)为0、500和1000s·mm^-2时DWI特点及其表观扩散系数(ADC)值。结果良、恶性肿瘤在DWI表现有所不同,13个良性肿瘤与脊髓(或脑干)的信号比值随b值增加迅速下降;22个恶性肿瘤与脊髓(或脑干)信号比值随b值增加变化不明显。恶性肿瘤的平均ADC值[(0.78±0.24)×10^-3mm^2·s^-1]低于良性肿瘤[(1.48±0.20)×10^-3mm^2·s^-1],差异有统计学意义(t=8.9,P〈0.01);良、恶性肿瘤的ADC值受试者特异性曲线(ROC)下面积Az值为0.971±0.030,当ADC值取1.13×10^-3mm^2·s^-1时,判断良、恶性肿瘤的敏感度为100%,特异度为90.5%,准确度90.5%。鳞状细胞癌的ADC值与分化程度相关,分化好者其ADC值高。囊性或液性病变(12个)、肿瘤坏死(4个)和脓肿(1个)在DWI上的信号强度与其组织病理成分相关,具有一定的信号特征和ADC值。淋巴结转移瘤的平均ADC值[(0.81±0.11)×10^-3mm^2·s^-1]高于良性淋巴结病变[(0.69±0.04)×10^-3mm^2·s^-1],差异有统计学意义(t=3.48,P〈0.01),但是两者之间有较大的重叠,且在DWI上表现相仿。结论DWI和ADC值在头颈部病变的鉴别诊断中具有重要价值。  相似文献   

10.
目的了解先天性肛门直肠畸形(ARM)患儿横纹肌复合体(SMC)发育状态及其与排便功能的关系。方法64例患儿进行盆腔MRI检查,其中对照组25例,为无直肠肛管疾病,因其他疾病需进行盆腔MRI检查者,ARM组39例。应用不同序列体部相控阵列线圈或头部线圈MRI对SMC从多个层面进行观测及定量分析,评估其发育状态与排便功能的关系。术后39例ARM患儿均进行1~6年的随访,对30例5岁以上患儿进行主、客观排便功能的检查。结果对照组SMC宽度绝对值为(3.63±0.22)mm,与年龄有相关性(r=0.998,P〈0.01);SMC宽度相对值为0.50±0.02,与年龄无相关性(r=0.265,P〉0.05)。低、中位ARM患儿肌肉发育指数(MI)分别为0.49±0.05和0.47±0.05,发育良好;高位ARM患儿MI为0.28±0.06,仅部分SMC发育不良。30例5岁以上的随访患儿中,当MI≤0.18时,直肠肛管收缩压差较MI〉0.18时明显降低[分别为(0.85±0.20)、(2.24±1.02)kPa,t:3.55,P〈0.01],肛管高压区长度明显缩短[分别为(10.88±3.64)、(20.26±4.34)mm,t=5.18,P〈0.01],直肠肛管角〉100°,7例中5例ARM术后出现肛门失禁。当MI〉0.18时,直肠肛管角〈90°,23例中21例ARM术后排便功能好。结论MRI检查能清楚地显示对照组和ARM组患儿SMC发育状态,MI可以作为SMC发育的量化指标,并可用于评估ARM患儿SMC的发育状态,当MI≤0.18时可作为SMC发育不良的客观指标。  相似文献   

11.
The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.  相似文献   

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14.
Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.  相似文献   

15.
Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).  相似文献   

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KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief,intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.,≥90%of VO2 peak).  相似文献   

17.
Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas (CCF) and their complications such as pseudoaneurysms. Methods: Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% (4/22). A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% (8/22). Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.  相似文献   

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In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex® ESI 16 (European Standard Investigator 16) and the PowerPlex® ESI 17 Systems. The PowerPlex® ESI 16 System combines the 11 loci compatible with the UK National DNA Database®, contained within the AmpFlSTR® SGM Plus® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR® SGM Plus® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex® ESI 17 System amplifies the same loci as the PowerPlex® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR® SGM Plus® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.  相似文献   

19.
Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula (BSF). Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types (A and B) of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 (87.5%) of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. (J Intervent Radiol, 2007, 16: 253-257)  相似文献   

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The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.  相似文献   

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