投弹让我们再也“伤不起”

<正>投弹训练伤是发生率甚高的一种训练伤,严重影响了官兵身体健康和训练质量效益。为使基层官兵科学掌握投弹训练的动作规范,减少投弹训练伤发生,下面我们将有关防治常识与战友们共享。造成投弹骨折的力学原理投弹骨折一般是由投弹姿势错误造成的。错误的投弹姿势产生的力学原理是投弹时没有转肩翻肘,上臂绕体侧运动位置较低,处于外展位时,肘关     

投弹和射击易发生的损伤

投弹是一项全身运动 ,涉及肩臂、手腕和腰、腿动作的协调一致。当突然爆发力量投出 ,在准备活动不足、挥臂动作不正确、用力过猛等情况下 ,易造成扭伤、韧带撕裂或肩、肘关节脱位。投弹性肱骨骨折亦不少见。这些损伤一般不会发生在首次投弹 ,而是在经历一定训练后有上臂肿痛的时候出现。此时应加强卫生监督 ,避免发展至关节脱位或应力性骨折。射击时 ,为练习射击姿势 ,长时间固定于某一姿态或挂砖练习 ,极易发生静力紧张而导致腰、肘局部肌群疲劳 ,休息时应按摩或活动肢体以促进恢复 ;长时间卧位练习尤其在寒冷或潮湿地面 ,易引起肘、膝关节…     

腕舟骨骨折夹角与X线形态的对照分析

目的测量舟骨骨折线夹角和X线形态,探讨舟骨形态在损伤时与桡骨远端尺倾关节面夹角的相关性,为临床提供可靠的影像学依据。方法对100例舟骨骨折线与桡骨远端尺倾关节面所成的角度和两端长度及宽度进行测量分型。结果骨折夹角最大70°,最小20°,其中Ⅰ型30～50°者82例,Ⅱ型50°以上10例,Ⅲ型30°以下8例。舟骨X线形态细长型82例,粗短型11例,不规则型7例。结论粗短型舟骨损伤后骨折夹角较大在50～70°之间,多见于舟骨远端。细长型夹角在30～50°之间,好发腰部。不规则型舟骨夹角在30°以下,常见在近端多合并翻转或其它腕骨多发性损伤。     

1332名男性青年肘关节角度的测量

现行的《招收飞行学员体格检查标准》规定:“肘外翻及轻度肘过伸、肘伸展不全左右对称,功能正常”者可合格。即:肘内翻者;肘外翻及轻度过伸、肘伸展不全又左右不对称,功能不正常者;重度肘过伸、肘伸展不全者,均不合格。重点是“左右对称”和“功能正常”。笔者检查山东籍男性青年学生1 322名,右侧肘外翻角平均10.48°,内翻角4.93°,     

主胰管胰头段水平角及开角方向与急性胰腺炎相关性的MRI研究

【摘要】目的：探讨主胰管胰头段水平角及开角方向与急性胰腺炎的相关性。方法：回顾性连续搜集临床及上腹部MRI检查诊断为急性胰腺炎的213例患者的临床资料,按纳入和排除标准入选60例（其中男38例,女22例,平均年龄45岁）为观察组,同期收集43例正常胰腺（男22例,女21例,平均年龄53岁）为对照组。两组均行MRCP,数据上传至工作站行图像处理,在主胰管显示清晰完整的层面上连续三次测量主胰管胰头段及主胰管头尾两端连线与水平线的夹角,记录平均数值及主胰管胰头段水平角方向并行统计学分析。结果：急性胰腺炎组,主胰管胰头段及主胰管头尾两端连线与水平线的夹角分别为25.64°±20.32°和28.07°±11.11°,而正常胰腺组为30.56°±18.56°和28.65°±10.49°（t=1.254/0.253,P=0.213/0.801 ）。60例急性胰腺炎组中,主胰管胰头段开角向上36例,主胰管胰头段与水平线的夹角为32.19°±23.19°, 向下24例,其夹角为16.08°±8.80°;43例正常胰腺组,开角方向上37例,主胰管胰头段与水平线的夹角为32.77°±18.91°, 向下6例,其夹角为16.94°±7.66°。急性胰腺炎组与正常胰腺组,向上或向下开角方向,主胰管胰头段与水平线的夹角差异均无统计学意义（t=0.117/0.219,P=0.907/0.828）,而主胰管胰头段与水平线的开角方向差异具有统计学意义（χ2=8.232,P=0.004）。全部病例中向上开角的角度（32.48°±20.98°）与向下开角的角度（16.26°±8.46°）间差异有统计学意义（t=4.901,P=0.000）。结论：急性胰腺炎与主胰管胰头段水平角大小无关,但与水平角的开角方向密切有关,临床急性胰腺炎多以开角向下方向为主。     

人体卧姿着陆冲击动态响应特性研究

目的探讨飞船返回着陆时不同强度和不同姿态冲击下人体动态响应的规律.方法 5名健康男青年,以仰卧20°,承受4～10 G、50～80 ms;仰卧30°～60°,10 G、50 ms,半正弦脉冲的着陆冲击.分别记录冲击塔平台,座椅及人体头、肩、胸和髂处的Z和X向加速度及被试者心电图.结果随着陆冲击强度的增加,人体头、肩、胸和髂处X向加速度响应值均增大;20°,10 G冲击时,头Z向和X向加速度峰值超调量分别为93%和102%; 随仰卧角度的增加,人体头、肩、胸和髂X向加速度响应均下降,而头Z向加速度及超调量在40°仰卧角时最小.结论人体对着陆冲击的传递函数表明,人体具有多阶共振频率,分别为25 Hz、34 Hz、39 Hz、43 Hz、50 Hz、64 Hz和70 Hz.     

成人髋臼发育不良并骨性关节病的X线诊断

目的:通过对髋关节正位平片的检查和测量,探讨成人髋臼发育不良并骨性关节病的X线诊断。方法:回顾性分析我院40例,共69个髋关节成人髋臼发育不良继发退行性骨关节病的X线表现,测量其CE角(中心边缘角)、sharp角(髋臼角)和髋顶切线角。结果:CE角最大27°,最小-25°,平均11.2°。sharp角最大59°,最小49°,平均55.6°。髋顶切线角全部为零度和负角,零度28髋,负角41髋。继发退行性骨关节病,表现为髋臼顶及边缘骨质增生硬化,髋臼和/(或)股骨头囊变,以髋臼更为明显。结论:X线正位平片可良好地显示髋关节骨结构,结合CE角、sharp角、髋顶切线角等相关测量,骨盆正位片目前仍是放射科诊断髋臼发育不良并骨性关节病最简单实用的方法。     

短臂管型石膏固定治疗陈旧腕舟骨骨折18例临床报告

目的:观察采用不固定所有掌指关节的聚氨酯短臂管型石膏外固定治疗陈旧腕舟骨骨折的疗效。方法:自1999年8月至2008年1月在本所就诊的18例陈旧腕舟骨骨折患者,受伤至开始石膏固定平均6.3个月(2~12个月),其中2例断端部分硬化,另2例舟骨近侧骨折块有缺血坏死改变。采用聚氨酯短臂管型石膏固定腕关节,固定范围从肘前横纹下5cm到手掌横纹,腕关节固定于10°背伸、20°尺偏位置,所有掌指关节都不固定。每1至2个月检查石膏固定情况并复查X线片,石膏若有松动及时更换。结果:16例经X线片证实获得骨折愈合(88.9%),平均固定4.7个月(3~8个月),其中2例舟骨近侧骨折块缺血坏死患者,其达到骨折愈合的固定时间分别是5个月和6个月。2例骨折未愈合:其中1例为骨折断端有部分硬化,固定5个月无愈合迹象;另1例固定2个月后未愈合,患者放弃治疗。骨折愈合的16例中,14例在去除石膏后随访平均9.3个月(2~24个月),有4例腕背伸受限约10°,3例诉腕活动时轻微疼痛,其余患者腕关节活动范围无受限,无疼痛。结论:陈旧腕舟骨骨折伤后1年内,骨折断端无明显硬化者,多数可以采用不固定所有掌指关节的聚氨酯短臂管型石膏固定治愈;陈旧腕舟骨骨折近端骨折块发生缺血坏死者,虽然石膏固定治疗所需时间较长,但仍有愈合可能。     

不同体位着陆冲击时人体的动态响应

目的探讨不同体位着陆冲击时人体动态响应的变化。方法 5名健康男青年 ,承受峰值 1 0G ,作用时间为 50ms的半正弦脉冲的着陆冲击 ,冲击方向与人体纵轴的夹角 (体位角 )从 30°～ 70°间隔 1 0°增加 ,分别在人体头、肩、胸、髂部安装二维加速度计记录人体的动态响应。结果在本实验条件下 ,人体头Z向 (头盆向 )响应在 50°角时达最小 ,其值为 1 0 .36± 2 .44G ;在 70°角时响应达最大 ,其值为 1 8.0 7± 3.2 9G。胸Z向响应在 70°时达最小 ,其值为 1 0 .39± 3.97G ;在 60°时达最大 ,其值为 1 5.42± 3.61G。头X向 (胸背向 )响应在 30°时达最小 ,其值为 7.58± 1 .1 8G ;在 70°时响应达最大 ,其值为 1 8.89± 1 .85G。胸X向响应在 30°达最小 ,其值为 7.2 1± 1 .99G ;在 70°角时响应达最大 ,其值为 1 7.67± 2 .1 6G。结论在本实验条件下 ,人体对抗着陆冲击的最佳体位角为 50°。     

特殊的"Turner"综合征1例

患者 ,男性 ,32岁。因外伤来我院就诊。查体 :五官端正 ,发育良好 ,胸廓无畸形 ,双肺呼吸动度及语颤正常 ,心界无扩大 ,双肺呼吸音清 ,未闻及干湿性罗音及病理性杂音。既往无任何病史 ,并否认遗传及其它病史 ,父母及子女均无类似病史。尿液检查未见促性腺激素。　　X线表现 :双手第四掌骨及双足第四跖骨对称性短小 ,右手腕角 12 3° ,左手腕角 12 0°均小于正常人腕角均值( 131.5°)。两指骨长度超过第四掌骨均 3cm ,出现指骨优势 ;第 4、5掌骨顶端连线与第三掌骨头相交 ,即掌骨征阳性。双侧四肢、0躯干及各大关节形态结构及骨质密度如常。…     

Effects of throwing overweight and underweight baseballs on throwing velocity and accuracy

The purpose of this review is to determine how throwing overweight and underweight baseballs affects baseball throwing velocity and accuracy. Two studies examined how a warm-up with overweight baseballs affected throwing velocity and accuracy of 5 oz regulation baseballs. One of these studies showed significant increases in throwing velocity and accuracy, while the other study found no significant differences. Three training studies (6 to 12 weeks in duration) using overweight baseballs were conducted to determine how they affected ball accuracy while throwing regulation baseballs. No significant differences were found in any study. From these data it is concluded that warming up or training with overweight baseballs does not improve ball accuracy. Seven overweight and 4 underweight training studies (6 to 12 weeks in duration) were conducted to determine how throwing velocity of regulation baseballs was affected due to training with these overweight and underweight baseballs. The overweight baseballs ranged in weight from 5.25 to 17 oz, while the underweight baseballs were between 4 and 4.75 oz. Data from these training studies strongly support the practice of training with overweight and underweight baseballs to increase throwing velocity of regulation baseballs. Since no injuries were reported throughout the training studies, throwing overweight and underweight baseballs may not be more stressful to the throwing arm compared to throwing regulation baseballs. However, since currently there are no injury data related to throwing overweight and underweight baseballs, this should be the focus of subsequent studies. In addition, research should be initiated to determine whether throwing kinematics and kinetics are different between throwing regulation baseballs and throwing overweight and underweight baseballs.     

Pathomechanics of the throwing shoulder

Many anatomic, physiological, and biomechanical alterations have been observed in overhead athletes who present with painful shoulders. This is probably due to the complex kinetic chain mechanics required in the overhead throwing or serving motion. Any alteration along the kinetic chain can result in deficits in force production or increase in joint loads in other parts of the chain. The "disabled throwing shoulder" (DTS) is a general term that describes the limitations in function that exist in symptomatic overhead athletes. DTS typically results from a "cascade to injury" with alterations in the kinetic chain. Evaluation of athletes with the DTS should include examination of the local and distant anatomic injuries and screening for physiological (muscle inflexibilities, weakness, or imbalances) or biomechanical (motions, positions) alterations.     

Rehabilitation of the throwing shoulder

Rehabilitation of the injured throwing arm should not be directed simply toward beginning strengthening exercises and returning the athlete to throwing as soon as possible. The total comprehensive program has been described and consists of seven phases that begin with making the proper diagnosis of a shoulder injury. Once the proper diagnosis is made, the pathophysiology of throwing injuries has to be understood by the physician, the trainer, and the athlete, and then the actual treatment begins in phase III. Initial treatment many times consists of a short period of relative rest as well as physical therapy modalities to relieve pain, and once pain is relieved phase IV begins, which is the actual techniques of range of motion, flexibility, and strengthening maneuvers. Once adequate flexibility, range of motion, and pain-free motion have been achieved, as well as adequate endurance strength, proper warm-up techniques are begun, and then a return to throwing is achieved in phase VI. The total rehabilitative cycle is concluded with phase VII, which consists of an off-season conditioning program to verify that the athlete will maintain year-round maximum condition of not only the throwing shoulder but of the entire athlete.     

Shoulder rotational properties of throwing athletes

Throwing arm injuries are common and often related to the shoulder external and internal rotation. Quantitative assessment may provide new insights to physical assessment and options for treatment. After having signed IRB approved consents and filled out injury questionnaires, 96 baseball pitchers were examined on both shoulders using a custom-made wireless device. The resistance onset angle (ROA), end-point angle (EPA), shoulder rotational flexibility (SRF) in both external and internal rotation, and rotational ranges of motion (ROM) of both shoulders were determined. About 34% of subjects had surgeries on their throwing arm. Another 15% of subjects had throwing arm injuries that did not require surgical treatments. The throwing arm had significantly lower internal ROA, EPA and SRF, but significantly higher external ROA, EPA and SRF than the non-throwing arm. There were significant differences in shoulder rotational properties among groups with different surgery locations. Subjects with shoulder surgeries had greater internal rotation flexibility of their throwing arm than those with surgeries on the elbow. Throwers with injury and surgery history had significantly different shoulder rotational properties. Abnormal shoulder rotational properties may be related to throwing arm injuries. A better understanding of their relationship may lead us to effective preventive measures of throwing arm injuries.     

Imaging of the overhead throwing athlete

Knowledge of overhead throwing biomechanics is crucial to understand specific injuries encountered in throwing athletes on diagnostic imaging. Most specific injuries of overhead throwing athletes occur at the shoulder and elbow. Throwing athletes are susceptible to rotator cuff tears from tensile overload and external and internal impingement. The labrum is also commonly degenerated or torn secondary to overuse syndrome, internal impingement, and microtrauma. The elbow is typically injured secondary to excessive valgus forces during throwing. The ulnar collateral ligament, ulnar nerve, and common flexor tendon origin are all at increased risk of injury. Capitellar osteochondral injuries and loose intra-articular bodies are also frequent. Knowledge of injury pathophysiology is crucial to understanding the treatment rationale in throwing athletes.     

Management of medial epicondylitis inthe throwing athlete

Medial epicondylitis in the throwing athlete is typically a result of repetitive loading of the flexor pronator massor because of acute overload of the flexor pronator mass. It manifests itself as pain with or after a period of throwing and is typically associated with a more prolonged, frequent, or strenuous regimen. The mechanics in throwing include elbow extension, forearm pronation, and wrist palmar flexion in motion progressed from the acceleration phase to the release phase. The active contraction with forearm pronation and wrist palmar flexion, combined with extension at the elbow, results in an eccentric load being applied to the flexor pronator mass. The additional concern of valgus stress being applied with the throwing mechanism simply exacerbates this mechanical predisposition to overload of the flexor pronator mass.     

Nerve injuries in the throwing elbow

The unique anatomy of the elbow combined with the angular velocity and stresses placed across this hinge joint while throwing can cause a large number of pathologic changes associated with nerves. Although the ulnar nerve is the most commonly injured, neuropathies are also seen with the branches of the median and radial nerves. These neuropathies are typically responsive to rest, activity modification, ice, splinting, and anti-inflammatories. A graduated return to throwing is then needed before returning to play. When conservative measures fail, surgical decompression is warranted, but results have been less than perfect.     

Acromioclavicular injuries in the throwing athlete

Acromioclavicular injuries in the overhead or throwing athlete are frequently encountered by team physicians. Treatment regimens vary greatly, depending on dominant versus nondominant arm, injury in-season or out-of-season, and the athlete's goals for future seasons. This article focuses on each of these unique issues with regards to acromioclavicular separations and fractures, acromioclavicular arthritis, and acromioclavicular osteolysis.     

Shoulder injuries in the throwing athlete

Shoulder injuries in the throwing athlete are becoming more frequent. Sports specialization at a younger age, playing multiple seasons, increased awareness of injury and injury prevention, advances in diagnosis, and surgical treatment all play a part in the increase in diagnosis of these injuries. Understanding the biomechanics of throwing and pathologies that are encountered in the throwing athlete can aid the clinician in successful diagnosis and nonoperative/operative treatment of the throwing athlete. This article discusses the relevant anatomy, biomechanics, and pathoanatomy of the throwing shoulder. Additionally, understanding the kinetic chain can assist in the nonoperative rehabilitation of the injured shoulder. Surgical reconstruction is indicated when nonoperative efforts have been exhausted and is directed based on the extent of the pathology to the capsuloligamentous structures, labrum, and rotator cuff.