军事训练伤所致前交叉韧带撕裂情况分析

目的 对军事训练伤所致前交叉韧带撕裂的情况进行调查分析,探讨预防措施。方法 回顾性分析2021-01至2022-12武警浙江总队医院收治的59例军事训练伤致膝关节前交叉韧带撕裂患者的临床及影像学资料,观察前交叉韧带撕裂的MRI表现,分析致伤科目、合并伤情况。结果 致伤科目：木马训练24例(40.68%),400 m障碍训练21例(35.59%),长跑训练5例(8.47%),球类运动5例(8.47%),器械训练2例(3.39%),擒敌对抗1例(1.69%),攀登训练1例(1.69%)。MRI图像前交叉韧带撕裂表现为韧带肿胀、信号增高、纤维连续性中断、附着端回缩、胫骨前移等改变,同时伴有半月板损伤、骨折及内外侧副韧带损伤的发生。其中,木马训练组骨折发生率、内外侧副韧带损伤率均高于障碍训练组与其他训练组,差异有统计学意义(P<0.05)。木马训练组合并伤最重,较易发生3种合并伤,即前交叉韧带合并骨折、半月板损伤及内外侧副韧带损伤;障碍训练组合并伤次之。结论 官兵应加深对木马训练与400 m障碍训练的认识,采用循序渐进的训练方式,日常强化膝关节周围肌肉训练,合理设置场地,减少前交叉韧带撕...     

军训致膝前交叉韧带损伤的流行病学研究

 目的 分析武警军事训练中前交叉韧带(anterior cruciate ligament,ACL)损伤的流行病学特点,进而指导军事训练,做好预防、诊断、治疗工作.方法 回顾性研究2003-01至2010-06在我科住院治疗的ACL损伤部队患者153例(93膝),对损伤发生率、好发项目、损伤原因及机制、治疗方法等进行统计分析.结果在400 m障碍训练中发生率最高,其次为篮球、擒拿格斗训练;并且反复受伤为特点.结论 为减轻及预防ACL,应提高对本病的认识,避免反复、疲劳训练,ACL重建术应在伤后3个月内进行.     

关节镜治疗膝关节军事训练损伤418例临床分析

目的通过对418例膝关节军事训练损伤患者利用膝关节镜检查、治疗的结果进行分析,指导膝部军事训练损伤的及时诊断及治疗。方法回顾性分析2001年7月—2010年6月行膝关节镜检查治疗的现役军人伤病员共418例,其中男性412例,女性6例;年龄18~36岁,平均21.6岁。受伤原因:行军、越野跑、跨越障碍等损伤289例;器械训练、投弹训练、摔跤、足球、篮球运动等损伤116例;驾驶训练损伤13例。损伤类型:半月板损伤211例,前交叉韧带(ACL)损伤128例,后交叉韧带(PCL)损伤12例,多发韧带损伤22例,膝关节创伤性滑膜炎45例。分析关节镜下所见损伤的种类及治疗效果。结果关节镜下可见418例中前交叉韧带、后交叉韧带损伤及多发韧带损伤共计160例,半月板损伤211例,膝关节滑膜炎45例。术后95%以上病例功能恢复满意,无行走疼痛。结论军事训练致膝关节损伤常见,关节镜明确诊断并及时治疗,可最大限度地避免关节内结构的继发损伤。     

30例冬季项目运动员前交叉韧带损伤的临床表现特点

目的:研究我国冬季项目运动员前交叉韧带(ACL)损伤的临床表现特点,并提出了防治原则。方法:选取北京大学第三医院运动医学研究所2010年1月1日至2017年12月31日住院治疗的30例冬季项目运动员前交叉韧带损伤病例作为研究对象。查阅既往电子病历,记录研究对象的基本信息和病史,包括受伤情况、初次医疗处理情况和症状体征。查阅患者受伤后患膝MRI,评估患者受伤情况与合并损伤。查阅患者手术记录,结合术中关节镜录像评估患者合并损伤并确认手术方式。结果:30例前交叉韧带损伤病例,年龄19.76±4.06岁,其中女性病例20例。30例前交叉韧带损伤病例中有17例(56.7%)初诊诊断正确,另外13例并未诊断出ACL损伤。前交叉韧带损伤合并关节内其他结构损伤20例,占66.7%。前交叉韧带损伤合并外侧半月板损伤病例的手术间隔时间明显短于合并内侧半月板损伤的病例(P=0.032)。初次受伤到手术的时间间隔范围是8天～1000天,平均170.70±251.36天。30例前交叉韧带损伤病例术后均恢复原有运动水平,取得了良好的运动成绩。结论:冬季项目运动员前交叉韧带损伤多合并膝关节其它结构损伤,具有较高的危...     

膝关节韧带损伤的预防

正膝韧带损伤是一种常见的军事伤,在进行大强度训练特别是在400米障碍训练时,如果韧带受到的牵拉力超过其耐受值时,即会发生韧带损伤。膝韧带损伤发生后表现为局部肿痛、压痛或关节不稳定,向暴力方向牵拉时疼痛加剧。如果治疗不当,有可能发生不稳定或创伤性关节炎。发生膝关节损伤后,要迅速明确诊断,早期处理,全面修复。一部分损伤可直接修复,严重者需以临近的肌腱、筋腱等组织转移修复。常见原因在基层营连训练中,400米障碍、轻装5公     

经关节镜自体骨-髌腱-骨移植重建膝前交叉韧带21例

自 1997年 4月以来 ,笔者采用自体中 1/ 3髌韧带骨 -髌韧带 -骨 (ｂｏｎｅ -ｐａｔｅｌｌａｒｔｅｎｄｏｎ -ｂｏｎｅ ,ＢＰＢ)移植物经关节镜重建膝关节前交叉韧带 2 1例 ,取得了良好的疗效。现报告如下。临　床　资　料1.一般资料 :本组共 2 1例 ,男 10例 ,女 11例 ;年龄 16～ 35岁。左膝 8例 ,右膝 13例。运动损伤 16例 ,交通伤 5例。受伤至接受手术时间 2个月～ 5年。所有患者均存在明显关节不稳定症状 ,单纯前交叉韧带损伤 6例 ,合并外侧半月板损伤 5例 ,内侧半月板损伤 3例 ,双侧半月板损伤损伤 2例 ,内侧副韧带损伤 4例 ,后外侧复合…     

Leeds-Keio人工韧带辅助自体髌腱(中1/3)移植重建前交叉韧带

目的:临床应用Leeds-Keio人工韧带辅助自体髌腱(中1/3)移植重建前交叉韧带,治疗前交叉韧带断裂,并观察其临床效果.方法:1995年10月至1998年2月间,应用Leeds-Keio人工韧带辅助自体骨-髌腱(中1/3)-骨-髌前筋膜-股四头肌腱瓣重建前交叉韧带32例.术后实施积极的康复训练.结果:术后随访26例、7～9年(平均8年),Lysholm功能评分由术前平均67分提高到术后平均87分,Noyes功能评分由术前平均147分提高到术后平均230分,患者对手术的主观评价满意度平均为86%(70～99%).运动员患者术后第6个月恢复正式训练、比赛.16例术后(平均20个月)在行内固定物取出时进行了关节镜检查,重建韧带外形及张力良好.术后再伤导致人工韧带断裂1例,1例出现明显异物反应取出人工韧带.结论:应用Leeds-Keio人工韧带辅助自体髌腱(中1/3)重建前交叉韧带的临床治疗效果满意,术后可采用快速康复程序,康复快,运动员患者术后早期即可恢复训练与比赛.提示应用Leeds-Keio人工韧带辅助自体髌腱(中1/3)移植重建前交叉韧带可行,适合复合韧带损伤患者和期望迅速恢复运动训练的运动员.     

装甲步兵某部春训期间训练科目与训练伤的分布调查分析

目的探讨装甲步兵在春季共同科目训练期间,训练科目与训练伤之间关系和分布特征。方法由驻军医院骨科医师和部队医务人员组成训练伤调查医疗组,采取逐一询问,以及查阅训练期间营、团卫生部门医疗登记。结果春训期间训练伤共发生78例,占参训人员的5·7%,400m障碍和5km越野发生训练伤占48·7%和39·7%。结论装甲步兵春训期间,在训练科目中400m障碍和5km越野发生训练伤率高,训练伤种类以四肢关节损伤和疲劳性骨折发生率高。     

膝关节前交叉韧带损伤的应用解剖及防治

目的控讨空降兵膝关节前交叉韧带损伤的机制,寻求防治的方法。方法测量正常国人标本股骨髁间窝横、纵径及其相关值;建立生物力学模型,模拟膝关节伸直前交叉韧带及其重建韧带的损伤机制;强化腘绳肌、腓肠肌肌力训练;开展髁间窝扩大成形术。结果临床应用29例中随访1年以上者20例,无1例出现重建韧带撞击现象,膝关节稳定性能良好。髁间窝扩大成形后,重建韧带撞击现象消失。强化腘绳肌、腓肠肌训练方法运用于我院空降医疗队伞训中,无1例出现膝关节前交叉韧带损伤。结论正常髁间窝相关值可能为空降兵筛选体检及髁间窝扩大成形术提供参考指标;髁间窝扩大成形能有效预防重建韧带撞击现象,替代前交叉韧带的功能;加强腘绳肌、腓肠肌肌力训练,强化其与前交叉韧带协同作用,是预防前交叉韧带损伤的有效措施。     

探讨半月板边缘部垂直撕裂与前交叉韧带损伤的关系

目的 探讨半月板边缘部垂直撕裂对诊断前交叉韧带(ACL)损伤的价值.方法 回顾性分析经关节镜证实的149例半月板撕裂的膝关节MRI结果,判断半月板撕裂的形态、位置以及前交叉韧带的情况.结果 149例半月板撕裂膝关节中,34个膝关节共36个半月板撕裂(其中2个膝关节内、外侧半月板同时撕裂),MRI显示为半月板边缘部垂直撕裂类型,其中29个膝关节同时伴有前交叉韧带损伤.其余115个膝关节,MRI显示为其他半月板撕裂类型,其中49例膝关节同时伴有前交叉韧带损伤.膝关节半月板边缘部垂直撕裂类型与其他的半月板撕裂类型比较,其合并前交叉韧带损伤的发生率分别为85.3%及42.6%,两者间具有显著性差异(χ2=19.2,P＜0.01).半月板边缘部垂直撕裂提示膝关节前交叉韧带损伤的敏感性、特异性和阳性似然比分别为37.2%、93.0%和5.3.结论半月板边缘部垂直撕裂大部分合并有ACL损伤.     

武警某队属医院收治的骨关节训练伤特点及膝关节损伤的危险因素

目的 探讨武警某队属医院收治的骨关节训练伤特点及膝关节损伤的危险因素。方法 收集2020年1-12月因骨关节军事训练伤在武警湖北总队医院骨科住院治疗官兵的病例资料,通过统计骨关节训练伤种类、构成比及受伤训练科目与时间来分析骨关节训练伤的特点。采用回顾性病例对照研究的设计,以分层整群抽样的方式在全总队范围抽取83名发生过膝关节损伤的官兵为损伤组,91名从未发生膝关节损伤的官兵作为未损伤组,向两组受试对象发放问卷,通过问卷设置一般情况、行为习惯、身体素质、训练运动量、主观情绪、社会认知6个维度共20个问题,对问卷内容采用单因素分析和二元Logistic回归分析以探索膝关节损伤的相关危险因素。结果 (1)2020年,武警湖北总队医院共收治骨关节训练伤住院病例155例,含12类疾病诊断,其中膝关节损伤在骨关节训练伤疾病谱系中占比最高,400m障碍是最常导致骨关节损伤的训练科目,1-3月及7-9月为骨关节训练伤发病的高峰期。(2)膝关节损伤的单因素分析显示,损伤组的行中、大强度训练量与消极情绪人数占比高于未损伤组(P<0.05);与损伤组相比,未损伤组中有饮茶习惯的人数占比较高(P<...     

武警某寒区部队军事训练伤情况调查

 目的 对武警驻寒冷地区基层部队执勤战士的训练伤情况进行调查,结合其执勤任务特点为下一步提出合理化预防措施提供理论指导。方法 采用问卷调查法与查阅相关病例资料相结合的方法观察2017年入伍战士服役期间训练伤分布情况并进行描述。结果 武警某寒区部队战士新训期间、服役1年及服役2年时训练伤发生率差异无统计学意义(χ²=4.52,P=0.10)。新训期间的训练伤类型87.3%为急性损伤,损伤部位以下肢为主;服役1年与服役2年战斗班战士的训练伤类型以慢性损伤为主,分别为55.9%和64.3%,损伤部位第一位为腰部,其次为膝部。2年内不同班别训练伤的发生率,战斗班远高于后勤班(χ²=8.12,P=0.04)、(χ²=14.40,P=0.00)。训练伤程度总了解率为14.2%,其中患有训练伤战士对训练伤了解率高于未患有训练伤的战士,差异有统计学意义 (χ²=347.09,P=0.00)。服役1年或服役2年时,训练伤发生时间均集中在冬季,主要原因与对训练伤相关知识掌握不充分相关。结论 战士们在服役期间会出现不同心理状态及不同类型训练伤,积极做好卫生宣讲和疏导工作并及时调整训练内容或训练强度,在一定程度上能够降低训练伤的发生率。     

A randomized trial of preexercise stretching for prevention of lower-limb injury

PURPOSE: This study investigated the effect of muscle stretching during warm-up on the risk of exercise-related injury. METHODS: 1538 male army recruits were randomly allocated to stretch or control groups. During the ensuing 12 wk of training, both groups performed active warm-up exercises before physical training sessions. In addition, the stretch group performed one 20-s static stretch under supervision for each of six major leg muscle groups during every warm-up. The control group did not stretch. RESULTS: 333 lower-limb injuries were recorded during the training period, including 214 soft-tissue injuries. There were 158 injuries in the stretch group and 175 in the control group. There was no significant effect of preexercise stretching on all-injuries risk (hazard ratio [HR] = 0.95, 95% CI 0.77-1.18), soft-tissue injury risk (HR = 0.83, 95% CI 0.63-1.09), or bone injury risk (HR = 1.22, 95% CI 0.86-1.76). Fitness (20-m progressive shuttle run test score), age, and enlistment date all significantly predicted injury risk (P < 0.01 for each), but height, weight, and body mass index did not. CONCLUSION: A typical muscle stretching protocol performed during preexercise warm-ups does not produce clinically meaningful reductions in risk of exercise-related injury in army recruits. Fitness may be an important, modifiable risk factor.     

高频超声测量前交叉韧带厚径与前交叉韧带损伤的相关性

 目的 探讨应用高频超声测量前交叉韧带(anterior cruciate ligament, ACL)厚径与ACL损伤的相关性。方法 选择单侧非接触性ACL损伤现役男性军人患者30例为ACL损伤组,另选择现役男性健康军人30名为对照组。应用高频超声测量ACL胫骨止点端厚径,ACL损伤组检查健侧ACL,对照组检查双侧ACL。对比分析对照组左侧、右侧ACL厚径,再对比分析ACL损伤组健侧、对照组ACL厚径。结果 对照组左侧、右侧ACL厚径分别为(8.11±0.64)mm、(8.03±0.61)mm,差异无统计学意义(P<0.05)。ACL损伤组健侧ACL厚径为(6.25±0.37)mm,小于对照组(8.07±0.61) mm,差异有统计学意义(P<0.05)。结论 ACL厚径小会增加ACL损伤的风险,高频超声测量ACL厚径可作为一项评估ACL损伤风险的筛查指标。     

Incidence of anterior cruciate ligament injury among active duty U.S. military servicemen and servicewomen

Although some studies have reported an increased incidence of anterior cruciate ligament (ACL) injuries in women athletes, little is known about the gender differences in injury patterns in the U.S. military. Using the Defense Medical Epidemiology Database, a search was performed for International Classification of Diseases, 9th Revision (ICD-9) codes 717.83 (old disruption of ACL) and 844.2 (sprain, strain cruciate ligament of the knee) among all servicemen and servicewomen between 1997 and 2003. Multivariate Poisson regression analysis was used to estimate the rate of ACL injuries per 1000 person-years, controlling for age and race, for each ICD-9 code. We computed rate ratios and 95% confidence intervals (CIs) by using male as the reference category. The injury rates for code 717.83 were 3.09 cases per 1,000 person-years for men and 2.29 cases per 1000 person-years for women, controlling for age and race (relative risk, 0.74; 95% CI, 0.71-0.76). The injury rates for ICD-9 code 844.2 were 3.79 cases per 1000 person-years for men and 2.95 cases per 1,000 person-years for women, controlling for age and race (relative risk, 0.78; 95% CI, 0.76-0.80). There was not an observed increase in the incidence of ACL injuries among female soldiers in the U.S. military between 1997 and 2003.     

Benefits of a musculoskeletal screening examination for initial entry training soldiers

Soldiers reporting for Individual Entry Training from basic training posts frequently arrive unable to initiate or complete training due to musculoskeletal injuries. Therefore, a screening examination was developed to identify musculoskeletal injuries and provide appropriate medical intervention as needed. During a consecutive 5-week period, 1013 soldiers reported for training to Fort Lee, Virginia. Of these, 105 (10.4%) reported for medical screening because they stated that they had an injury or could not pass a physical fitness test. After screening, 76 (72%) were found to have physical restrictions that would limit their ability to fully participate in training. The injured soldiers were referred for and received medical intervention. Of the total number of soldiers screened, 97 (92%) were able to complete their training, pass a physical fitness test, and graduate on time. This study documents the use and benefits of a brief musculoskeletal screening examination for individual entry training soldiers.     

前交叉韧带重建军人患者快速康复与传统康复对术后功能恢复的影响

目的 比较快速康复训练与传统康复训练对军人患者前交叉韧带重建术后膝关节功能及运动恢复的影响.方法 回顾性分析2018-06至2019-06在东部战区总医院骨科行关节镜下前交叉韧带重建术的102例军人患者资料,分为快速康复组(51例)和传统康复组(51例).分别记录两组患者术前、术后疼痛视觉模拟量表(VAS)评分、Lys...     

The physical training and rehabilitation program: duration of rehabilitation and final outcome of injuries in basic combat training

During calendar year 1998, 6% (N = 2,010: men [m] = 670, 3%, women [w] = 1,340, 12%) of soldiers in basic combat training at Fort Jackson, South Carolina (N = 32,251), were unable to continue training as a result of a training-related injury. These soldiers were recommended for the Physical Training and Rehabilitation Program (PTRP) for recovery and rehabilitation. Forty-two percent of recommended soldiers were discharged from the Army rather than assigned to PTRP. The 1,164 (m = 356, w = 808) soldiers assigned to PTRP sustained 1,673 injuries (m = 444, w = 1229). Eighty-three percent of the injuries in PTRP were in the overuse (44%) and stress fracture (39%) categories. Of the 1,164 soldiers assigned to PTRP, 52% (m = 214, w = 386) returned to training. The average (+/- SD) length of stay in PTRP for soldiers returning to duty was 62 +/- 42 days (m = 57 +/- 39, w = 65 +/- 43). Rehabilitation challenges and significant motivational issues presumably contributed to the 52% return to duty incidence for PTRP soldiers.     

Anterior cruciate ligament injury in elite football: a prospective three-cohort study

Anterior cruciate ligament (ACL) injury causes long lay-off time and is often complicated with subsequent new knee injury and osteoarthritis. Female gender is associated with an increased ACL injury risk, but few studies have adjusted for gender-related differences in age although female players are often younger when sustaining their ACL injury. The objective of this three-cohort study was to describe ACL injury characteristics in teams from the Swedish men’s and women’s first leagues and from several European men’s professional first leagues. Over a varying number of seasons from 2001 to 2009, 57 clubs (2,329 players) were followed prospectively and during this period 78 ACL injuries occurred (five partial). Mean age at ACL injury was lower in women compared to men (20.6 ± 2.2 vs. 25.2 ± 4.5 years, P = 0.0002). Using a Cox regression, the female-to-male hazard ratio (HR) was 2.6 (95% CI 1.4–4.6) in all three cohorts studied and 2.6 (95% CI 1.3–5.3) in the Swedish cohorts; adjusted for age, the HR was reduced to 2.4 (95% CI 1.3–4.2) and 2.1 (95% CI 1.0–4.2), respectively. Match play was associated with a higher ACL injury risk with a match-to-training ratio of 20.8 (95% CI 12.4–34.8) and 45 ACL injuries (58%) occurred due to non-contact mechanisms. Hamstrings grafts were used more often in Sweden than in Europe (67 vs. 34%, P = 0.028), and there were no differences in time to return to play after ACL reconstruction between the cohorts or different grafts. In conclusion, this study showed that the ACL injury incidence in female elite footballers was more than doubled compared to their male counterparts, but also that they were significantly younger at ACL injury than males. These findings suggest that future preventive research primarily should address the young female football player.     

前交叉韧带损伤的MRI诊断与关节镜下所见的比较研究

目的：探讨MRI对前交叉韧带(ACL)损伤的诊断准确率极其对临床治疗的指导意义。方法：7l例关节镜手术患者术前行MRI检查，根据MRI诊断分为正常、部分损伤和断裂组，将MRI诊断结果与关节镜下所见进行对比。结果：以关节镜下所见为标准，MRI诊断准确率正常组为87．5％(7／8)，部分损伤组为61．9％(13／21)，断裂组为90．5％(38／42)。本组MRI诊断ACL损伤总诊断准确率为95．8％。ACL与胫骨平台夹角小于450和各序列扫描均未见ACL影像为诊断ACL完全断裂的可靠依据。结论：MRI是诊断ACL损伤的有效无创性检查方法，但部分损伤与完全断裂有时难以鉴别，ACL重建术前应常规行关节镜探查。