投掷损伤

在军事训练中，投弹是基础训练项目之一。随着部队新训练大纲的实施，对投弹训练的要求有所调整，但在训练中，尤其是新兵训练中，肱骨骨折等投掷损伤仍时有发生，而此类损伤与一般骨与关节损伤的防治原则有所不同。因此，了解和掌握投掷损伤的发生机制和防治原则，对预防训练伤的发生、保证部队正常训练具有重要意义。     

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     

投弹的运动学分析和投弹骨折的预防

目的从运动学角度分析投弹运动的基本规律,探讨发生肱骨螺旋形骨折的力学机制和预防要点。方法训练现场测试采用常速摄像机定点、定焦,正侧面拍摄30名士兵的投弹动作,采用爱捷人体解析系统处理;6名士兵在肢体14个相关点贴敷反光标记,在实验室进一步测试,采用运动分析仪测定投弹运动全过程的姿态及各关节点速度峰值时的手臂角、肩臂角、躯干上臂夹角等,数据处理用Kintrak软件完成。结果30名士兵弹体最大和最小出手速度分别为14.776～9.285m/s[(12.23±1.36)m/s];并给出了肩、肘、腕速度峰值的两类情况。记录了从引臂-加速-投弹出手的运动全过程,腕关节加速度最大时和前臂与X方向夹角加速度最大时,躯干上臂夹角均值分别为90.2°、99.1°,而此时手臂角均值分别为80.2°、95.2°,肩臂角均在160°。结论投弹应以肩关节为主要转动中心,上臂带动前臂从肩上方运动,速度由肩-肘-腕依次达到最大值,既可得到最大出手速度,也可避免不必要的损伤。投掷臂从肩侧“撇弹”是易发肱骨骨折的危险动作,应特别强调加以避免。     

投弹骨折的防与治

<正>投弹骨折又称投掷骨折,是指投弹训练中直接由投弹所造成的骨折,具体地讲,就是投弹所引起的肱骨骨折。一般分两种:一种是反复应力作用引起的肱骨干骨折,骨干完全折断,占75%左右,多发生于中下1/3交界处,合并桡神经损伤者亦非罕见,此类损伤多先有局部肿痛、骨内压增高等症状,然后有小的骨裂,最后形成完全骨折,故也称     

投掷伤48例致伤机理分析

投掷伤主要包括:肱骨中下段螺旋形骨折、肩关节脱位、臂丛神经牵拉伤。其中尤以投掷骨折合并挠神经损伤最为严重。投掷是部队训练的固定科目,投掷伤是部队最常见的训练伤之一。如何减少或避免投掷伤的发生应受到部队基层官兵和医护人员的重视。现将我院1990年3月～1996年3月收治的48例投掷伤分析报告如下。     

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…     

训练致内收肌断裂二例报告

行军训练发生疲劳骨折,投弹致肱骨骨折及肌腱牵拉伤较为常见。训练中发生大腿内收肌断裂则殊为罕见,现将我院收治二例报告如下: 例1男、26岁,早操时未活动肢体,练搏击拳时左下肢极度外展拉伤,大腿内侧肿胀,     

科学施训防止新兵训练伤

新兵集训期间是训练伤的高发期,新兵训练伤的发生存在着复杂的内在和外在因素。比如:有的新战士年轻气盛,担心训练成绩差会让人瞧不起,于是在训练中便不顾自身实际,一味硬拼,结果往往会由于训练强度超过了自身的承受极限而导致训练伤的发生;有的新战士对高难度的训练课目缺乏足够的心理准备,训练过程中思想过度紧张、恐惧,也极易导致训练伤的发生;有的新战士由于动作要领掌握不当,完成任务困难,甚至动作变形,从而导致训练伤的发生;有的施训者在组织训练的过程中,随意性比较大,训前没有制定科学的训练计划,训练时想训什么就训什么,极易使新战…     

让伞花“无伤”开放

正伞兵是各国军事力量的重要的组成部分,具有机动性和突破性强等特点,在现代战争中占有重要地位。因此,了解跳伞训练伤并制定相应的预防措施具有重要意义。军事跳伞训练伤的主要类型根据训练的不同阶段,军事跳伞训练伤可分为地面动作训练伤和伞降训练伤,而伞降训练伤又可分为开伞伤、坠落伤和着陆伤三大类。有研究报道,地面动作训练伤主要发生在踝、腰、小腿     

投弹致肱骨骨折8例

1991年5月～1992年7月,我们收治因投弹训练不当,引起肱骨骨折8例,现报告如下。 1 临床资料本组8例,均为男性,年龄19～28岁;战士7例,干部1例;右侧7例,左侧1例。入伍后第一次投弹引起7例,其中3年后再次投弹又致骨折1例;动作要领未掌握4例,过度疲劳2例,准备不充分1     

64例脑外伤死亡CT回顾分析

目的:就64例脑外伤致死的CT资料,研究其外伤类型的CT征像。以提高脑外伤的CT诊断水平,探讨提示预后不良的主要类型和CT特点,以指导临床治疗。材料与方法:回顾分析64例脑外伤死亡病例的CT资料,按其具有若干种损伤分类统计,并就各种损伤表现作一总结。结果:单一损伤4例,两种损伤同时存在10例,三种损伤同时存在36例,四种以上损伤14例。结论:多种复合颅脑损伤是最常见的死亡原因,而单一损伤中弥漫性脑轴索损伤(DAI),原发全脑室出血是致死的主要原因。复合损伤中,广泛硬膜下血肿、半球脑肿胀、脑干损伤更具危险性。病灶大小和占位效应与预后有明显关系。CT检查及随访可客观反映颅脑损伤的严重程度、动态观察病情变化,为临床诊断和治疗提供可靠依据。     

Soft tissue coverage using pedicled flap in combat zone:A case series

Background:Soft tissue reconstruction is typically conducted after evacuation from theater of operations.If circumstances do not allow timely evacuation,however,defect site may need to be reconstructed in the combat zone.Case presentation:A total of 41 patients with extremity soft tissue defect were treated using pedicled flaps by a single orthopedic surgeon during four deployments in Chad,Afghanistan and Mali between 2010 and 2017.The mean age was 25.6 years.A total of 46 injury sites in extremities required flap coverage:19 combat-related injuries (CRIs)and 27 non-combat related injuries (NCRIs).Twenty of the injury sites were infected.Overall,63 pedicled flap transfers were carried out:15 muscle flaps,35 local fasciocutaneous flaps and 13 distant fasciocutaneous flaps.The flap types used did not differ for CRIs or NCRIs.Mean follow-up was 71 days.Complications included deep infection (n=6),flap failure (n=1) and partial flap necrosis (n=1).Limb salvage rate was 92.7％ (38/41).Conclusions:Soft tissue defect can be managed with simple pedicled flaps in theatre of operations if needed.Basic reconstructive procedures should be part of the training for military orthopedic surgeons.Trial registration:Retrospectively registered in January2019 (2019-0901-001).     

不同兵种训练伤流行病学调查

目的：了解步兵、炮兵和特训兵三兵种平时训练伤流行病学特征,为防治伤病提供科学依据。方法：参照《中国人民解放军军事训练伤诊断分类标准》,对1 613例训练伤从兵种、年龄、损伤时间、损伤部位及性质进行比较分析。结果：①步兵年均训练伤发生率为4.9%,炮兵2.5%,特训兵5.2%,步兵、特训兵与炮兵比较,差异显著（P〈0.05）;②全年训练伤发病率以7月份最高;③发生于18～22岁组的训练伤为59.5%,高于其他年龄组;④急性创伤性损伤以骨折多见,慢性疲劳性损伤以腰部劳损多见,训练伤发生率步兵、特训兵以下肢损伤最高,炮兵以腰部损伤最高。结论：步兵和特训兵比炮兵更易发生训练损伤,三兵种的慢性疲劳性损伤发生率均高于急性损伤。     

四肢软组织损伤的评估与治疗

软组织损伤通常是指皮肤、皮下组织、筋膜、肌肉、肌腱、韧带、滑膜、关节囊等软组织及周围神经、血管的损伤。四肢软组织损伤在临床工作中常会遇到,处理不当会使治疗周期大大延长,增加致残率和病死率,降低患者生活质量,对患者和社会造成严重影响。对软组织损伤严重性的评估,不仅是对患者整体评价的一个重要组成部分,而且也影响着骨折的处理。随着科技的迅速发展和机械化程度的不断提高,使得机械化因素在各类致伤因素中成为主要因素,尤其是交通事故等引起的各类高能量损伤,往往都是多发伤,伤情大多较严重。因此,充分认识软组织的损伤程度并正确处理,是创伤和骨折得以有效治疗的基础。     

Epidemiology of musculoskeletal and soft tissue injuries aboard a U.S. Navy ship

OBJECTIVE: The objective of this study was to characterize injuries occurring to crew members aboard a U.S. Navy ship. METHODS: A retrospective review of crew member medical records was conducted covering a 90-day period during which the ship was intermittently at sea. Data on new injuries were collected and sorted. Injuries were classified as soft tissue or musculoskeletal, acute or overuse, and occurring with the ship at sea or in port. RESULTS: There was a total incidence of 16.5 injuries per 100 man-months. Acute musculoskeletal injuries contributed 2.6 injuries per 100 man-months and resulted in 79 lost and 192.5 modified work days. Overuse musculoskeletal injuries were responsible for 9.3 injuries per 100 man-months and caused 1 lost and 255.5 modified work days. Soft tissue injuries had an incidence of 4.6 injuries per 100 man-months and resulted in no lost and only 106 modified work days. The relative risk of sustaining a soft tissue injury in port compared with at sea was 1.1, but this was not statistically significant. The relative risk of sustaining an acute musculoskeletal injury in port compared with at sea was 3.5 (p = 0.01). CONCLUSIONS: Overuse musculoskeletal injuries occurred with the greatest incidence, but acute musculoskeletal injuries were responsible for the greatest morbidity. Soft tissue injuries occurred with an intermediate incidence but had the lowest overall morbidity. The safest place for crew members assigned to this Navy ship was aboard that ship at sea. Further studies of this nature could help guide medical efforts at injury treatment and prevention for shipboard personnel.     

Injury and injury rates in Muay Thai kick boxing

OBJECTIVE:To determine the type and number of injuries that occur during the training and practice of Muay Thai kick boxing and to compare the data obtained with those from previous studies of karate and taekwondo. METHODS:One to one interviews using a standard questionnaire on injuries incurred during training and practice of Muay Thai kick boxing were conducted at various gyms and competitions in the United Kingdom and a Muay Thai gala in Holland. RESULTS:A total of 152 people were questioned, 132 men and 20 women. There were 19 beginners, 82 amateurs, and 51 professionals. Injuries to the lower extremities were the most common in all groups. Head injuries were the second most common in professionals and amateurs. Trunk injuries were the next most common in beginners. The difference in injury distribution among the three groups was significant (p< or =0.01). Soft tissue trauma was the most common type of injury in the three groups. Fractures were the second most common in professionals, and in amateurs and beginners it was sprains and strains (p< or =0.05). Annual injury rates were: beginners, 13.5/1000 participants; amateurs, 2.43/1000 participants; professionals, 2.79/1000 participants. For beginners, 7% of injuries resulted in seven or more days off training; for amateurs and professionals, these values were 4% and 5.8% respectively. CONCLUSIONS:The results are similar to those found for karate and taekwondo with regard to injury distribution, type, and rate. The percentage of injuries resulting in time off training is less.     

The importance of soft tissues in certain skeletal traumatic lesions

Soft tissue aspects of skeletal trauma are discussed according to two categories: (1) those injuries in which the significance of the soft tissue in the pathophysiology of the skeletal lesion is indicated by the characteristics of the skeletal injury (such as extension teardrop fracture, little leaguer's elbow, "baseball fracture," and Bennett's fracture); and (2) those injuries in which the associated soft tissue injury, or complication, may be reasonably inferred by the location and nature of the skeletal injury (such as major facial fractures, posterior sternoclavicular dislocations, fractures of the lower rib and lumbar transverse processes, and pelvic disruptions).     

How evidence based is the management of two common sports injuries in a sports injury clinic?

Objectives: To examine the diagnosis and management of adults attending a sports injury clinic, to establish to what extent the management of the two most common injuries treated at this clinic is evidence based, and to explore factors that affect management. Methods: A retrospective examination of 100 random case notes extracted age, sex, sport, type and site of injury, treatment, and outcome. Systematic literature reviews examined the extent and quality of scientific evidence for the management of the two most commonly presenting injuries. A clinical attachment period and practitioner interviews allowed recognition of factors impinging on management decisions. Results: Patellofemoral pain syndrome (PFPS; 10% of all injuries) and Achilles tendinopathy (6% of all injuries) were the most commonly presenting injuries. The mean (SD) number of treatments used for PFPS was 2.8 (0.9). The mean number of treatments used for Achilles tendinopathy was 3.7 (1.0). Clinicians reported that personal experience formed the basis of management plans in 44% of PFPS cases and 59% of Achilles tendinopathy cases, and that primary research evidence only accounted for 24% of management plans in PFPS and 14% in Achilles tendinopathy. Practitioners were unaware of literature supporting over 50% of the treatment modalities they used. However, clinicians were often using evidence based treatments, unaware of the supporting research data. Conclusions: This study highlights a lack of evidence base, a lack of knowledge of the research evidence, and a lack of management based on the current evidence that is available for these conditions. Practitioners practised evidence based medicine in under 50% of cases.     

交通事故致肢体严重挤压伤的临床诊治分析

目的 研究交通事故所致肢体挤压伤的临床特点及治疗方法.方法 利用创伤数据库采集分析我院自2003年1月～2008年1月收治的交通伤病人诊治信息,统计分析其中挤压伤的发生特点、临床特点、救治方法与结果等.结果 5年共收治交通伤2845例,肢体挤压伤82例,其中青壮年77例,占93.90%;发生部位分别为:小腿39例(47...     

锁骨下血管损伤的救治

目的 探讨锁骨下血管损伤的有效治疗方法。方法 对15例锁骨下血管损伤的救治进行回顾性分析,本组6例行血管修补,3例行人造血管移植,2例行大隐静脉桥接,1例行直接端一端吻合。结果 手术修复成功12例,静脉修复后均无明显肢体肿胀,动脉修复术后1年随访,均可清晰地触及桡动脉搏动。其中2例并发臂丛神经损伤,术后1年随访未完全恢复。死亡3例。结论 对锁骨下血管损伤应做到诊断迅速,快速有效止血,及时补充血容量和纠正休克。手术修复应根据具体情况选择适当切口,严格遵循显微外科技术,针对不同的情况选择血管吻合、修补、自体静脉或人造血管移植。