胫骨应力骨折形成力学分析.docVIP

胫骨应力骨折形成力学分析 胫骨应力骨折形成的力学分析 更新日期：2009-07-13 点击： 丁志强　张伟　郑洪涛 提要　总结了30例胫骨应力骨折病人的临床资料，发现新兵训练所致的胫骨应力骨折均发生在大负 荷训练后，其正位X线片特点为骨折多发生在胫骨中上1/3内侧皮质，该部位和股骨纵轴延长 线相交，提示膝关节正常轻微外翻可能和胫骨应力骨折的发生有关。由股骨纵轴下传给胫 骨中上段内侧皮质的力可分解成两个力，一个是沿胫骨纵轴下传的力，另一个是使胫骨向内 移动的水平剪力，剪力的长期累加，可能和胫骨应力骨折的发生有关。另外，胫骨 中上段是松质骨和皮质骨的移行部位，该部位特有的骨组织解剖结构可能是胫骨相对薄弱的原因。 主题词　胫骨/应力骨折　力学/分析　临床研究 中国分类号：R683.42　文献标识码：A　文章编号：1001-6015(2000)04-0015-02 THE FORMATION OF TIBIAL STRESS FRACTURE: A Mechanical Analysis Ding Zhiqiang，Zhang Wei，and Zheng Hongtao Nanjiang Branch of Xinjiang General-Unit Hospital, PLA Armed Police Troops, Kashi 844000 Through summing up the clinical data of 30 cases of tibial stress fracture, it was found that all of tibial stress fractures resulting from recruit training occurred after large-load training. The anteroposterior X-ray films showed that most of the fracture sites were located in the medial bone cortix of the middle or upper third tibia, which crosses with the extended line of the femoral longitudinal axis, suggesting that tibial stress fracture may be related to the normal slight valgus of the knee. The forces that travel down from the femoral longitudinal axis to the medial bone cortex of the middle or upper tibia may be divided into two forces, one of which travels down along the tibial longitudinal axis and the other is a horizontal shear that moves the tibia inward. The long-term accumulation of the shear may be related to the occurrence of tibial stress fracture. In addition, the upper and middle tibia is the transitional zone of the cancellous and cortical bones, which may be a relative weak and thin site of the tibia with its special anatomical structure. Key Words:　tibia/stress fracture　mechanics/analysis　clinical study 　　胫骨应力骨折是新兵训练时较为常见的疾病，我院在1985年6月～1998年12月共收治胫骨应力骨折病人30例32条胫骨，通过治疗及复查随访，我们体会到胫骨应力骨折的发生及X线表现均有其特点。现总结报告如下。 1　临床资料 1.1　一般资料　本组病例均为男性战士，年龄17～23岁，平均19.2岁，左侧12例，右侧20例，双侧2例。 1.2　诊断标准　①病人均在新兵大负荷训练后发病，训练项目为每天5km长跑、跳鞍马及三大步伐。②临床小腿中上段酸痛，停止训练休息后减轻或消失，继续训练后局部疼痛加重，严重者跛行。患肢小腿中上段胫