STRESS-FRACTURES IN THE ATHLETE - DIAGNOSIS AND MANAGEMENT
STRESS-FRACTURES IN THE ATHLETE - DIAGNOSIS AND MANAGEMENT
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DOI：
10.2165/00007256-199214050-00005
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发表时间：
1992-11-01
期刊：
影响因子：
9.8
通讯作者：
WEBB, R
中科院分区：
文献类型：
--
作者：
STERLING, JC;EDELSTEIN, DW;WEBB, R
应力性骨折对于运动医学临床医生来说是一种棘手的损伤。第一次描述是在军事人员，但最近有一个越来越多的认识和诊断应力性骨折的运动人口。应力性骨折在四肢均有描述。有些骨折似乎有一定程度的运动特异性。骨是一种动态的组织，其响应于应力而增强和重塑。对应力的适应不良导致骨细胞活性取代成骨细胞活性，从而使骨变弱。这些弱化的区域可能会骨折并产生前驱症状和临床表现。与活动相关的潜伏发作的局部疼痛是临床史上的标志。体格检查可显示局部压痛、发红和肿胀。X光片可以阴性长达4个月。诊断的金标准是三相锝-99m骨扫描。应力性骨折的治疗通常是保守的。极少数病例需要手术治疗。保守治疗的算法包括：休息，适当的治疗和预防护理教育，止痛剂，系列X光片，冰敷和物理治疗方式，适当的运动，以防止停止训练，康复和有计划的返回参与和竞争。
Stress fractures can be a troublesome injury for the sports medicine clinician. The first description was in military personnel, but recently there is an increasing awareness and diagnosis of stress fractures in the athletic population. Stress fractures have been described in all extremities. Some fractures appear to have a degree of sports specificity. Bone is a dynamic tissue which strengthens and remodels in response to stress. Maladaptation to stress causes osteoclastic activity to supersede osteoblastic activity, thereby allowing weakening of the bone. These areas of weakening may fracture and create prodromal symptoms and clinical findings. Localised pains of insidious onset which are activity related are the hallmarks in the clinical history. The physical examination can exhibit localised tenderness, redness and swelling. Radiographs can be negative for up to 4 months. The gold standard for diagnosis is the triple phase technetium-99m bone scan. The treatment of a stress fracture is usually conservative. Very few cases require surgical management. The algorithm of conservative management includes: rest, appropriate education for treatment and preventive care, analgesics, serial radiographs, icing and physical therapy modalities, appropriate exercise to prevent detraining, rehabilitation and a regimented return to participation and competition.