军训中下肢应力骨折的机理与防治──附生物力学分析

THE MECHANISM AND MANAGEMENT OF STRESS FRACTURES OF LOWER EXTREMITY OCCURED IN MILITARY TRAINING-CLINICAL INVESTIGATION AND BIOMECHANICS ANALYSIS

作者自１９９１年４月至１９９５年２月共治疗股骨干应力骨折８例，胫骨干应力骨折９６例。经临床观察研究，并从解剖和生物力学角度探讨了骨折发生的机理。认为下肢应力骨折是由于骨本身的结构不能适应训练时应力的变化所致。当骨结构的破坏超过了骨的塑形能力时，便导致应力骨折。由于解剖上的因素，股骨中下段和胫骨内侧中段在运动时是受力的薄弱点，是骨折的好发部位。预防的办法是安排训练计划时，应考虑到骨的塑形能力，而不是仅考虑肌肉的适应程度。以８周一个层次进行，跑步训练初期以慢跑为主，可减少股骨的倾斜度，减轻股骨中下段弯矩和剪应力的影响。

From April 1991 to Feburary 1995, 104 cases of stress fractures of lower extremities (8 cases involved femur; the other 96 cases, tibia) were treated in our hospital. The niechanism of this kind of fracture was explored by clinical observation, anatomic investigation and biomechanical analysis. It was found that the main cause of stress fracture of lower extremity was the bony intrinsic construction failed to adapt to the stress varying during the training course. When the destruction of bony structure was in excess of the remodeling capacity of the bone, the stress fracture was resulted.Owning to the anatomic characteristics, the distal one-third of femur and the middle medical aspect of tibia were the significant weak points in leg movement, and then they become the common site of stress fracture. For the prevention of these fracture, the remodeling capacity of the bone must be considered, instead of keeping the muscular adaption in the mind only in the training course arrangment. Slow running will reduce the femoral inclination and then decrease the shearing force.