胫骨应力骨折形成的力学分析

THE FORMATION OF TIBIAL STRESS FRACTURE: A Mechanical Analysis

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 ,该部位与股骨纵轴延长线相交 ,提示膝关节正常轻微外翻可能与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 ,可能与胫骨应力骨折的发生有关。另外 ,胫骨中上段是松质骨与皮质骨的移行部位 ,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。

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.