训练致青年腰椎峡部裂的病因分析

Etiological analysis of lumbar spondylolysis related to training in young people

目的调查分析训练伤导致的腰椎峡部裂的发生原因,为降低腰椎峡部裂发生率提供理论依据。方法对2016年1月—2021年3月解放军总医院第七医学中心收治的因训练导致腰椎峡部裂的234例患者进行问卷调查,记录患者身高、体质量、日常训练项目、训练强度、受伤时姿势、受伤时从事的训练项目、骨折部位等资料,并进行统计学分析,总结腰椎峡部裂的好发部位、危险因素等。结果训练导致的腰椎峡部裂好发于L5(发生率为85.0%),发生率显著高于L3、L4,差异均有统计学意义(P<0.05)。负重行进和负重蹲起造成腰椎峡部裂的发生率显著升高。受伤瞬间腰部姿势:后伸102例(43.6%),前屈49例(20.9%),旋转39例(16.7%),侧曲12例(5.1%),不确定32例(13.7%),训练中腰椎在后伸状态下更容易发生峡部裂。结论腰椎在后伸状态下峡部剪切力增大,负重会造成峡部剪切力进一步增大而导致骨折,负重行进及负重蹲起是最易造成腰椎峡部裂的训练项目。

Objective To investigate possible risk factors of lumbar spondylolysis related to training in young people,so as to reduce the incidence of lumbar spondylolysis.Methods A questionnaire survey was conducted in 234 young patients with lumbar spondylolysis admitted in Seventh Medical Center affiliated to China PLA General Hospital from January 2016 to March 2021.Data collection was performed in all the patients including height,body mass,training items,training intensity,posture at the moment of injury,training items at the time of injury and fracture site.Statistical analysis was carried out to summarize the predilection site and possible risk factors of lumbar spondylolysis.Results The predilection site of lumbar spondylolysis related to training was at L5,incidence rate was 85.0%,which was significantly higher than that of L3,L4(P<0.05).The incidence of lumbar spondylolysis caused by weight bearing walking and weight bearing squatting increased significantly.Posture at the moment of injury:extension in 102 cases(43.6%),flexion in 49(20.9%),rotation in 39(16.7%),lateral bending in 12(5.1%)and uncertain in 32(13.7%).During training,lumbar spondylolysis was more likely to occur in the state of extension.Conclusions When lumbar extension,the force in isthmus increases,and the weight-bearing will cause the force further increase,leading to fracture.Weight-bearing walking and weight-bearing squatting are the training items most likely to cause lumbar spondylolysis.