体育学院学生踝关节扭伤及其相关因素的横断面研究

Crosssectional study on ankle sprain and its related factors in physical education college

目的:调查分析体育学院学生踝关节扭伤的流行情况、风险因素与早期治疗情况,以期获得准确的流行病学资料。方法:自2019年3月至2019年5月对西安体育学院在校大学生展开研究,根据纳排标准共纳入552名(1104侧踝关节)在校体育学院学生,其中男309名,女243名;年龄16~24(20.9±3.7)岁。记录年龄、性别、身体质量指数(body mass index,BMI)等数据。通过自制踝关节扭伤调查问卷表评估体育学院学生急性和陈旧性踝关节扭伤的患病率与发生率,首次扭伤后治疗方案(冷敷、石膏或支具制动和药物)、目前行走时踝关节疼痛视觉模拟评分(visual analogue scale,VAS);采用Cumberland踝关节不稳评分问卷(Cumberland ankle instability tool,CAIT)和Maryland足部功能评分评估踝关节功能。通过踝关节外侧韧带超声检查评估踝关节不稳运动员外侧韧带损伤情况。结果:至少有1次踝关节扭伤的急性踝关节扭伤(acute ankle sprain,AAS)的患病率为96.20%(531/552),AAS的发生率为59.96%(622/1104)。慢性踝关节不稳(chronic ankle instability,CAI)的患病率为16.85%(93/552),CAI的发生率为8.97%(99/1104)。四大类运动中,踝关节扭伤次数比例最高的是表演类专业22.20%(14/63),包括健美操和舞蹈表演;其次为球类专业8.60%(14/163)。首次扭伤后94.4%的学生接受了冷敷治疗,约60%到医院就诊;但是,首次给予规范支具或石膏固定的只有44.7%,给予硬护踝治疗的只有35.3%。扭伤次数≥4次共有44名,总发生率为7.97%(44/552);Cumberland评分为(26.6±2.4)分,扭伤次数<4次的Cumberland评分为(29.2±1.1)分,考虑扭伤次数≥4次是踝关节不稳的1个风险因素。同时,扭伤次数≥4次时,VAS明显高于<4次的评分(P<0.05);Maryland足部功能评分明显低于<4次的评分(P<0.05)。肌骨超声检查显示慢性踝关节不稳运动员的距腓前韧带(anterior tibiofibular ligament,ATFL)厚度为(2.41±0.41)mm,跟腓韧带(calcaneofibular ligament,CFL)厚度为(1.92±0.21)mm,均较健侧增厚,差异无统计学意义(P>0.05)。结论:体育学院学生中94%的学生至少发生过1次运动相关的踝关节扭伤,其中以表演类、球类运动最为常见。在初次扭伤后,给予规范支具或石膏固定的比例不足50%。扭伤次数≥4次是CAI的1个风险因素;肌骨超声检查显示ATFL和CFL均有增厚,但无统计学差异。

Objective To explore prevalence,risk factors and treatment of ankle sprain of young college student,in order to obtain accurate epidemiological data.Methods From March 2019 to May 2019,552 college students(1104 sides of anke joints)from Xi'an Physical Education university were enrolled in study according to inclusion and excludion standard,including 309 males and 243 females aged from 16 to 24 years old with an average of(20.9±3.7)years old.Age,gender,and body mass indes(BMI)etc were recorded.Morbidity of acute and chronic ankle sprains of physical students,treatment after the first sprain(cold compress,cast or plaster bracing and medicine),visual analogue scale(VAS)during walking were assessed through ankle sprain questionnaire;Cumberland ankle instability tool(CAIT),Maryland foot score were applied to assess ankle function.Lateral ankle ligament injury was objectively assessed by musculoskeletal ultrasonography.Results The prevalence of acute ankle sprain(AAS)was 96.20%(531/552),and the incidence of AAS was 59.96%(622/1104).The prevalence of chronic ankle joint instability(CAI)was 16.85%(93/552),and the incidence of CAI was 8.97%(99/1104).In the four categories of sports,college student suffered from multiple sprains in performance majors group was 22.20%(14/63),including of aerobicsand dance performance.The incidence of AAS of ball sports was 8.60%(14/163).After the first sprain,most college students(94.4%)were received cold compression,about 60%of them went to hospital;however,only 44.7%students were received standard treatmens(cast or plaster),only 35.3%of them were received hard ankle orthosis.In 552 college students,44 students were suffered from more than 4 times of ankle sprain,and the total incidence was 7.97%(44/552).Cumberland score was 26.6±2.4,Cumberland score of students sprained ankle joint more than 4 times was(29.2±1.1),suggested it was a risk factor for ankle joint instability.VAS of students sprained ankle joint more than 4 times was higher than that of less than 4 times(P<0.05),Maryland foot score was significantly lower than that of that of<4 times(P<0.05).Musculoskeletal ultrasonography measured the thickness of anterior tibiofibular ligament(ATFL)was(2.41±0.41)mm,and the thickness of calcaneofibular ligament(CFL)was(1.92±0.21)mm,and had no statistical difference(P>0.05).Conclusion Nintyfour percent college students had at least once ankle sprain,ankle sprains were more common in erobics and ball sports.After the first sprain,the proportion of cast or plaster treatment was less than 50%.Sprained ankle joint more than 4 times is a risk factor,and musculoskeletal ultrasonography showed thickening of both ATFL and CFL,while no statstical difference.