Upon entering the military recruits are challenged physically, this is exceptionally difficult for women as their anatomy predisposes them to more impact injuries than men. Female military recruits are placed at a hig...Upon entering the military recruits are challenged physically, this is exceptionally difficult for women as their anatomy predisposes them to more impact injuries than men. Female military recruits are placed at a higher risk for shin splints, a repetition injury known in the medical field as medial tibial stress syndrome (MTSS). This review paper explores studies about MTSS, its prevalence, and expression in military recruits, particularly as its expression differs across gender. This paper will cover how the external environment of boot camp results in a higher prevalence of MTSS than the general population and how increased occurrence of MTSS in females has been attributed to specific physical attributes. This includes smaller tibial cross-sectional dimensions, greater than average hip range of motion, and differences in lower extremity mechanics during running and other repetitive physical activities. The external environment of boot camp coupled with these intrinsic factors highlight the importance of providing running education for women prior to arrival at boot camp and designing training regiments that account for these physiological differences.展开更多
Medial tibial stress syndrome(MTSS) is a debilitating overuse injury of the tibia sustained by individuals whoperform recurrent impact exercise such as athletes and military recruits. Characterised by diffuse tibial a...Medial tibial stress syndrome(MTSS) is a debilitating overuse injury of the tibia sustained by individuals whoperform recurrent impact exercise such as athletes and military recruits. Characterised by diffuse tibial anteromedial or posteromedial surface subcutaneous periostitis, in most cases it is also an injury involving underlying cortical bone microtrauma, although it is not clear if the soft tissue or cortical bone reaction occurs first. Nuclear bone scans and magnetic resonance imaging(MRI) can both be used for the diagnosis of MTSS, but the patient's history and clinical symptoms need to be considered in conjunction with the imaging findings for a correct interpretation of the results, as both imaging modalities have demonstrated positive findings in the absence of injury. However, MRI is rapidly becoming the preferred imaging modality for the diagnosis of bone stress injuries. It can also be used for the early diagnosis of MTSS, as the developing periosteal oedema can be identified. Retrospective studies have demonstrated that MTSS patients have lower bone mineral density(BMD) at the injury site than exercising controls, and preliminary data indicates the BMD is lower in MTSS subjects than tibial stress fracture(TSF) subjects. The values of a number of tibial geometric parameters such as cross-sectional area and section modulus are also lower in MTSS subjects than exercising controls, but not as low as the values in TSF subjects. Thus, the balance between BMD and cortical bone geometry may predict an individual's likelihood of developing MTSS. However, prospective longitudinal studies are needed to determine how these factors alter during the development of the injury and to find the detailed structural cause, which is still unknown. Finite element analysis has recently been used to examine the mechanisms involved in tibial stress injuries and offer a promising future tool to understand the mechanisms involved in MTSS. Contemporary accurate diagnosis of either MTSS or a TSF includes a thorough clinical examination to identify signs of bone stress injury and to exclude other pathologies. This should be followed by an MRI study of the whole tibia. The cause of the injury should be established and addressed in order tofacilitate healing and prevent future re-occurrence.展开更多
目的探讨胫骨结节远端高位截骨术(distal tibial tuberosity high tibial osteotomy,DTT-HTO)中胫骨近端内侧角(medial proximal tibia angle,MPTA)与下肢力线比率(weight-bearing line ratio,WBLR)的相关性,为手术提供依据。方法选取2...目的探讨胫骨结节远端高位截骨术(distal tibial tuberosity high tibial osteotomy,DTT-HTO)中胫骨近端内侧角(medial proximal tibia angle,MPTA)与下肢力线比率(weight-bearing line ratio,WBLR)的相关性,为手术提供依据。方法选取2019年10月至2021年10月在北京中医药大学第三附属医院微创关节科行DTT-HTO治疗的26例(28膝)患者,其中男4例,女22例;左膝9个,右膝19个;年龄50~81岁,平均年龄(65.68±6.53)岁。所有患者均完成手术并随访,期间无不良事件发生。采用MPTA和WBLR评估手术前后下肢力学状态的变化;并计算手术前后MPTA和WBLR的改变值,采用美国特种外科医院(the hospital special surgery,HSS)评分评估手术前后膝关节功能,并计算手术前后HSS的改变值。本研究将WBLR设置在50%~70%的良好位置,采用SPSS 25.0软件进行数据分析。绘制受试者工作特征(receiver-operating characteristic,ROC)曲线,得到曲线下面积(area under the curve,AUC),分别计算50%和70%WBLR对应的MPTA临界值。根据两个临界值将患者分为矫正不足组、矫正适当组和矫正过度组,比较三组患者术前基线信息,术前、术后WBLR、MPTA、HSS和手术前后的改变值。用SPSS 25.0软件绘制术前、术后和手术前后改变值WBLR和MPTA的相关性分析散点图。结果术后WBLR、MPTA、HSS与术前比较均有明显变化,差异有统计学意义(P>0.01)。无论术前、术后或手术前后改变值,MPTA均与WBLR相关,AUC均大于0.5。计算得出,50%和70%WBLR对应的MPTA的临界值分别为90.5°和93.5°,50%和70%WBLR对应的MPTA改变值的临界值分别为6.5°和9.5°。三组术前基线信息差异无统计学意义;术前MPTA、术后MPTA改变值、术后MPTA、术后WBLR、术后HSS和术后WBLR改变值在三组间比较差异有统计学意义,并根据阳性结果进行组间两两比较。结论MPTA对膝骨关节炎有一定的诊断价值。作为一种简单省时的单关节测量方法,建议将MPTA应用于C型臂膝关节术中图像,并作为除下肢力线外HTO测量的参考值,以达到术中测量准确、方便的要求。展开更多
文摘Upon entering the military recruits are challenged physically, this is exceptionally difficult for women as their anatomy predisposes them to more impact injuries than men. Female military recruits are placed at a higher risk for shin splints, a repetition injury known in the medical field as medial tibial stress syndrome (MTSS). This review paper explores studies about MTSS, its prevalence, and expression in military recruits, particularly as its expression differs across gender. This paper will cover how the external environment of boot camp results in a higher prevalence of MTSS than the general population and how increased occurrence of MTSS in females has been attributed to specific physical attributes. This includes smaller tibial cross-sectional dimensions, greater than average hip range of motion, and differences in lower extremity mechanics during running and other repetitive physical activities. The external environment of boot camp coupled with these intrinsic factors highlight the importance of providing running education for women prior to arrival at boot camp and designing training regiments that account for these physiological differences.
文摘Medial tibial stress syndrome(MTSS) is a debilitating overuse injury of the tibia sustained by individuals whoperform recurrent impact exercise such as athletes and military recruits. Characterised by diffuse tibial anteromedial or posteromedial surface subcutaneous periostitis, in most cases it is also an injury involving underlying cortical bone microtrauma, although it is not clear if the soft tissue or cortical bone reaction occurs first. Nuclear bone scans and magnetic resonance imaging(MRI) can both be used for the diagnosis of MTSS, but the patient's history and clinical symptoms need to be considered in conjunction with the imaging findings for a correct interpretation of the results, as both imaging modalities have demonstrated positive findings in the absence of injury. However, MRI is rapidly becoming the preferred imaging modality for the diagnosis of bone stress injuries. It can also be used for the early diagnosis of MTSS, as the developing periosteal oedema can be identified. Retrospective studies have demonstrated that MTSS patients have lower bone mineral density(BMD) at the injury site than exercising controls, and preliminary data indicates the BMD is lower in MTSS subjects than tibial stress fracture(TSF) subjects. The values of a number of tibial geometric parameters such as cross-sectional area and section modulus are also lower in MTSS subjects than exercising controls, but not as low as the values in TSF subjects. Thus, the balance between BMD and cortical bone geometry may predict an individual's likelihood of developing MTSS. However, prospective longitudinal studies are needed to determine how these factors alter during the development of the injury and to find the detailed structural cause, which is still unknown. Finite element analysis has recently been used to examine the mechanisms involved in tibial stress injuries and offer a promising future tool to understand the mechanisms involved in MTSS. Contemporary accurate diagnosis of either MTSS or a TSF includes a thorough clinical examination to identify signs of bone stress injury and to exclude other pathologies. This should be followed by an MRI study of the whole tibia. The cause of the injury should be established and addressed in order tofacilitate healing and prevent future re-occurrence.
文摘目的探讨胫骨结节远端高位截骨术(distal tibial tuberosity high tibial osteotomy,DTT-HTO)中胫骨近端内侧角(medial proximal tibia angle,MPTA)与下肢力线比率(weight-bearing line ratio,WBLR)的相关性,为手术提供依据。方法选取2019年10月至2021年10月在北京中医药大学第三附属医院微创关节科行DTT-HTO治疗的26例(28膝)患者,其中男4例,女22例;左膝9个,右膝19个;年龄50~81岁,平均年龄(65.68±6.53)岁。所有患者均完成手术并随访,期间无不良事件发生。采用MPTA和WBLR评估手术前后下肢力学状态的变化;并计算手术前后MPTA和WBLR的改变值,采用美国特种外科医院(the hospital special surgery,HSS)评分评估手术前后膝关节功能,并计算手术前后HSS的改变值。本研究将WBLR设置在50%~70%的良好位置,采用SPSS 25.0软件进行数据分析。绘制受试者工作特征(receiver-operating characteristic,ROC)曲线,得到曲线下面积(area under the curve,AUC),分别计算50%和70%WBLR对应的MPTA临界值。根据两个临界值将患者分为矫正不足组、矫正适当组和矫正过度组,比较三组患者术前基线信息,术前、术后WBLR、MPTA、HSS和手术前后的改变值。用SPSS 25.0软件绘制术前、术后和手术前后改变值WBLR和MPTA的相关性分析散点图。结果术后WBLR、MPTA、HSS与术前比较均有明显变化,差异有统计学意义(P>0.01)。无论术前、术后或手术前后改变值,MPTA均与WBLR相关,AUC均大于0.5。计算得出,50%和70%WBLR对应的MPTA的临界值分别为90.5°和93.5°,50%和70%WBLR对应的MPTA改变值的临界值分别为6.5°和9.5°。三组术前基线信息差异无统计学意义;术前MPTA、术后MPTA改变值、术后MPTA、术后WBLR、术后HSS和术后WBLR改变值在三组间比较差异有统计学意义,并根据阳性结果进行组间两两比较。结论MPTA对膝骨关节炎有一定的诊断价值。作为一种简单省时的单关节测量方法,建议将MPTA应用于C型臂膝关节术中图像,并作为除下肢力线外HTO测量的参考值,以达到术中测量准确、方便的要求。
