新战士100名强化训练前后腰椎椎弓峡部断裂情况调查

新战士100名强化训练前后腰椎椎弓峡部断裂情况调查 新战士100名强化训练前后腰椎椎弓峡部断 裂情况调查 中国临床康复第70卷第4厢2006-01—25出版 164ChineseJournalofClinicalRehabilitation,January252006Vo1.10No.4 ? CLINICALREsEARCH? Investigationonspondylolysisoflumbarvertebralarchin100recruits beforeandafterreinforcedtraining SongYi?ping,ZhangFa?hui 'DepartmentofOrthopedics,the97HospitalofChinesePLA,Xuzhou 22lO04.JiangsuProvince.China;ZResearehCenterforClinicalAnatomy. FuzhouGeneralHospitalofNanjinMilitaryAreaCommandofChinese PLA,Fuzhou350025,FuiianProvince,China 5ongYi—ping,Chiefphysician,DepartmentofOrthopedics,the97Hospital ofChinesePLA,Xuzhou22lOO4,JiangsuProvince,China Liuhongbinwi@l63.cam Received:2o05—02—05Accepted:2o05—O6—02(o5—03一l—63t/w) Abstract BACKGR0UND:Theincidencerateofspondylolysisoflumbarvertebral archinrecruitsishigherduringthetraining,anditaffectsthenormal training. 0BJECTIVE:Toanalyzethecorrelationoftheincidencerateofspondy— lolysisoflumbarvertebralarchwithtrainingandtheoriginallesionsat waistjnrecrujts. DESIGN:Arandomizedsamplingsurvey. SErr】NG:DepartmentofOrthopaedics.the97HospitalofChinesePLA. PARTIC?'ANTS:Totally100malerecruitsaged18.7yearsaveragelyen— rolledin2003wereinvolvedinthesurvey. METH0DS:The100recruitswerefollowedupforthewhalecourse.the X—rayexaminationatlumbarvertebraeofright.1ateralandtwo—slopeposi— tionswereobservedbeforetrainingandafterloo—dayreinforcedtraining. MAINOUTCOMEMEASURES:Theincidenceratesofspondylolysisof vertebralarch,andwhethertherewasslippageandotheraggravationsin thosewithspondylolysisbeforeweremainlyobserved. RESULTS:AUthe100recruitsenteredtheanalysisofresults.(Thein— cidencerateofspondylolysisofvertebralarchbeforeandaftertraining:Be— foretraining.5caseshadspondylolysisofLvertebralarch.andtheinei— denceratewas5%.Attheendofthel0o—daytraining.8caseshad spondylolysisoflumbarvertebralarch.andtheincidencerateincreasedto 8%.(2)TheresultsofX—rayexaminationbeforeandaftertraining:TheX— rayexaminationshowedthatisthmusnarrowingofleftandL^vertebralarch occurredin2casesandlcaserespectively.andspondylolysisofbilateral Lvertebralarchesoccurredin5eases,includinglcaseofdegreeIslip- pagebeforetraining.Attheendofthe100一daytraining.thedegreeIslip— pageandbelowoccurredin3ofthe5caseswithspondylolysisofbilateral L^vertebralarchesbefore.another3caseswithoriginalnarrowingoflam— barvertebralarchallhadbreakage. C0NCLUS10N:Theincidencerateofspondylolysisofvertebralarchis associatedwiththetrainingintensity.Itsuggestesthattheexaminationof spinalcordshouldbereinforcedinenrolledrecruits.andtheitemsofX— rayexaminationatlumbarvertebraeofright.1ateralandtwo—slopepositions shouldbeadded. SongYP.ZhongFHInvestigationonspondylol~isoflumbarvertebralarchinlO0 recruitsbeforeandafterreinforcedtrainingz0Li,whuang?2006;10141: 164-51China)[wwwzglcldtom] INTRoDUCTIoN TheincidencerateofspondylolysisoflumbarvertebralarchiS usuallyabout4%.butitishigheramongtheyouthinthearmy.In ordertoadapttotheneedsofnormalizationandmodernizationin thearmy,themilitarytrainingintensityisgraduallyincreased,so thediseasesatlumbarvertebraearealsoincreased.whichaffects thenormaltrainingtosomeextent,evenaffectsthefightingspirit ofthetroop.Inordertounderstandthedistributionofthediseases atlumbarvertebraeinsoldiers.thecurrentstudyinvestigatedand analyzed100.recruitsenrolledin2003beforeandaftertraining. SUBJECTSANDMETHoDS SuMects Totally100malerecruitsaged18to21yearswithanaverageof 18.7years.whowereenrolledin2003.wererandomlyselected fromtherecruitswhowereunderintensivetrainingfor1oodays. Methods The1o0randomlyselectedrecruitswereexaminedbythespecial physicians.andtheX.rayexaminationatlumbarvertebraeof right,lateralandtwo?slopepositionswasperformedonallthe subjectsinthe97HospitalofChinesePLAbeforetrainingand aftertrainingrespectively.rrheX?rayfilmswereobserveduni? formly,theinventorieswerefilled.andthenthedatawereana— lyzed. Evaluationstandards Spondylolysisoflumbarvertebraewasdividedinto4degrees:<1/ 4asdegreeI,1/4—1/2asdegreeII,1/2-3/4asdegreeIII,>3/4 asdegreeIV. RESULTS Quantitativeanalysisoftheparticipants Totally100subjectswereinvestigated,andallwerefollowed?up duringthetraining,andenteredtheanalysisofresults. Incidencerateofspondylolysisofvertebralarchbeforeand aftertraining Beforetraining,5caseshadspondylolysisofkvertebralarch,and theincidenceratewas5%.Attheendofthe100一daytraining.8 caseshadspondylolysisoflumbarvertebralarch,andtheinci? dencerateincreasedto8%. ResultsofX?rayexaminationbeforeandaftertraining rrheX—rayexaminationshowedthatisthmusnarrowingofleftand rightvertebralarchoccurredin2casesand1caserespectively, whichaccounted3%.andspondylolysisofbilateralvertebral archesoccurredin5cases(5%),including1caseofdegreeIslip? pagebeforetraining.17casessufferedfromSlsubfissure,14from sacralizationorS1sacralization,and7fromlumbarside—flexion. Attheendofthe100一daytraining.thedegreeIslippageandbe? lowoccurredin3ofthe5caseswithspondylolysisofbilateral vertebralarchesbefore,another3caseswithoriginalnarrowingof lumbarvertebralarchallhadbreakage.rrheotherlesionsoflum? bosascralvertebraewerethesameasbeforetraining.Afterlumbar loadingandtraining,therewerelumbagofdifferentseverityinthe chiefcomplaints,buttheywerecapableoftheself-careofdaily li. DISCUSSION EpidemiologicalcharactersofthespOndy10Iysis0fI岫bar vertebI-aIarch Spondylolysisoflumbarvertebmehasthecongenital,family,inva— siveandacquiI_eddiflferences.Thespondylolysisandvertebral slippagearethecommonreasonsf0rlowbackpain,alsotIlecom? monspinaldiseasesf0ryoutIl,whichmajnlyoccuratk.5.I11e ISSN167l一5926CN21一l470/R wurw.:om3385083@sina.m宋一平,等.新战士100名强化训练前后腰椎椎弓峡部断 裂情况调查 trainingforrecruitsischaracterizedbyhighintensity,overloading, highfrequencyandrepetition,whichoftenexceedstherepairinga— bilityoforgan,sofatiguefractureoccurseasily.Thedatainthe currentstudyshowed,that.theincidencerateintherecruitswas 5%whentheywereenrolled.including1caseofdegreeIslip— page.butitincreasedto8%afterthe100一daytraining.andthe slippageunderdegreeIoccurredin3cases.Itsuggeststhatbe— causetheintensityoftheintensivetrainingisgreatandlumbar vertebraeisgivenmostoftheforces,itleadstothespondylolysis insubjectswhohaddevelopmentaldefectofisthmus.Sothe chanceforinjuryatwaistisrelativelyincreased,andtheincidence rateaftertrainingisalsoincreased.Theresultsindicatethatboth theintensityandtimeoftrainingcanaffecttheinjuryoflumbar vertebrae.Inthecurrentstudy,otherchangesoflumbarvertebrae werealsoobserved,suchassubfissure,sacralizationorSl sacralization,etc.Atypicalspondylolysisoflumbarvertebralarch usuallyhasnoclinicalsymptoms,oronlyslightpaininwaistand leg,whichcannotattractenoughattention,especiallythatprimary healthstaffhavenoenoughcognitiontoit,sotherecruitscannot betreatedtimely.Ontheotherhand,thepatientswithatypical spondylolysisoflumbarvertebralarchalreadywereenrolledinthe pastbecausethatthedegreeofattentionwasnotenoughorthe physicalexaminerswerelackoftheknowledgeofspinalcordSoit issuggestedthattheexperiencedspecialphysiciansshouldbear— rangedintheexaminationofspinalcordfortherecruitsduringthe healthcheckoftheenrollmentandthattheitemsofX?-rayexami?- nationatlumbarvertebraeofright,lateralandtwo—slopepositions shouldbeadded.Inordertoensurethefightingspiritofthe troops,thosewhowerefoundtohavenarrowingoflumbarvertebral arch,oralreadyhavespondylolysisoflumbarvertebralarchshould notbeenrolled.Atthesametime.thosewithlumbarside—flexion over15.,andthosewithseverecongenitalvariationalsoshould notbeenrolled. Operationindicationsforthespondylolysisoflumbarverte- bralarch Thetreatmentofspondylolysisoflumbarvertebralarchisstillun— derdiscussion.Mostpatientswithspondylolysishavenosymptoms, andthereispossibilityofspontaneouscureinchildrenandyouths, sotooearlyoperationisusuallynotadvocated.Theetiologicalfac— torsofthesymptomsarestillnotcompletelyunderstood,butmost scholarsthinkthatitisassociatedwiththerepeatedstressandin— jury,whicharemorefrequentlyobservedinyoungpeople.Itis provedbybiomechanicstudies[J21thatfatigueloadingcouldlead tothespondylolysisoflumbarvertebralarch,especiallythatthe chancewasgreaterwiththosealreadyhavingdysplasiaoflumbar vertebralarch,tileisthmuswaseasilyinjuredinthebackward extensionunderverticalloading,andthevertebralarchwasalso forcedtorotateundertheshearingstressoflosingbalance,be— causeoftheanatomiccharacterofisthmusofvertebralarch,it hadtoendurethepressure,whichresultedintheincreaseofthe incidencerateofspondylolysisoflumbarvertebrae.Somescholars believedthatsimplespondylolysisoflumbarvertebraeormild j +会议名称:2006北京麻醉与疼痛治疗论坛 会议主题:加强国内外麻醉与疼痛的 学术交流与合作,促进麻醉与疼痛学科在我 i国的健康发展 i会议时间:2oo6一o4—7/lO 165 slippagehadnoclinicalsymptomsoronlyhadslightpaininwaist andleg,sooperationisnotnecessary.Buttheactiveintensityof spinalcordinyouthisgreat,especiallytheintensivemilitary trainingofrecruits.Withtimeprolonging,long—timeactivity,hy— perplasiaoflocalscartissuesandthedegenerationofinterverte— braldiscinslippingvertebraecouldleadtotheexcessiveconstric— tionofintervertebralspace,andresultintheslippedlumbarverte— braehardtoreposition.Suchreoperationhasgreatinvasion,and theoperativeeffectisusuallynotidea1.Sotheauthorsuggeststhat operationshouldbegivenearlytorepairspondylolysisintimeso astopreventtheoccurrenceofslippageandthesecondarylumbar spinalstenosis. REFERENCES 1SuezawaY,JacobHA,BernoskiFP.Themechanicalresponseoftheneuralarchof thelumbosacralvertebraanditsclinicalsignificance./mOnhop1980;4(3):205-9 2FarfanHF,OsteriaV,LamyC.Themechanicaletiologyofspondylolysisandof spondylolisthesisClin&hop1976;(117):40-55 新战士100名强化训练前后腰椎椎弓峡部断裂 情况调查 宋一平'.张发惠 解放军第九十七医院骨科,江苏省徐州市22l0o4;解放军南京军区 福州总医院军区临床解剖学研究中心,福建省福州市35oo25 宋一平.男.1954年生,山东省淄博市人,汉族,1975年苏州医学院毕 业,主任医师.主要从事骨科,脊柱和关节疾病的研究. 摘要 背景:新战士在新兵训练期间出现腰椎椎弓峡部断裂发病率较高并影 响了正常训练. 目的:部队新兵中腰椎椎弓峡部断裂的发病率与训练及其腰部原 有病变的关系. 设计:随机抽样调查. 单位:解放军第九十七医院骨科. 对象:某部2003年入伍的新兵100名.男性.平均年龄l8.7岁. 方法:对100名新兵全程追踪随访.于训练前及100d强化训练后分别 摄腰部X射线正,侧位和双斜位片进行对照观察. 主要观察指标:椎弓峡部断裂病例发病率,原有断裂者有无滑脱等加重 现象.' 结果:调查对象100名均进入结果分析.?新兵训练前,后椎弓峡部断 裂发病率:训练开始前的入伍新兵.椎弓峡部断裂5例.发病率为 5%.100d训练结束时,腰椎椎弓峡部断裂8例.发病率增加至8%.? 新兵训练前,后X射线检查结果:100名新战士X射线片训练开始前, 左侧椎弓峡部变细2例.右侧椎弓峡部变细l例;双侧椎弓峡 部断裂5例,其中l例呈I度滑脱.100d训练结束时,原双侧椎弓峡 部断裂5例中I度以内滑脱3例,另3例原腰椎椎弓变细者均发生断 裂. 结论:腰椎椎弓峡部断裂发病率与训练强度有关.建议加强入伍新兵脊 柱体检.常规加拍腰椎正,侧位和双斜位X射线片检查项目. 主题词:脊柱裂,隐性;腰椎:发病率;军事人员;腰腿痛 中国分类号:R274,35文献标识码:A文章编号:167l-5926(2006)O4-0164-02 宋一平.张发惠.新战士100名强l'-~JII练前后腰椎椎弓峡部断裂情况调查U】_中国临 床康复.2006,10141:164—5[wwwzglckfcom] fEditedbyNieWX/YinYI/SongLP/WangL1 会议地点:北京市 主办单位:北京大学医学部,哈佛医学院 会务组联系方式 联系人:白雪,盛王艳 联系电话:010—58075088;, ' +"+.+"+.+.+"++.+"+., ? 会讯传递? : 58075099—102/108+ : E-mail:bhap_ essay@163.cornt 通讯地址:北京市丰台区方庄芳城因一十 区日座??室j邮政编码:100078i