Sterling J C, Edelstein D W, Calvo R D, Webb R
Texas Center for Sports Medicine and Orthopaedic Surgery, Sugar Land.
Sports Med. 1992 Nov;14(5):336-46. doi: 10.2165/00007256-199214050-00005.
Stress fractures can be a troublesome injury for the sports medicine clinician. The first description was in military personnel, but recently there is an increasing awareness and diagnosis of stress fractures in the athletic population. Stress fractures have been described in all extremities. Some fractures appear to have a degree of sports specificity. Bone is a dynamic tissue which strengthens and remodels in response to stress. Maladaptation to stress causes osteoclastic activity to supersede osteoblastic activity, thereby allowing weakening of the bone. These areas of weakening may fracture and create prodromal symptoms and clinical findings. Localised pains of insidious onset which are activity related are the hallmarks in the clinical history. The physical examination can exhibit localised tenderness, redness and swelling. Radiographs can be negative for up to 4 months. The gold standard for diagnosis is the triple phase 99mtechnetium bone scan. The treatment of a stress fracture is usually conservative. Very few cases require surgical management. The algorithm of conservative management includes: rest, appropriate education for treatment and preventive care, analgesics, serial radiographs, icing and physical therapy modalities, appropriate exercise to prevent detraining, rehabilitation and a regimented return to participation and competition.
应力性骨折对于运动医学临床医生来说可能是一种棘手的损伤。首次描述是在军事人员中，但最近在运动员群体中对应力性骨折的认识和诊断越来越多。所有四肢都曾有应力性骨折的报道。一些骨折似乎具有一定程度的运动特异性。骨骼是一种动态组织，会根据应力进行强化和重塑。对应力的适应不良会导致破骨细胞活性超过成骨细胞活性，从而使骨骼变弱。这些变弱的区域可能会骨折，并产生前驱症状和临床表现。临床病史中的典型特征是隐匿性起病且与活动相关的局部疼痛。体格检查可表现为局部压痛、发红和肿胀。X线片在长达4个月内可能为阴性。诊断的金标准是三相99m锝骨扫描。应力性骨折的治疗通常是保守的。极少数病例需要手术治疗。保守治疗的方案包括：休息、进行适当的治疗和预防保健教育、使用镇痛药、系列X线片检查、冰敷和物理治疗方法、进行适当的运动以防止体能下降、康复以及有计划地恢复参与训练和比赛。
