Caine D, Roy S, Singer K M, Broekhoff J
Department of Exercise and Movement Science, University of Oregon, Eugene.
Am J Sports Med. 1992 May-Jun;20(3):290-8. doi: 10.1177/036354659202000310.
We conducted a radiographic survey to determine skeletal age and the nature and prevalence of stress-related changes affecting the distal radial growth plate in 60 young competitive gymnasts (39 females, 21 males). Comparison of results for chronological and skeletal age revealed a significant delay in maturation for girls (P less than 0.001). Radiographic evaluation revealed 5 gymnasts (4 girls and 1 boy) with stress-related changes of the left wrist, and four of these were considered to be minimal. These results, in conjunction with our previous findings and the review of related literature, reveal three important observations. First, the widening and irregularities of the distal radial physis that we described previously appear to be the first in a spectrum of abnormal changes secondary to overuse and probably represent a stress fracture of the distal radial growth plate. The radiographic changes associated with this injury are not the normal adaptive changes seen in young, competitive gymnasts. Secondly, more serious long-term abnormality may result even though the injury may initially resemble a Salter-Harris type I or II stress fracture. Long-term complications may include symmetrical or asymmetrical retardation or halted growth at the affected site, positive ulnar variance, and associated pathoanatomic sequelae. Thirdly, the incidence of distal radial growth plate stress injury remains unclear; we recommend a further, large-scale prospective epidemiologic study involving both male and female gymnasts. We urge that physicians and other health professionals associated with gymnastics clubs educate coaches about the possibility of significant injury to the distal radial physis, risk factors, and suggested preventive measures.
我们进行了一项影像学调查，以确定60名年轻竞技体操运动员（39名女性，21名男性）的骨骼年龄以及影响桡骨远端生长板的应力相关变化的性质和发生率。实际年龄与骨骼年龄结果的比较显示，女孩成熟明显延迟（P<0.001）。影像学评估发现5名体操运动员（4名女孩和1名男孩）的左手腕有应力相关变化，其中4例被认为是轻微的。这些结果，结合我们之前的发现以及相关文献综述，揭示了三个重要观察结果。首先，我们之前描述的桡骨远端骨骺增宽和不规则似乎是过度使用继发的一系列异常变化中的首个表现，可能代表桡骨远端生长板的应力性骨折。与这种损伤相关的影像学变化并非年轻竞技体操运动员中常见的正常适应性变化。其次，即使损伤最初可能类似于Salter-Harris I型或II型应力性骨折，也可能导致更严重的长期异常。长期并发症可能包括受影响部位的对称性或不对称性生长迟缓或生长停滞、尺骨正向变异以及相关的病理解剖后遗症。第三，桡骨远端生长板应力损伤的发生率仍不清楚；我们建议开展一项进一步的、涉及男女体操运动员的大规模前瞻性流行病学研究。我们敦促与体操俱乐部相关的医生和其他健康专业人员向教练宣传桡骨远端骨骺严重损伤的可能性、风险因素以及建议的预防措施。
