Mann Jeffrey A, Pedowitz David I
Department of Orthopedic Surgery, Summit Medical Center, Oakland, CA 94612, USA.
Foot Ankle Clin. 2009 Jun;14(2):187-204. doi: 10.1016/j.fcl.2009.01.003.
Despite increased awareness of stress fractures of the tarsal navicular and a heightened index of suspicion by those physicians evaluating sports related foot pain, these injuries remain difficult to diagnose. There is often a considerable delay in the diagnosis because of its subtle and often vague clinical presentation. Accompanying a thorough history and physical, the authors recommend plain radiographs of the foot and ankle, followed by a CT scan to fully characterize any fracture of the navicular and to rule out other etiologies of foot pain. If a CT scan is negative, and a high clinical suspicion persists, an MRI scan is then obtained to rule out a stress reaction. While often successful, non-operative treatment of navicular stress fractures is prolonged and often frustrating to the competitive athlete; surgical intervention for appropriately selected patients can result in full symptom resolution and a return to the desired level of athletic participation.
尽管跗舟骨应力性骨折的知晓率有所提高，且评估与运动相关足部疼痛的医生的怀疑指数也有所提高，但这些损伤仍难以诊断。由于其临床表现细微且往往模糊不清，诊断往往会有相当长的延迟。除了详细的病史和体格检查外，作者建议对足踝进行X线平片检查，随后进行CT扫描，以全面描述舟骨的任何骨折情况，并排除足部疼痛的其他病因。如果CT扫描结果为阴性，但临床高度怀疑，那么应进行MRI扫描以排除应力反应。虽然非手术治疗舟骨应力性骨折通常是成功的，但对于竞技运动员来说，治疗时间较长且常常令人沮丧；对适当选择的患者进行手术干预可使症状完全缓解，并恢复到期望的运动参与水平。
