Newman Phil, Witchalls Jeremy, Waddington Gordon, Adams Roger
Faculty of Health, Physiotherapy, University of Canberra, Bruce, ACT, Australia.
Open Access J Sports Med. 2013 Nov 13;4:229-41. doi: 10.2147/OAJSM.S39331.
Medial tibial stress syndrome (MTSS) affects 5%-35% of runners. Research over the last 40 years investigating a range of interventions has not established any clearly effective management for MTSS that is better than prolonged rest. At the present time, understanding of the risk factors and potential causative factors for MTSS is inconclusive. The purpose of this review is to evaluate studies that have investigated various risk factors and their association with the development of MTSS in runners.
Medical research databases were searched for relevant literature, using the terms "MTSS AND prevention OR risk OR prediction OR incidence".
A systematic review of the literature identified ten papers suitable for inclusion in a meta-analysis. Measures with sufficient data for meta-analysis included dichotomous and continuous variables of body mass index (BMI), ankle dorsiflexion range of motion, navicular drop, orthotic use, foot type, previous history of MTSS, female gender, hip range of motion, and years of running experience. The following factors were found to have a statistically significant association with MTSS: increased hip external rotation in males (standard mean difference [SMD] 0.67, 95% confidence interval [CI] 0.29-1.04, P<0.001); prior use of orthotics (risk ratio [RR] 2.31, 95% CI 1.56-3.43, P<0.001); fewer years of running experience (SMD -0.74, 95% CI -1.26 to -0.23, P=0.005); female gender (RR 1.71, 95% CI 1.15-2.54, P=0.008); previous history of MTSS (RR 3.74, 95% CI 1.17-11.91, P=0.03); increased body mass index (SMD 0.24, 95% CI 0.08-0.41, P=0.003); navicular drop (SMD 0.26, 95% CI 0.02-0.50, P=0.03); and navicular drop >10 mm (RR 1.99, 95% CI 1.00-3.96, P=0.05).
Female gender, previous history of MTSS, fewer years of running experience, orthotic use, increased body mass index, increased navicular drop, and increased external rotation hip range of motion in males are all significantly associated with an increased risk of developing MTSS. Future studies should analyze males and females separately because risk factors vary by gender. A continuum model of the development of MTSS that links the identified risk factors and known processes is proposed. These data can inform both screening and countermeasures for the prevention of MTSS in runners.
胫骨内侧应力综合征（MTSS）影响5% - 35%的跑步者。过去40年对一系列干预措施的研究尚未确立任何比长时间休息更有效的MTSS管理方法。目前，对MTSS的风险因素和潜在致病因素的理解尚无定论。本综述的目的是评估研究各种风险因素及其与跑步者MTSS发生之间关联的研究。
使用“MTSS AND prevention OR risk OR prediction OR incidence”等术语在医学研究数据库中搜索相关文献。
对文献的系统评价确定了十篇适合纳入荟萃分析的论文。有足够数据进行荟萃分析的指标包括体重指数（BMI）的二分变量和连续变量、踝关节背屈活动范围、舟骨下降、矫形器使用、足型、MTSS既往史、女性性别、髋关节活动范围和跑步年限。发现以下因素与MTSS有统计学显著关联：男性髋关节外旋增加（标准平均差[SMD] 0.67，95%置信区间[CI] 0.29 - 1.04，P < 0.001）；既往使用矫形器（风险比[RR] 2.31，95% CI 1.56 - 3.43，P < 0.001）；跑步年限较少（SMD -0.74，95% CI -1.26至 -0.23，P = 0.005）；女性性别（RR 1.71，95% CI 1.15 - 2.54，P = 0.008）；MTSS既往史（RR 3.74，95% CI 1.17 - 11.91，P = 0.03）；体重指数增加（SMD 0.24，95% CI 0.08 - 0.41，P = 0.003）；舟骨下降（SMD 0.26，95% CI 0.02 - 0.50，P = 0.03）；以及舟骨下降>10 mm（RR 1.99，95% CI 1.00 - 3.96，P = 0.05）。
女性性别、MTSS既往史、跑步年限较少、使用矫形器、体重指数增加、舟骨下降增加以及男性髋关节外旋活动范围增加均与发生MTSS的风险增加显著相关。未来研究应分别分析男性和女性，因为风险因素因性别而异。提出了一个将已确定的风险因素和已知过程联系起来的MTSS发展连续模型。这些数据可为跑步者MTSS的筛查和预防对策提供参考。
