军校基础军事训练中受伤史与意外受伤的关联
Association of Injury History and Incident Injury in Cadet Basic Military Training.
作者信息
Kucera Kristen L, Marshall Stephen W, Wolf Susanne H, Padua Darin A, Cameron Kenneth L, Beutler Anthony I
机构信息
1Department of Exercise and Sports Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC; 2Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC; 3Sports Medicine Research Laboratory, The University of North Carolina at Chapel Hill, Chapel Hill, NC; 4John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, NY; 5Department of Family Medicine, The Uniformed Services University of the Health Sciences, Bethesda, MD.
出版信息
Med Sci Sports Exerc. 2016 Jun;48(6):1053-61. doi: 10.1249/MSS.0000000000000872.
PURPOSE
This study aimed to determine the association between injury history at enrollment and incident lower extremity (LE) injury during cadet basic training among first-year military cadets.
METHODS
Medically treated LE injuries during cadet basic training documented in the Defense Medical Surveillance System were ascertained in a prospective cohort study of three large US military academies from 2005 to 2008. Both acute injuries (International Classification of Disease, Ninth Revision, codes in the 800-900s, including fracture, dislocations, and sprains/strains) and injury-related musculoskeletal injuries (International Classification of Disease, Ninth Revision, codes in the 700s, including inflammation and pain, joint derangement, stress fracture, sprain/strain/rupture, and dislocation) were included. Risk ratio (RR) and 95% confidence interval (CI) were computed using multivariate log-binomial models stratified by gender.
RESULTS
During basic training, there were 1438 medically treated acute and 1719 musculoskeletal-related LE injuries in the 9811 cadets. The most frequent LE injuries were sprains/strains (73.6% of acute injuries) and inflammation and pain (89.6% of musculoskeletal-related injuries). The overall risk of incident LE injury was 23.2% (95% CI = 22.3%-24.0%). Cadets with a history of LE injury were at increased risk for incident LE injury. This association was identical in males (RR = 1.74, 95% CI = 1.55-1.94) and females (RR = 1.74, 95% CI = 1.52-1.99). In site-specific analyses, strong associations between injury history and incident injury were observed for hip, knee ligament, stress fracture, and ankle sprain. Injury risk was greater (P < 0.01) for females (39.1%) compared with males (18.0%). The elevated injury risk in females (RR = 2.19, 95% CI = 2.04-2.36) was independent of injury history (adjusted RR = 2.09, 95% CI = 1.95-2.24).
CONCLUSION
Injury history upon entry to the military is associated with the incidence of LE injuries sustained during cadet basic training. Prevention programs targeted at modifiable factors in cadets with a history of LE injury should be considered.
目的
本研究旨在确定一年级军校学员入学时的受伤史与学员基础训练期间下肢（LE）受伤事件之间的关联。
方法
在一项对2005年至2008年美国三所大型军事院校进行的前瞻性队列研究中，确定了国防医疗监测系统记录的学员基础训练期间接受医学治疗的LE损伤情况。纳入了急性损伤（国际疾病分类第九版，编码在800 - 900范围内，包括骨折、脱位和扭伤/拉伤）以及与损伤相关的肌肉骨骼损伤（国际疾病分类第九版，编码在700范围内，包括炎症和疼痛、关节紊乱、应力性骨折、扭伤/拉伤/断裂和脱位）。使用按性别分层的多变量对数二项式模型计算风险比（RR）和95%置信区间（CI）。
结果
在基础训练期间，9811名学员中有1438例接受医学治疗的急性LE损伤和1719例与肌肉骨骼相关的LE损伤。最常见的LE损伤是扭伤/拉伤（占急性损伤的73.6%）和炎症及疼痛（占与肌肉骨骼相关损伤的89.6%）。LE损伤事件的总体风险为23.2%（95%CI = 22.3% - 24.0%）。有LE损伤史的学员发生LE损伤事件的风险增加。这种关联在男性（RR = 1.74，95%CI = 1.55 - 1.94）和女性（RR = 1.74，95%CI = 1.52 - 1.99）中相同。在特定部位分析中，观察到髋部、膝关节韧带、应力性骨折和踝关节扭伤的损伤史与损伤事件之间存在强关联。女性（39.1%）的损伤风险高于男性（18.0%）（P < 0.01）。女性升高的损伤风险（RR = 2.19，95%CI = 2.04 - 2.36）与损伤史无关（调整后的RR = 2.09，95%CI = 1.95 - 2.24）。
结论
入伍时的受伤史与学员基础训练期间发生的LE损伤发生率相关。应考虑针对有LE损伤史学员的可改变因素制定预防计划。
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