Reinking Mark F, Austin Tricia M, Richter Randy R, Krieger Mary M
Rueckert-Hartman College for Health Professions, School of Physical Therapy, Regis University, Denver, Colorado.
Department of Physical Therapy & Athletic Training, Doisy College of Health Sciences, Saint Louis University, Saint Louis, Missouri.
Sports Health. 2017 May/Jun;9(3):252-261. doi: 10.1177/1941738116673299. Epub 2016 Oct 1.
Medial tibial stress syndrome (MTSS) is a common condition in active individuals and presents as diffuse pain along the posteromedial border of the tibia.
To use cross-sectional, case-control, and cohort studies to identify significant MTSS risk factors.
Bibliographic databases (PubMed, Scopus, CINAHL, SPORTDiscus, EMBASE, EBM Reviews, PEDRo), grey literature, electronic search of full text of journals, manual review of reference lists, and automatically executed PubMed MTSS searches were utilized. All searches were conducted between 2011 and 2015.
Inclusion criteria were determined a priori and included original research with participants' pain diffuse, located in the posterior medial tibial region, and activity related.
Systematic review with meta-analysis.
Level 4.
Titles and abstracts were reviewed to eliminate citations that did not meet the criteria for inclusion. Study characteristics identified a priori were extracted for data analysis. Statistical heterogeneity was examined using the I index and Cochran Q test, and a random-effects model was used to calculate the meta-analysis when 2 or more studies examined a risk factor. Two authors independently assessed study quality.
Eighty-three articles met the inclusion criteria, and 22 articles included risk factor data. Of the 27 risk factors that were in 2 or more studies, 5 risk factors showed a significant pooled effect and low statistical heterogeneity, including female sex (odds ratio [OR], 2.35; CI, 1.58-3.50), increased weight (standardized mean difference [SMD], 0.24; CI, 0.03-0.45), higher navicular drop (SMD, 0.44; CI, 0.21-0.67), previous running injury (OR, 2.18; CI, 1.00-4.72), and greater hip external rotation with the hip in flexion (SMD, 0.44; CI, 0.23-0.65). The remaining risk factors had a nonsignificant pooled effect or significant pooled effect with high statistical heterogeneity.
Female sex, increased weight, higher navicular drop, previous running injury, and greater hip external rotation with the hip in flexion are risk factors for the development of MTSS.
胫骨内侧应力综合征（MTSS）在运动人群中较为常见，表现为沿胫骨后内侧缘的弥漫性疼痛。
通过横断面研究、病例对照研究和队列研究来确定MTSS的重要危险因素。
利用了书目数据库（PubMed、Scopus、CINAHL、SPORTDiscus、EMBASE、循证医学评论、PEDRo）、灰色文献、期刊全文电子检索、参考文献列表人工查阅以及自动执行的PubMed MTSS检索。所有检索均在2011年至2015年期间进行。
纳入标准事先确定，包括参与者疼痛弥漫、位于胫骨后内侧区域且与活动相关的原始研究。
荟萃分析的系统评价。
4级。
对标题和摘要进行审查，以排除不符合纳入标准的文献。提取事先确定的研究特征用于数据分析。使用I指数和Cochrane Q检验检查统计异质性，当两项或更多研究考察一个危险因素时，采用随机效应模型计算荟萃分析。两位作者独立评估研究质量。
83篇文章符合纳入标准，22篇文章包含危险因素数据。在两项或更多研究中涉及的27个危险因素中，5个危险因素显示出显著的合并效应且统计异质性较低，包括女性（比值比[OR]，2.35；可信区间[CI]，1.58 - 3.50）、体重增加（标准化均数差[SMD]，0.24；CI，0.03 - 0.45）、舟骨下降增加（SMD，0.44；CI，0.21 - 0.67）、既往跑步损伤（OR，2.18；CI，1.00 - 4.72）以及髋关节屈曲时更大的髋关节外旋（SMD，0.44；CI，0.23 - 0.65）。其余危险因素的合并效应不显著或合并效应显著但统计异质性较高。
女性、体重增加、舟骨下降增加、既往跑步损伤以及髋关节屈曲时更大的髋关节外旋是MTSS发生的危险因素。
