Komatsu Jun, Mogami Atsuhiko, Iwase Hideaki, Obayashi Osamu, Kaneko Kazuo
Departments of Medicine for Motor Organs, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Department of Orthopaedic Surgery, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, 410-2295, Shizuoka, Japan.
Arch Orthop Trauma Surg. 2019 Jan;139(1):25-33. doi: 10.1007/s00402-018-3035-5. Epub 2018 Sep 7.
Posterior tibial stress fractures are more frequent than anterior tibial stress fractures, and they are considered to have a good prognosis for returning to sports; cases leading to a complete fracture are rare. A 17-year-old male involved in high school athletics middle-distance running had a 3-week history of pain with training. He was running up to 300 km/week on streets and cross-country in an even distribution. He had posterior tibial stress fractures, but despite the lower leg pain, he continued running. One year later, he was brought to the emergency department after having sustained an injury to the right lower leg while running in a middle-distance race; bilateral tibial stress fractures, with one side complete and the opposite side incomplete, had developed simultaneously. This relatively rare case of bilateral posterior stress fractures, with one side a complete fracture and the opposite side an incomplete fracture, that was treated surgically via exchange intramedullary nailing is reported. The patient could begin light jogging from 3 months after surgery and was without symptoms at 5 months after surgery. He could resume middle-distance racing after 1 year. Posterior tibial cortical fractures are more common and respond better to conservative treatment than anterior tibial stress fractures, and they are a common fracture type in runners. We believe that close, careful follow-up is necessary if patients continue excessive training.
胫后应力性骨折比胫前应力性骨折更常见，并且被认为恢复运动的预后良好；导致完全骨折的病例很少见。一名17岁的男性高中生田径运动员在训练时有3周的疼痛史。他每周在街道和越野赛道上均匀跑步达300公里。他患有胫后应力性骨折，但尽管小腿疼痛，他仍继续跑步。一年后，他在一次中长跑比赛中右小腿受伤后被送往急诊科；双侧胫骨应力性骨折同时出现，一侧为完全骨折，另一侧为不完全骨折。本文报道了这例相对罕见的双侧后应力性骨折，一侧为完全骨折，另一侧为不完全骨折，通过交锁髓内钉手术治疗的病例。患者术后3个月开始轻度慢跑，术后5个月无症状。1年后他可以恢复中长跑。胫后皮质骨折比胫前应力性骨折更常见，对保守治疗反应更好，并且是跑步者中常见的骨折类型。我们认为，如果患者继续过度训练，密切、仔细的随访是必要的。
