Kizaki Kazuha, Yamashita Fumiharu, Mori Daisuke, Funakoshi Noboru
Department of Orthopaedic Surgery and Rheumatology, Kyoto Shimogamo Hospital, Kyoto, Japan.
Department of Orthopaedic Surgery and Rheumatology, Kyoto Shimogamo Hospital, Kyoto, Japan.
J Foot Ankle Surg. 2019 May;58(3):489-491. doi: 10.1053/j.jfas.2018.09.024. Epub 2019 Feb 11.
Despite a high incidence of proximal diaphyseal stress fractures of the fifth metatarsal (zone 3) in soccer (football) players, studies that examine risk factors of the fractures in professional soccer players are scarce; in particular, ankle structures have not yet been investigated. This study was designed to investigate ankle structures of professional soccer players with proximal diaphyseal stress fractures of the fifth metatarsal. We reviewed the ankle radiographs of 100 professional soccer players (stress fractures n = 15; controls n = 85) and measured the medial malleolar slip angle (MMSA), the ratio of the medial malleolar length to the width of the talar dome (MML:TD ratio), the ratio of the lateral malleolar length to the width of the TD (LML:TD ratio), and the ratio of the MML to the LML (MML:LML ratio). The MMSA (p < .01: 28.7° ± 5.8° versus 23.0° ± 4.9°) in the stress fractures was significantly wider and the MML:TD ratio (p = .08: 0.49 ± 0.08 versus 0.52 ± 0.07) had a trend to be smaller compared with the values of the controls. Logistic regression analysis revealed that a wider malleolar slip angle became a factor associated with stress fractures in professional soccer players (p < .01: odds ratio 1.27, 95% confidence interval 1.110 to 1.463). Receiver operating characteristic curve with MMSA for the stress fractures was depicted with an area under the curve of 0.778, and the suitable cut-off point was set at MMSA >27° with a positive likelihood ratio of 3.67 (95% confidence interval 2.173 to 6.188). Our study results show that a wide MMSA was associated with proximal diaphyseal stress fractures of the fifth metatarsal in professional soccer players.
尽管在足球运动员中，第五跖骨近端骨干应力性骨折（3区）的发生率很高，但针对职业足球运动员骨折风险因素的研究却很少；尤其是，尚未对踝关节结构进行调查。本研究旨在调查患有第五跖骨近端骨干应力性骨折的职业足球运动员的踝关节结构。我们回顾了100名职业足球运动员的踝关节X光片（应力性骨折患者n = 15；对照组n = 85），并测量了内踝滑移角（MMSA）、内踝长度与距骨穹窿宽度之比（MML:TD比值）、外踝长度与TD宽度之比（LML:TD比值）以及MML与LML之比（MML:LML比值）。与对照组相比，应力性骨折组的MMSA（p < 0.01：28.7°±5.8° 对 23.0°±4.9°）明显更宽，MML:TD比值（p = 0.08：0.49±0.08 对 0.52±0.07）有变小的趋势。逻辑回归分析显示，更大的踝滑移角成为职业足球运动员应力性骨折的相关因素（p < 0.01：比值比1.27，95%置信区间1.110至1.463）。应力性骨折的MMSA的受试者工作特征曲线下面积为0.778，合适的截断点设定为MMSA > 27°，阳性似然比为3.67（95%置信区间2.173至6.188）。我们的研究结果表明，较大的MMSA与职业足球运动员第五跖骨近端骨干应力性骨折有关。
