Bennell K L, Malcolm S A, Wark J D, Brukner P D
School of Physiotherapy, University of Melbourne, Australia.
Br J Sports Med. 1996 Sep;30(3):200-4. doi: 10.1136/bjsm.30.3.200.
It would seem that the development of a stress fracture results from unsuccessful adaptation of bone to a change in its mechanical environment caused by repetitive loading. It involves the physiological processes of microdamage production and remodelling. Whether the initiating factor is microdamage production or activation of remodelling through direct effects of strain is unclear. The remodelling process involves both the removal of bone which has become fatigue damaged or is extraneous to the requirements of the new loading environment, and the addition of new bone in an manner that is best suited to withstand the new mechanical strain. Normally this process is well modulated and does not cause symptoms. If the amount of bone removed is not sufficient to unduly weaken bone structure and the addition of new bone occurs sufficiently rapidly to correct any weakness before failure occurs or to repair microdamage, the process will successfully lead to a bone with appropriate material strength and geometry to withstand the new strain environment. However, if there is imbalance between bone removal and replacement, together with accumulation of microdamage, signs and symptoms of a stress fracture may result. Any factors which influence bone load, bone strength, or remodelling have the potential to result in a stress fracture. Attention should be paid to the identification of these factors in an attempt to prevent this overuse injury in athletes.
应力性骨折的发生似乎是由于骨骼未能成功适应重复负荷导致的机械环境变化。它涉及微损伤产生和重塑的生理过程。引发因素是微损伤的产生还是通过应变的直接作用激活重塑尚不清楚。重塑过程既包括去除已发生疲劳损伤或不符合新负荷环境要求的多余骨骼，也包括以最适合承受新机械应变的方式添加新骨。通常这个过程受到良好调节，不会引起症状。如果去除的骨骼量不足以过度削弱骨骼结构，并且新骨添加得足够快，能够在骨折发生前纠正任何弱点或修复微损伤，那么这个过程将成功地使骨骼具有适当的材料强度和几何形状，以承受新的应变环境。然而，如果骨骼去除和替换之间失衡，再加上微损伤的积累，可能会导致应力性骨折的体征和症状。任何影响骨负荷、骨强度或重塑的因素都有可能导致应力性骨折。为预防运动员的这种过度使用损伤，应注意识别这些因素。
