Buckwalter J A, Brandser E A
University of Iowa Hospitals and Clinics, Iowa City, USA.
Am Fam Physician. 1997 Jul;56(1):175-82.
Stress fractures of the axial and appendicular skeleton typically present as localized pain that develops without a history of specific acute injury. The differential diagnosis includes primary or metastatic neoplasms, infections, musculoskeletal soft tissue injuries, nerve compression syndromes and joint diseases. Plain radiographs may demonstrate changes consistent with fracture, including a fracture line or fracture callus. In many cases, however, initial radiographs are normal or nondiagnostic. This occurs most frequently in three situations: (1) when radiographs are obtained soon after the onset of symptoms, before the appearance of a fracture line or new bone formation; (2) in patients with osteopenia, in whom detection of a fracture line and new bone formation is difficult, and (3) when the fracture involves areas of the skeleton that are difficult to study with plain films (including the spine and pelvis). When the plain films are normal, other tests such as bone scans, computed tomography or magnetic resonance imaging usually demonstrate the fracture.
轴骨和附属骨骼的应力性骨折通常表现为局部疼痛，其发生并无特定急性损伤史。鉴别诊断包括原发性或转移性肿瘤、感染、肌肉骨骼软组织损伤、神经压迫综合征和关节疾病。普通X线片可能显示与骨折相符的改变，包括骨折线或骨痂。然而，在许多情况下，最初的X线片是正常的或无法诊断的。这种情况最常发生在三种情形下：（1）症状出现后不久即进行X线检查，此时骨折线或新骨形成尚未出现；（2）在骨质减少的患者中，难以检测到骨折线和新骨形成；（3）当骨折累及普通X线片难以检查的骨骼区域时（包括脊柱和骨盆）。当普通X线片正常时，其他检查如骨扫描、计算机断层扫描或磁共振成像通常能显示骨折情况。
