Caine D, Howe W, Ross W, Bergman G
Department of Physical Education, Health and Recreation, Western Washington University, Bellingham 98225, USA.
Clin J Sport Med. 1997 Oct;7(4):302-8. doi: 10.1097/00042752-199710000-00007.
Stress-related injuries to the distal radius have been noted in female gymnasts with potential for resultant premature closure and abnormal growth at this site. The purpose of this study was comprehensively to review and critically to appraise the available literature to examine the evidence related to this question: does repetitive physical loading inhibit growth of the radius in female gymnasts?
MEDLINE and SPORT Discuss were searched from 1975 to the present by using "gymnast" in combination with injury, growth plate, epiphyseal, and ulnar variance. Additional references were retrieved from the bibliographies of the retrieved articles.
All descriptive and analytic studies that included data related to stress-related injuries affecting the distal radius of competitive female gymnasts were included. Conclusions regarding the effects of gymnastics training on radial growth of female gymnasts were limited to data from case reports, clinical series, cross-sectional studies, and descriptive cohort studies. Data from relevant experimental animal studies also were included.
In reviewing the literature, particular attention was paid to the relative strengths of the different study designs. From these data, information associated with growth inhibition at the distal radius was examined.
The descriptive research reviewed included clinical, cross-sectional, and cohort studies that establish the existence of stress-related injuries affecting one or more constituent parts of the epiphyseal-physeal-metaphyseal (EPM) complex of the distal radius, symptomatic ulna-radial-length difference (URLD), and distal radius physeal arrest among female gymnasts. Five cross-sectional studies showed radiographic abnormalities consistent with distal radius physeal-stress reaction in 10-85% of gymnasts studied. Two cross-sectional studies indicated "abnormal" positive URLD in 8-20% of wrists radiographed. Four cross-sectional studies showed significant correlations between training intensity and URLD, suggesting a dose-response relation. Three cross-sectional studies indicate greater URLD in gymnasts compared with nongymnasts. Radiographic evidence of distal radius physeal arrest involving physically immature female gymnasts is presented in four studies (two clinical series, one cross-sectional, and one descriptive cohort). In animal studies, prolonged physical training has also been shown to inhibit or stop growth in weight-bearing long bones. However, there were no rigorous studies (i.e., randomized control trials or analytic cohorts) examining the question.
The results of this critical review of the scientific literature support the plausibility of stress-related distal radius physeal arrest with secondary URLD. However, the strength of evidence is inadequate to be conclusive.
在女性体操运动员中已注意到桡骨远端与应力相关的损伤，该部位有过早闭合和生长异常的可能性。本研究的目的是全面回顾并严格评估现有文献，以检验与这个问题相关的证据：重复性身体负荷是否会抑制女性体操运动员桡骨的生长？
通过将“体操运动员”与损伤、生长板、骨骺和尺骨变异相结合，检索了1975年至目前的MEDLINE和SPORT Discuss数据库。从检索到的文章的参考文献中获取了其他参考文献。
纳入所有描述性和分析性研究，这些研究包含与影响竞技女性体操运动员桡骨远端的应力相关损伤的数据。关于体操训练对女性体操运动员桡骨生长影响的结论仅限于病例报告、临床系列、横断面研究和描述性队列研究的数据。相关实验动物研究的数据也被纳入。
在回顾文献时，特别关注了不同研究设计的相对优势。从这些数据中，研究了与桡骨远端生长抑制相关的信息。
所回顾的描述性研究包括临床、横断面和队列研究，这些研究证实了女性体操运动员中存在影响桡骨远端骨骺-干骺端-骨干（EPM）复合体一个或多个组成部分的应力相关损伤、有症状的尺桡骨长度差异（URLD）以及桡骨远端骨骺停滞。五项横断面研究显示，在10%-85%的受研究体操运动员中存在与桡骨远端骨骺应力反应一致的影像学异常。两项横断面研究表明，在8%-20%的接受X线检查的手腕中存在“异常”的阳性URLD。四项横断面研究显示训练强度与URLD之间存在显著相关性，提示存在剂量反应关系。三项横断面研究表明，与非体操运动员相比，体操运动员的URLD更大。四项研究（两项临床系列、一项横断面研究和一项描述性队列研究）提供了涉及身体未成熟女性体操运动员桡骨远端骨骺停滞的影像学证据。在动物研究中，长期体育训练也已被证明会抑制或停止负重长骨的生长。然而，没有严格的研究（即随机对照试验或分析性队列研究）探讨这个问题。
对科学文献的这项批判性综述结果支持了应力相关的桡骨远端骨骺停滞伴继发性URLD的合理性。然而，证据的力度不足以得出定论。
