Gerber J P, Williams G N, Scoville C R, Arciero R A, Taylor D C
United States Army Sports Physical Therapy Residency Program, Keller Army Community Hospital, West Point, New York 10996-1197, USA.
Foot Ankle Int. 1998 Oct;19(10):653-60. doi: 10.1177/107110079801901002.
The purpose of this study was to examine a young athletic population to update the data regarding epidemiology and disability associated with ankle injuries. At the United States Military Academy, all cadets presenting with ankle injuries during a 2-month period were included in this prospective observational study. The initial evaluation included an extensive questionnaire, physical examination, and radiographs. Ankle sprain treatment included a supervised rehabilitation program. Subjects were reevaluated at 6 weeks and 6 months with subjective assessment, physical examination, and functional testing. The mean age for all subjects was 20 years (range, 17-24 years). There were 104 ankle injuries accounting for 23% of all injuries seen. There were 96 sprains, 7 fractures, and 1 contusion. Of the 96 sprains, 4 were predominately medial injuries, 76 were lateral, and 16 were syndesmosis sprains. Ninety-five percent had returned to sports activities by 6 weeks; however, 55% of these subjects reported loss of function or presence of intermittent pain, and 23% had a decrement of >20% in the lateral hop test when compared with the uninjured side. At 6 months, all subjects had returned to full activity; however, 40% reported residual symptoms and 2.5% had a decrement of >20% on the lateral hop test. Neither previous injury nor ligament laxity was predictive of chronic symptomatology. Furthermore, chronic dysfunction could not be predicted by the grade of sprain (grade I vs. II). The factor most predictive of residual symptoms was a syndesmosis sprain, regardless of grade. Syndesmosis sprains were most prevalent in collision sports. This study demonstrates that even though our knowledge and understanding of ankle sprains and rehabilitation of these injuries have progressed in the last 20 years, chronic ankle dysfunction continues to be a prevalent problem. The early return to sports occurs after almost every ankle sprain; however, dysfunction persists in 40% of patients for as long as 6 months after injury. Syndesmosis sprains are more common than previously thought, and this confirms that syndesmosis sprains are associated with prolonged disability.
本研究的目的是对年轻运动员群体进行检查，以更新有关踝关节损伤的流行病学和残疾情况的数据。在美国军事学院，所有在2个月期间出现踝关节损伤的学员都被纳入了这项前瞻性观察研究。初始评估包括一份详尽的问卷、体格检查和X光片检查。踝关节扭伤的治疗包括一个有监督的康复计划。在6周和6个月时对受试者进行重新评估，包括主观评估、体格检查和功能测试。所有受试者的平均年龄为20岁（范围为17 - 24岁）。共有104例踝关节损伤，占所有损伤病例的23%。其中有96例扭伤、7例骨折和1例挫伤。在96例扭伤中，4例主要为内侧损伤，76例为外侧损伤，16例为下胫腓联合扭伤。95%的患者在6周时已恢复体育活动；然而，这些受试者中有55%报告有功能丧失或间歇性疼痛，与未受伤侧相比，23%的患者在单腿侧跳测试中下降超过20%。在6个月时，所有受试者都已恢复全面活动；然而，40%的人报告有残留症状，2.5%的患者在单腿侧跳测试中下降超过20%。既往损伤和韧带松弛均不能预测慢性症状。此外，扭伤的程度（I级与II级）也无法预测慢性功能障碍状况。最能预测残留症状的因素是下胫腓联合扭伤，无论其程度如何。下胫腓联合扭伤在碰撞性运动中最为常见。这项研究表明，尽管在过去20年里我们对踝关节扭伤及其损伤康复的认识和理解有了进展，但慢性踝关节功能障碍仍然是一个普遍存在的问题。几乎每次踝关节扭伤后患者都能早期恢复运动；然而，40%的患者在受伤后长达6个月的时间里仍存在功能障碍。下胫腓联合扭伤比之前认为的更为常见，这证实了下胫腓联合扭伤与长期残疾有关。
