■由于成年人的愈合时间延长和骨不连的发生率较高,因此,舟骨骨应力损伤(BSIs)被认为是“高风险”,但是,根据我们的知识,没有在青少年运动员中进行全面检查。
■描述青少年的舟骨BSIs的特征。
■案例系列;证据级别,4.
■在9年的研究期间,在8个学术中心对10至19岁的X线诊断为骨舟状BSI的患者进行了回顾性分析。年龄,性别,体重指数(BMI),初级运动,体检结果,成像,治疗,外科技术,回到运动时间,并对并发症进行分析。
■在110名患者中(平均年龄,14.7±2.7岁;65%为女性),常见的主要运动是越野/田径(29/92[32%])和体操/舞蹈(25/92[27%])。在44%(48/110)的患者中确定了4级BSI,射线照相或磁共振成像上存在骨折线。非手术治疗(平均年龄,14.4±2.6年),包括受保护的负重和保护靴(69/88[78%])或铸件(19/88[22%]),在所有患者中进行了试验,94例患者(85%)成功。手术治疗(平均年龄,最终对16名患者(15%)进行了17.1±1.4年)。需要手术的患者的BMI更高,影像学上出现的骨折线百分比更高(非手术:36/94[38%];手术:14/16[88%])。恢复负重的中位时间,跑步,手术组的完全运动持续时间明显长于非手术组(P<0.05)。与手术相关的并发症包括延迟愈合各1例,骨不连,和痛苦的植入物,后者需要二次手术。
■青少年骨舟骨BSIs最常见于瘦身运动的女性患者。需要手术的青少年年龄更大,有更高的BMI,并有4级BSIs,他们在单或双螺钉固定后的中位5个月内恢复运动,术后并发症的风险较低.更好地了解舟状BSI的体征和症状以及适当的诊断成像可能会导致更早的诊断和改善的结果。
Tarsal navicular bone stress injuries (BSIs) are considered \"high risk\" because of prolonged healing times and higher rates of nonunion in adult populations but, to our knowledge, have not been comprehensively examined in adolescent athletes.
To describe the characteristics of tarsal navicular BSIs in adolescents.
Case series; Level of evidence, 4.
A retrospective analysis of patients aged 10 to 19 years with a radiographically diagnosed tarsal navicular BSI was performed at 8 academic centers over a 9-year study period. Age, sex, body mass index (BMI), primary sport, physical examination findings, imaging, treatment, surgical technique, return-to-sport time, and complications were analyzed.
Among 110 patients (mean age, 14.7 ± 2.7 years; 65% female), common primary sports were cross-country/track and field (29/92 [32%]) and gymnastics/dance (25/92 [27%]). Grade 4 BSIs were identified in 44% (48/110) of patients, with fracture lines present on radiography or magnetic resonance imaging. Nonoperative treatment (mean age, 14.4 ± 2.6 years), consisting of protected weightbearing and either a protective boot (69/88 [78%]) or a cast (19/88 [22%]), was trialed in all patients and was successful in 94 patients (85%). Operative treatment (mean age, 17.1 ± 1.4 years) was ultimately pursued for 16 patients (15%). Patients who required surgery had a higher BMI and a higher percentage of fracture lines present on imaging (nonoperative: 36/94 [38%]; operative: 14/16 [88%]). The median time to return to weightbearing, running, and full sport was significantly longer in duration for the operative group than the nonoperative group (P <.05). Complications associated with surgery included 1 case each of delayed union, nonunion, and painful implants, the latter of which required secondary surgery.
Adolescent tarsal navicular BSIs were identified most commonly in female patients in leanness sports. Adolescents who required surgery were more likely to be older, have higher BMIs, and have grade 4 BSIs, and they returned to sport within a median of 5 months after single- or double-screw fixation with a low risk of postoperative complications. A better understanding of the presenting signs and symptoms and appropriate diagnostic imaging of navicular BSIs may lead to an earlier diagnosis and improved outcomes.