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Youth Sport Specialization: Current Concepts and Clinical Guides 青少年体育专业:当前概念与临床指南
Pub Date : 2024-03-22 DOI: 10.1177/15563316241237526
Dai Sugimoto, Kristin E. Whitney, P. d’Hemecourt, A. Stracciolini
The concept of youth sport specialization has evolved over the past decade, from a focus on the risk of overuse injury to a broader awareness of its effects on mental health, social well-being, quality of life, growth and maturation, sport performance, and long-term athletic success. This review article considers a recently revised definition of youth sport specialization, as well as guidelines and consensus statements from various sports medicine organizations, with practical applications for young athletes.
在过去的十年中,青少年运动专项化的概念不断发展,从关注过度运动损伤的风险,到更广泛地认识到其对心理健康、社会福利、生活质量、成长和成熟、运动表现以及长期运动成功的影响。这篇综述文章探讨了最近修订的青少年运动专项定义,以及各种运动医学组织的指导方针和共识声明,并将其实际应用于青少年运动员。
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引用次数: 0
High Rates of Abnormal Patellofemoral Morphology in Adolescents With Anterior Knee Pain: A Retrospective Review 青少年膝关节前侧疼痛患者髌骨形态异常率高:回顾性研究
Pub Date : 2024-03-20 DOI: 10.1177/15563316241231805
Julia S. Retzky, Preston W Gross, Shevaun M. Doyle, S. Strickland
Background: Anterior knee pain is a common reason for referral to a pediatric orthopedic surgeon. Although previous studies have found that adults with anatomic risk factors for patellofemoral instability (patella dislocation) are predisposed to anterior knee pain, no studies have elucidated the relationship between anatomic risk factors for patellofemoral instability and anterior knee pain in children. Purpose: We sought to characterize common radiographic findings in adolescent patients with a chief complaint of anterior knee pain and to determine the prevalence of abnormal patellofemoral morphology. Methods: We conducted a retrospective review of patients 13 to 18 years old with anterior knee pain at a single tertiary care metropolitan institution from 2016 to 2021. X-rays and magnetic resonance imaging (MRI) were evaluated in those diagnosed with “chondromalacia patellae,” “chondromalacia,” “patellofemoral disorders,” or “anterior knee pain.” Patella alta, tibial tubercle-trochlear groove (TT-TG) distance, tubercle height, Wiberg patella type, patellar tilt, and trochlear dysplasia characterization were recorded. Results: Of the 293 adolescents with anterior knee pain included, 62 had bilateral anterior knee pain. Of the 172 MRIs, 72 (42%) met criteria for patella alta, Caton-Deschamps Index (CDI) >1.3, 35% had a TT-TG distance >15 mm, and 32% had lateral patellar tilt >15°. Magnetic resonance imaging findings included infrapatellar fat pad signal hyperintensity (41%) and patellofemoral dysplasia (23%). Of all 293 adolescents, 74% had images showing abnormal patellofemoral morphology, of which 30% had a history of 1 or more patellar dislocation. Overall, 40% of the adolescents had surgery, most commonly medial patellofemoral ligament (MPFL) reconstruction (18%). Conclusions: In this retrospective review, nearly 3/4 of adolescents with anterior knee pain had images showing abnormal patellofemoral morphology, including patella alta, increased TT-TG distance, trochlear dysplasia, or abnormal lateral patellar tilt; only 18% had MPFL surgery. These findings suggest that primary care providers might consider obtaining X-rays and/or MRIs to evaluate for pathology that warrants orthopedic evaluation.
背景:膝关节前部疼痛是儿科骨科医生转诊的常见原因。尽管之前的研究发现,具有髌骨股骨不稳定(髌骨脱位)解剖学危险因素的成人易患膝关节前侧疼痛,但还没有研究阐明髌骨股骨不稳定解剖学危险因素与儿童膝关节前侧疼痛之间的关系。目的:我们试图描述以膝前疼痛为主诉的青少年患者的常见影像学发现,并确定髌骨形态异常的发生率。方法:我们对以膝关节前部疼痛为主诉的青少年患者进行了回顾性研究:我们对2016年至2021年期间在一家三级医疗都市机构就诊的13至18岁膝关节前侧疼痛患者进行了回顾性复查。对诊断为 "髌骨软化症"、"髌骨软化症"、"髌股关节紊乱 "或 "膝关节前部疼痛 "的患者进行了X光片和磁共振成像(MRI)评估。记录了髌骨高度、胫骨结节-韧带沟(TT-TG)距离、结节高度、Wiberg髌骨类型、髌骨倾斜度和韧带发育不良特征。结果在293名患有膝关节前部疼痛的青少年中,62人患有双侧膝关节前部疼痛。在 172 例核磁共振成像中,72 例(42%)符合髌骨上移标准,卡顿-德尚指数(CDI)>1.3,35% 的 TT-TG 距离>15 毫米,32% 的髌骨外侧倾斜>15°。磁共振成像结果包括髌下脂肪垫信号强度增高(41%)和髌骨发育不良(23%)。在所有293名青少年中,74%的人的图像显示髌骨形态异常,其中30%的人有过一次或多次髌骨脱位病史。总体而言,40%的青少年接受了手术治疗,其中最常见的是髌股内侧韧带(MPFL)重建术(18%)。结论:在这项回顾性研究中,近3/4的膝关节前疼痛青少年的图像显示髌骨形态异常,包括髌骨突出、TT-TG距离增加、髌骨发育不良或髌骨外侧倾斜异常;只有18%的青少年接受了MPFL手术。这些研究结果表明,初级保健提供者可以考虑获取 X 光片和/或核磁共振成像,以评估需要进行骨科评估的病理情况。
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引用次数: 0
Management of Concussion in the Young Athlete 年轻运动员脑震荡的处理
Pub Date : 2024-03-18 DOI: 10.1177/15563316241238014
Meghan A. Lamothe, Jillian Erickson, Kouros Emami
Sports-related concussion continues to be a rapidly growing public health concern in nearly all sports, and at all levels, in children and adolescents. Evidence-based clinical guidelines are constantly evolving but those specific to the pediatric population are less robust. There are nuances to treatment of the developing pediatric brain in the context of mild traumatic brain injury (mTBI). The purposes of this review are to (1) analyze the differences in concussion symptom presentation and recovery in children versus adults, (2) describe the role of the physical therapist in management of pediatric concussion, (3) examine current recommendations for return to participation in school and return to sport, and (4) highlight the psychological implications of concussion in the young athlete. We find that additional research is needed in nearly all aspects of concussion in the young athletic population. The current evidence stresses the importance of an active approach to recovery using a stepwise progression.
运动相关脑震荡仍然是一个快速增长的公共健康问题,几乎涉及所有运动项目和所有级别的儿童和青少年。以证据为基础的临床指南在不断发展,但专门针对儿科人群的指南却不那么健全。在轻微创伤性脑损伤(mTBI)的背景下,对发育中的小儿大脑进行治疗存在细微差别。本综述的目的是:(1)分析儿童与成人在脑震荡症状表现和恢复方面的差异;(2)描述理疗师在小儿脑震荡治疗中的作用;(3)研究当前关于重返校园和重返运动场的建议;以及(4)强调脑震荡对年轻运动员的心理影响。我们发现,在年轻运动员脑震荡的几乎所有方面都需要进行更多的研究。目前的证据强调了采用循序渐进的方式积极恢复的重要性。
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引用次数: 0
Return to Sports Following Spondylolysis Surgery in Children and Adolescents: A Systematic Review 儿童和青少年脊柱裂手术后重返运动场:系统回顾
Pub Date : 2024-03-16 DOI: 10.1177/15563316241234843
Preston W Gross, Michelle Yang, Ruth H. Jones, Shevaun M. Doyle
Spondylolysis is common in athletes participating in gymnastics, football, dance, and weightlifting. Few studies have reviewed return to sports (RTS) rates in young athletes after surgical intervention for spondylolysis. We sought to review the literature on RTS frequencies and timing, as well as postoperative treatment, in children and adolescents who underwent spondylolysis surgery. This was a systematic review, using the PubMed, Embase, and Cochrane databases, of primary, peer-reviewed studies published from 2014 to 2022 that investigated child and adolescent RTS after spondylolysis surgery. Each author independently reviewed each study’s design, number of participants, age range, fixation, postoperative course of treatment, frequency of RTS, and reasons for failure of RTS. The initial search produced 106 articles; 25 were reviewed in full and 9 were included in the final analysis, with a combined total of 177 patients. Sample sizes ranged from 5 to 52 participants. The most common fixations were direct repair (6 studies, n = 120), indirect repair (3 studies, n = 22), and fusion (2 studies, n = 35). Five studies mentioned the use of immediate postoperative immobilization. Physical therapy programs were initiated most often at 6 weeks postoperatively. The RTS rate of the 177 athletes (median age younger than 23 years) was 76% to 100%. The most common reason for failure to RTS was lower back pain. This systematic review suggests that young athletes RTS at a high rate following spondylolysis surgery, but more rigorous study is warranted. The review also found varied preferred fixation methodologies and postoperative treatment regimens across the available studies.
脊柱溶解症在体操、足球、舞蹈和举重运动员中很常见。很少有研究对脊柱溶解症手术治疗后年轻运动员的重返运动场(RTS)率进行回顾。我们试图回顾有关接受脊柱溶解手术的儿童和青少年恢复运动的频率和时间以及术后治疗的文献。我们使用 PubMed、Embase 和 Cochrane 数据库,对 2014 年至 2022 年间发表的有关脊柱裂手术后儿童和青少年 RTS 的主要同行评审研究进行了系统性回顾。每位作者独立审查了每项研究的设计、参与人数、年龄范围、固定方式、术后疗程、RTS发生频率以及RTS失败的原因。最初的搜索结果为 106 篇文章,其中 25 篇进行了全文审阅,9 篇纳入最终分析,合计共有 177 名患者。样本量从 5 到 52 人不等。最常见的固定方法是直接修复(6 项研究,n = 120)、间接修复(3 项研究,n = 22)和融合(2 项研究,n = 35)。有五项研究提到术后立即进行固定。物理治疗计划通常在术后 6 周开始实施。177名运动员(中位年龄小于23岁)的RTS率为76%至100%。未能进行 RTS 的最常见原因是下背部疼痛。这篇系统性综述表明,年轻运动员在脊柱溶解手术后的RTS率很高,但还需要进行更严格的研究。综述还发现,在现有的研究中,首选的固定方法和术后治疗方案各不相同。
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引用次数: 0
Variable Guidelines for Pediatric Medial Patellofemoral Ligament Reconstruction Rehabilitation Exists Across PRiSM Member Organizations PRiSM 成员组织的小儿内侧髌股韧带重建康复指南各不相同
Pub Date : 2024-03-13 DOI: 10.1177/15563316241233254
Elliot Greenberg, Joseph Hannon, Nathan Chaclas, Jeffrey Albaugh, Joseph T. Molony, Brendan A. Williams
Medial patellofemoral ligament (MPFL) reconstruction, typically used to restore stability to the patellofemoral joint after dislocation, often requires extensive rehabilitation to address acute impairment related to surgical intervention and also underlying non-anatomical deficits that may have contributed to the index injury. Rehabilitation guidelines, including objective functional performance assessment criteria, are lacking in the literature. We sought to summarize the clinical guidelines for rehabilitation and return to activity assessment after MPFL reconstruction as advocated by the member organizations of the Pediatric Research in Sports Medicine (PRiSM) Patellofemoral Research Interest Group (PF-RIG). We obtained and reviewed MPFL rehabilitation guidelines from 11 member organizations of the PRiSM PF-RIG, extracting information on weight-bearing advancement, bracing, use of supplemental strengthening modalities, and any objective criteria for advancing rehabilitation phases. We found highly variable agreement among guideline parameters at each treatment stage, with time-based criteria most widely used for early progression. Although functional metrics like strength or movement tests were more widely used in later phases of rehabilitation, there was substantial variation in testing mode and level of acceptable performance. Our review found that significant variability exists in current practice among PRiSM and PF-RIG member institutions regarding rehabilitation standards after MPFL reconstruction. Although we found broad consensus that objective strength or performance criteria should be employed to establish a better framework for clinical decision-making, most current guidelines lack standardization and sufficient detail to guide ideal clinical practice.
髌股关节内侧韧带(MPFL)重建通常用于恢复脱位后髌股关节的稳定性,通常需要大量的康复治疗,以解决与手术干预相关的急性损伤,以及可能导致指数损伤的潜在非解剖缺陷。文献中缺乏包括客观功能表现评估标准在内的康复指南。我们试图总结运动医学儿科研究(PRiSM)髌股关节研究兴趣小组(PF-RIG)成员组织倡导的 MPFL 重建后康复和恢复活动评估的临床指南。我们从 PRiSM PF-RIG 的 11 个成员组织获取并审查了 MPFL 康复指南,提取了有关负重推进、支撑、使用辅助强化方式以及推进康复阶段的任何客观标准的信息。我们发现,每个治疗阶段的指导参数之间的一致性差异很大,其中基于时间的标准最广泛用于早期进展。虽然力量或运动测试等功能性指标在康复的后期阶段得到了更广泛的应用,但测试模式和可接受程度存在很大差异。我们的研究发现,PRiSM 和 PF-RIG 成员机构在 MPFL 重建后的康复标准方面存在很大差异。尽管我们发现广泛的共识是应采用客观的强度或性能标准来建立更好的临床决策框架,但目前大多数指南缺乏标准化和足够的细节来指导理想的临床实践。
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引用次数: 0
Squeaking Shoulder Following Arthroscopic Shoulder Surgery: A Case–Control Study 肩关节镜手术后肩部吱吱作响:病例对照研究
Pub Date : 2024-03-13 DOI: 10.1177/15563316241236797
Si Heng Sharon Tan, V. P. Kumar, Joel Louis Zongwei Lim, R. Manohara, D. Z. Ng, Keng Soon Poh, Hsi Ming Bryan Tan
To date, the occurrence of unusual squeaking noises during shoulder movements following shoulder arthroscopic surgeries have been minimally reported. The aim of this study was to report the incidence, natural history, possible risk factors and functional outcomes of patients who reported to have squeaking noises following shoulder arthroscopic procedures. In this 2-year case-control study, all patients who underwent arthroscopic shoulder in a single institution were included. All patients were then evaluated preoperatively and postoperatively for demographics, pathology, surgical factors, and functional outcomes. The possible risk factors and functional outcomes of the patients who experienced squeaking following shoulder arthroscopic surgeries were then compared with those patients who did not experience squeaking following shoulder arthroscopic surgeries. Of the 360 patients included in the study, the incidence of squeaking following arthroscopic shoulder surgeries was 2.23%, and the incidence of squeaking following arthroscopic shoulder labral repair was 3.1%. The age, gender, hand dominance, body mass index, participation in sports, pathology, side of pathology, use of knot-tying versus knotless suture anchors, number of suture anchors, and surgical duration were not significantly different between patients who experienced squeaking and patients who did not. All patients had comparative functional outcomes preoperatively and postoperatively (at the 3-month, 6-month, and 1-year follow-ups). This case-control study provides an analysis of a series of patients with squeaking of the shoulder following arthroscopic shoulder surgeries. No risk factors or etiology of the condition have been identified in the series. However, there is no functional compromise among these patients who experienced squeaking following shoulder arthroscopic surgeries.
迄今为止,有关肩关节镜手术后肩部运动时出现异常吱吱声的报道极少。本研究旨在报告肩关节镜手术后出现吱吱声的患者的发病率、自然史、可能的风险因素和功能结果。在这项为期两年的病例对照研究中,纳入了在一家机构接受肩关节镜手术的所有患者。然后对所有患者进行术前和术后的人口统计学、病理学、手术因素和功能结果评估。然后将肩关节镜手术后出现吱吱声的患者与肩关节镜手术后未出现吱吱声的患者的可能风险因素和功能结果进行比较。在纳入研究的 360 名患者中,肩关节镜手术后出现吱吱声的发生率为 2.23%,肩关节镜肩关节唇修复术后出现吱吱声的发生率为 3.1%。出现吱吱声的患者与未出现吱吱声的患者在年龄、性别、手部优势、体重指数、运动参与度、病理类型、病理侧、使用打结缝合锚与无打结缝合锚、缝合锚数量以及手术持续时间等方面均无显著差异。所有患者在术前和术后(3 个月、6 个月和 1 年随访)的功能结果均具有可比性。该病例对照研究分析了一系列肩关节镜手术后出现肩关节吱吱声的患者。在这一系列病例中没有发现该病症的风险因素或病因。不过,这些在肩关节镜手术后出现吱吱声的患者并没有功能受损。
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引用次数: 0
ACL Injury Prevention Education Improves Implementation of Neuromuscular Training Among High School Sports Coaches: A Cross-Sectional Survey Study 前交叉韧带损伤预防教育提高了高中体育教练实施神经肌肉训练的水平:横断面调查研究
Pub Date : 2024-03-13 DOI: 10.1177/15563316241236194
J. Janosky, James Russomano, Connor Duscha, Alexandra Henderson, Alexandra Archer, James J Kinderknecht, Robert G. Marx
Neuromuscular training (NMT) programs delivered by trained personnel have demonstrated protective effects against anterior cruciate ligament (ACL) injury among high school sports participants, but few studies have investigated the impact of education on high school sports coaches’ knowledge and incorporation of NMT programs into daily practice sessions. We sought to evaluate changes in knowledge and behavior among high school sports coaches who completed an NMT-based injury prevention training program. High school sports coaches were invited to complete a free online training course in incorporating NMT into daily practice sessions. Anonymized surveys were administered before and after education and at 3 months to evaluate knowledge level and program effectiveness. Of the 13,640 coaches who enrolled in the training course in 2019, 1641 submitted pre- and post-education and 3-month follow-up surveys. Prior to training, 4.4% reported incorporating NMT into daily training sessions and the mean knowledge score was 1.89 ± 1.55. After training, 92.7% of participants reported that they intended to incorporate NMT into their daily training sessions and the mean knowledge score was 4.87 ± 1.11. At 3-month follow-up, 88.9% of participants reported incorporating NMT into daily training sessions. A chi-square test revealed a significant association between pre- and post-education incorporation of NMT into daily practice sessions, and a multiple regression analysis resulted in a significant model with intent to incorporate NMT into daily practice sessions identified as a significant behavior predictor. These survey results show that completion of a training course significantly improved ACL injury prevention knowledge among a cohort of high school sports coaches and likely contributed to the sustained incorporation of NMT into their daily practice sessions.
由训练有素的人员提供的神经肌肉训练(NMT)计划已证明对高中体育参与者的前十字韧带(ACL)损伤具有保护作用,但很少有研究调查了教育对高中体育教练的知识以及将 NMT 计划纳入日常训练课程的影响。我们试图评估完成基于 NMT 的损伤预防培训项目的高中体育教练在知识和行为方面的变化。我们邀请高中体育教练完成免费在线培训课程,将 NMT 纳入日常训练课程。在培训前后和 3 个月时进行了匿名调查,以评估知识水平和项目效果。在 2019 年报名参加培训课程的 13640 名教练中,有 1641 人提交了培训前后和 3 个月的跟踪调查。培训前,4.4% 的学员表示已将 NMT 纳入日常培训课程,平均知识分数为 1.89 ± 1.55。培训后,92.7% 的学员表示打算将 NMT 纳入日常培训课程,平均知识得分为 4.87 ± 1.11。在 3 个月的随访中,88.9% 的参与者表示已将 NMT 纳入日常训练课程。卡方检验显示,将 NMT 纳入日常练习课程的教育前和教育后之间存在显著关联,多元回归分析得出了一个显著模型,将 NMT 纳入日常练习课程的意图被确定为一个重要的行为预测因素。这些调查结果表明,完成培训课程极大地提高了一批高中体育教练的前交叉韧带损伤预防知识,很可能有助于将 NMT 持续纳入他们的日常训练课程。
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引用次数: 0
HSS Journal and Its Commitment to DEI: A Progress Report 人文社科期刊及其对 DEI 的承诺:进展报告
Pub Date : 2024-03-03 DOI: 10.1177/15563316241230949
Lauren A. Barber, Joy Jacobson, Charles N. Cornell
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引用次数: 0
Injury to the Main Branch of the Saphenous Nerve following Hamstring Tendon Graft Harvesting: A Report of 3 Cases 腘绳肌腱移植术后的隐神经主支损伤:3 个病例的报告
Pub Date : 2024-03-03 DOI: 10.1177/15563316241230285
Alexandra Flaherty, Cristian Escalera, Heather Haeberle, Stephen Fealy, Steve K. Lee
Hamstring tendon grafts are commonly utilized tendon autografts; however, the harvesting procedure can result in saphenous nerve injury due to its proximity to the semitendinosus and gracilis tendons. Injury to the main branch of the saphenous nerve is a less commonly reported and understood injury during these procedures. This case report aimed to identify and present cases of iatrogenic injury to the main branch of the saphenous nerve during hamstring tendon graft harvesting. A retrospective chart review of a tertiary-care hospital over the past 10 years was conducted. The search included clinical notes mentioning “saphenous neuropathy, neuralgia or neuritis” and magnetic resonance imaging (MRI) reports indicating saphenous nerve involvement. Patients with a history of a hamstring graft harvesting procedure and radiographically confirmed injury to the main branch of the saphenous nerve were included. Injury characteristics, symptoms, and sequential treatment were evaluated. Three cases of iatrogenic injury to the main branch of the saphenous nerve during hamstring graft harvesting were identified. Reported symptoms included pain, paresthesia, numbness, hypersensitivity, swelling, and discoloration. All 3 patients had persistent symptoms despite non-operative treatment and therefore underwent surgical intervention, which involved resection and reconstruction using allograft or burial into adjacent musculature. Postoperatively, 2 of 3 patients demonstrated resolution of symptoms. Iatrogenic injury to the main branch of the saphenous nerve is a complication that can occur during hamstring tendon harvesting procedures, leading to severe, persistent symptoms. A better understanding of the mechanism of injury is needed to minimize the risk of iatrogenic injury.
腘绳肌腱移植是常用的肌腱自体移植;但是,由于其靠近半腱肌和擒拿肌腱,采集过程可能会导致隐神经损伤。隐神经主支损伤是此类手术中较少报道和了解的损伤。本病例报告旨在确定并介绍在腘绳肌腱移植过程中隐神经主支先天性损伤的病例。我们对一家三级甲等医院过去 10 年的病历进行了回顾性检索。搜索范围包括提及 "隐神经病变、神经痛或神经炎 "的临床记录,以及显示隐神经受累的磁共振成像(MRI)报告。检索对象包括有腿筋移植手术史且经放射学证实隐神经主支受伤的患者。对损伤特征、症状和后续治疗进行了评估。共发现三例在腘绳肌移植物摘取过程中造成的隐神经主支先天性损伤。报告的症状包括疼痛、麻痹、麻木、过敏、肿胀和变色。尽管进行了非手术治疗,但这 3 名患者的症状仍持续存在,因此接受了手术治疗,包括切除和使用同种异体移植或埋入邻近肌肉组织进行重建。术后,3 名患者中有 2 人的症状得到缓解。隐神经主支的先天性损伤是腿筋肌腱采集手术中可能发生的并发症,会导致严重的持续性症状。需要更好地了解损伤机制,以最大限度地降低先天性损伤的风险。
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引用次数: 0
Tarsal Coalition: Surgical Management in the Young Athlete 跗关节联盟:年轻运动员的手术治疗
Pub Date : 2024-03-01 DOI: 10.1177/15563316241231791
J. Masquijo, Florencia Turazza
Tarsal coalition is an abnormal bony, cartilaginous, or fibrous bridge between 2 or more tarsal bones. Adolescent athletes with tarsal coalitions typically present with symptoms that include foot and/or ankle pain and limited range of motion. Loss of mobility can lead to abnormal loading, articular instability, deformity, and joint degeneration. Nonoperative management includes immobilization, physical therapy, and custom foot orthosis. Surgical options include coalition excision and fat graft interposition, foot realignment, or a combination of these. Surgical treatment requires evaluation of the coalition type, foot alignment, and degenerative changes in the adjacent joints.
跗骨联合是指两块或多块跗骨之间的骨桥、软骨桥或纤维桥异常。患有跗骨联合的青少年运动员通常会出现足部和/或踝部疼痛、活动范围受限等症状。活动度的丧失会导致异常负荷、关节不稳定、畸形和关节退化。非手术治疗包括固定、物理治疗和定制足部矫形器。手术治疗包括联盟切除和脂肪移植、足部矫正或上述方法的组合。手术治疗需要对联盟类型、足部排列和邻近关节的退行性变化进行评估。
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引用次数: 0
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HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery
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