耻骨下支应力性骨折与解剖结构的相关性研究
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摘要
目的分析与耻骨下支应力性骨折有关的解剖结构因素,评估其相关性的大小,并建立预测模型。方法回顾性调查2015年1月至2018年1月我院就诊的2 071名军人,筛选出近1个月有高强度训练史、耻骨区域无外伤史的共181例,其中男163例,女18例,年龄18～25岁,平均21.6岁。耻骨下支骨折24例,耻骨下支无骨折157例。根据骨盆正位X线片测得解剖结构数据包括:耻骨联合宽度、耻骨下支的长度、双侧耻骨下支夹角、耻骨下支最细处宽度、颈干角。利用Logistic回归模型对数据进行分析和预测。结果不同解剖结构因素对耻骨下支应力性骨折的影响分别为:颈干角影响不显著(相关性分析P>0.05),耻骨联合宽度和耻骨下支长度影响较小(相关性分析P<0.01,Logistic回归分析P>0.05),双侧耻骨下支夹角和耻骨下支最细处宽度影响显著(相关性分析P<0.01,Logistic回归分析P<0.01)。得到最优化的回归方程:In■,预测灵敏度为83.3%,特异度为82.2%。结论影响耻骨下支应力性骨折最主要的解剖结构因素为双侧耻骨下支夹角和耻骨下支最细处宽度,双侧耻骨下支夹角越大、耻骨下支最细处宽度越小,发生耻骨下支应力性骨折的风险越高;通过预测模型可以对新兵进行耻骨下支应力性骨折风险评估,准确度较高。
Objective To analyze the anatomical structural factors related to the ramus inferior ossis pubis stress fracture of military training recruits,assess their relevance,and establish a prediction model.Methods A retrospective survey of 2 071 military personnel who were treated in our hospital from January 2015 to January 2018 was conducted,with 181 cases(Male:163 Female:18 Age:18～25 Average age:21.6) having high-intensity training history and no history of trauma in the pubic region in the previous month.The cases included 24 with ramus inferior ossis pubis fracture and 157 with no ramus inferior ossis pubis fracture.The anatomical structure data measured from the radiograph of the pelvis included the width of symphysis pubis,the length of the ramus inferior ossis pubis,the intersection angle of bilateral ramus inferior ossis pubis,the width of the thinnest section of ramus inferior ossis pubis and collodiaphysial angle.The data was analyzed and predicted through Logistic Regression Model.Results The effect of collodiaphysial angle was not obvious(correlation analysis P>0.05);the width of symphysis pubis and the length of the ramus inferior ossis pubis had insignificant effect(correlation analysis P<0.01,logistic regression analysis P>0.05);Intersection angle of bilateral ramus inferior ossis pubis and the width of the thinnest section of ramus inferior ossis pubis have significant impacts(correlation analysis P<0.01,logistic regression analysis P<0.01);The optimized regression equation is:■.The predicted sensitivity was 83.3% and the specificity was 82.2%.Conclusion The most significant anatomical structural factor that affects ramus inferior ossis pubis stress fracture is the intersection angle of bilateral ramus inferior ossis pubis and the width of the thinnest section of ramus inferior ossis pubis.The larger the intersection angle of bilateral ramus inferior ossis pubis and the narrower the width of the thinnest section of ramus inferior ossis pubis is,the higher the risk of the ramus inferior ossis pubis stress fracture will be.In addition,with high accuracy,the prediction model can be applied to evaluate the risk of ramus inferior ossis pubis stress fracture of military training recruits.
Objective To analyze the anatomical structural factors related to the ramus inferior ossis pubis stress fracture of military training recruits,assess their relevance,and establish a prediction model.Methods A retrospective survey of 2 071 military personnel who were treated in our hospital from January 2015 to January 2018 was conducted,with 181 cases(Male:163 Female:18 Age:18～25 Average age:21.6) having high-intensity training history and no history of trauma in the pubic region in the previous month.The cases included 24 with ramus inferior ossis pubis fracture and 157 with no ramus inferior ossis pubis fracture.The anatomical structure data measured from the radiograph of the pelvis included the width of symphysis pubis,the length of the ramus inferior ossis pubis,the intersection angle of bilateral ramus inferior ossis pubis,the width of the thinnest section of ramus inferior ossis pubis and collodiaphysial angle.The data was analyzed and predicted through Logistic Regression Model.Results The effect of collodiaphysial angle was not obvious(correlation analysis P>0.05);the width of symphysis pubis and the length of the ramus inferior ossis pubis had insignificant effect(correlation analysis P<0.01,logistic regression analysis P>0.05);Intersection angle of bilateral ramus inferior ossis pubis and the width of the thinnest section of ramus inferior ossis pubis have significant impacts(correlation analysis P<0.01,logistic regression analysis P<0.01);The optimized regression equation is:■.The predicted sensitivity was 83.3% and the specificity was 82.2%.Conclusion The most significant anatomical structural factor that affects ramus inferior ossis pubis stress fracture is the intersection angle of bilateral ramus inferior ossis pubis and the width of the thinnest section of ramus inferior ossis pubis.The larger the intersection angle of bilateral ramus inferior ossis pubis and the narrower the width of the thinnest section of ramus inferior ossis pubis is,the higher the risk of the ramus inferior ossis pubis stress fracture will be.In addition,with high accuracy,the prediction model can be applied to evaluate the risk of ramus inferior ossis pubis stress fracture of military training recruits.
引文
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[3]全昌斌,由昆,李小龙,等.军训致耻骨支应力性骨折66例临床分析[J].解放军医学杂志,2002,27(8):740-742.
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[6]庄颖,杨萌,许章元,等.军事训练致女兵耻骨支应力性骨折的回顾性调查[J].解放军医药杂志,2015,27(8):101-104.
[7]Hill PF,Chatterji S,Chambers D,et al.Stess fracture of the pubic ramus in female recruits[J].J Bone Joint Surg(Br),1996,78(3):383-386.
[8]Pope RP.Prevention of pelvic stress fractures in female army recruits[J].Mil Med,1999,164(5):370-373.
[9]Kelly EW,Jonson SR,Cohen ME,et al.Stress fractures of the pelvis in female navy recruits:an analysis of possible mechanisms of injury[J].Mil Med,2000,165(2):142-146.
[10]王满,胡亚兰,魏瑞琐,等.军训女兵骨盆应力性骨折愈合时间研究[J].临床军医杂志,2004,32(1):20-21.
[11]孙献勇,时维东,肖永鑫,等.军训致耻骨下支应力性骨折15例临床及影像学分析[J].人民军医,2013,56(9):1010-1011.
[12]张宏文,钟世镇,王生虎,等.耻骨下支性别差异与训练伤的关系[J].中国临床解剖学杂志,1996,14(1):44-45.
[2]Cosman F,Ruffing J,Zion M,et al.Determinants of stress fracture risk in United States Military Academy cadets[J].Bone,2013,55(2):359-366.
[3]全昌斌,由昆,李小龙,等.军训致耻骨支应力性骨折66例临床分析[J].解放军医学杂志,2002,27(8):740-742.
[4]全昌斌,姚茹国,贾树林,等.耻骨支应力性骨折的螺旋CT表现[J].临床放射学杂志,2001,20(11):865-868.
[5]全昌斌,由昆,张毅军,等.耻骨支应力性骨折的X线诊断[J].中华放射学杂志,2001,35(11):818-820.
[6]庄颖,杨萌,许章元,等.军事训练致女兵耻骨支应力性骨折的回顾性调查[J].解放军医药杂志,2015,27(8):101-104.
[7]Hill PF,Chatterji S,Chambers D,et al.Stess fracture of the pubic ramus in female recruits[J].J Bone Joint Surg(Br),1996,78(3):383-386.
[8]Pope RP.Prevention of pelvic stress fractures in female army recruits[J].Mil Med,1999,164(5):370-373.
[9]Kelly EW,Jonson SR,Cohen ME,et al.Stress fractures of the pelvis in female navy recruits:an analysis of possible mechanisms of injury[J].Mil Med,2000,165(2):142-146.
[10]王满,胡亚兰,魏瑞琐,等.军训女兵骨盆应力性骨折愈合时间研究[J].临床军医杂志,2004,32(1):20-21.
[11]孙献勇,时维东,肖永鑫,等.军训致耻骨下支应力性骨折15例临床及影像学分析[J].人民军医,2013,56(9):1010-1011.
[12]张宏文,钟世镇,王生虎,等.耻骨下支性别差异与训练伤的关系[J].中国临床解剖学杂志,1996,14(1):44-45.