运动员上肢应力性骨折。文献综述

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上肢应力性（过度使用性）骨折是运动员中较为少见的一类病变。由于其发病缓慢、临床症状通常不明显，且影像学检查有时无异常发现，该病常被漏诊。本文旨在汇总该病的发病机制、临床特征、诊断方法与治疗策略的最新研究数据。通过PubMed（MEDLINE）数据库和Google搜索系统，对1975年至2024年间的文献进行了检索，采用“стрессовые переломы”（应力性骨折）、“нагрузочные переломы”（过度使用性骨折）、“верхние конечности”（上肢）、“спортсмены”（运动员）等关键词（stress fractures, overuse fractures, upper extremities, athletes），并组合使用OR和AND运算符。共计纳入70篇文献，其中 22篇发表于近10年内。应力性（过度使用性）骨折在约40%的运动员中发生，其中80–95%累及下肢， 仅有5–20%为上肢骨折。其发生原因是骨骼在反复机械负荷作用下，伴随骨周肌肉疲劳，使得破骨细胞介导的骨组织吸收速度超过成骨细胞介导的新骨生成速度。磁共振成像是首选的诊断手段。多数患者通过限制负荷和调整运动方式（如避免反复性致伤动作）即可实现骨折愈合。在某些情况下，如“体操运动员腕”III期、移位达到或超过10 mm的内上髁撕脱性骨折、尺侧副韧带部分或完全断裂、鹰嘴骨折及腕骨骨折等，常需进行外科干预。尽管上肢应力性骨折的发生率不高，但对运动员的竞技能力和职业发展可能造成显著影响。详尽的病史采集、体格检查与损伤机制分析有助于临床医生识别该病。通过合理限制训练负荷、避免诱因、逐步恢复训练强度并优化运动技术，多数患者可避免手术治疗并成功重返运动赛场。

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作者简介

Olga E. Agranovich

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

编辑信件的主要联系方式.
Email: olga_agranovich@yahoo.com
ORCID iD: 0000-0002-6655-4108
SPIN 代码: 4393-3694

MD, PhD, Dr. Sci. (Medicine)

俄罗斯联邦, Saint Petersburg

Sergei V. Vissarionov

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: vissarionovs@gmail.com
ORCID iD: 0000-0003-4235-5048
SPIN 代码: 7125-4930

MD, PhD, Dr. Sci. (Medicine), Professor, Corresponding Member of RAS

俄罗斯联邦, Saint Petersburg

Ekaterina V. Petrova

Email: pet_kitten@mail.ru
ORCID iD: 0000-0002-1596-3358
SPIN 代码: 2492-1260

MD, PhD, Cand. Sci. (Medicine)

俄罗斯联邦

Svetlana I. Trofimova

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: trofimova_sv@mail.ru
ORCID iD: 0000-0003-2690-7842
SPIN 代码: 5833-6770

MD, PhD, Cand. Sci. (Medicine)

俄罗斯联邦, Saint Petersburg

Andrey V. Sapogovskiy

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: sapogovskiy@gmail.com
ORCID iD: 0000-0002-5762-4477
SPIN 代码: 2068-2102

MD, PhD, Cand. Sci. (Medicine)

俄罗斯联邦, Saint Petersburg

Alina M. Khodorovskaya

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: alinamyh@gmail.com
ORCID iD: 0000-0002-2772-6747
SPIN 代码: 3348-8038

MD

俄罗斯联邦, Saint Petersburg

Evgeny D. Blagovechtchenski

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: eblagovechensky@hse.ru
ORCID iD: 0000-0002-0955-6633
SPIN 代码: 2811-5723

PhD, Cand. Sci. (Biology)

俄罗斯联邦, Saint Petersburg

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