2010级运动人体科学运动损伤与恢复专业方向研究生试卷M答案.doc

2010级运动人体科学运动损伤与恢复专业方向研究生试卷Anterior cruciate ligament (ACL) 前交叉韧带 Pathophysiology:病理学 The mechanism of ACL injury in the skeletally immature is the same as in adults, with most being noncontact. 在插管对骨未成熟前交叉韧带损伤的机制是成年人，而非接触的大部分相同。 Females have a higher incidence of noncontact ACL injury than their male counterparts. 女性具有非接触前交叉韧带损伤比男性的高发病 ACL injuries in this population may be tibial spine bony avulsions as well as ligament tears. 在这一人群的 ACL 损伤可能胫骨骨棘以及韧带撕裂。 ACL injury has been reported in up to 65% of children with acute hemarthrosis. 前交叉韧带损伤据报在小儿急性膝关节积血的 65%。 The presence of open growth plates requires special attention in determining treatment of ACL injuries. 开放的生长板的存在需要特别注意，在确定 ACL 损伤的治疗。Evaluation:评价 History原因 Establish the mechanism of injury. Classic presentation is sudden deceleration or twisting injury with a pop, immediate swelling, and inability to continue playing. 建立损伤的机制。经典的演示文稿是突然减速或扭曲损伤流行，立即肿胀，以及无法继续播放。 Physical examination体格检查 A positive Lachman test is sufficient to make the diagnosis. 积极的拉赫曼测试足以进行诊断。 Evaluate for other associated injuries, including ligamentous injury, patellofemoral instability, and meniscal injury. 其他相关的伤害，包括韧带损伤、 髌股关节不稳和半月板损伤的评估。 Imaging图像描述 Standard four-view x-rays: weight-bearing AP and tunnel; lateral with knee in extension; axial patellar view at 30- or 45- of knee flexion (merchant,sunrise). 标准四视图 x 射线： 负重 AP 和隧道 ；横向扩展 ； 在膝在 30 或 45 的膝关节屈曲 （商人，日出) 的轴向髌骨视图。 MRI is helpful in determining the extent of the ligamentous injury as well as associated injuries such as meniscal tears and chondral lesions. 磁共振成像是有助于确定韧带损伤的严重程度以及相关如半月板和软骨病变的损伤。Treatment:治疗方法 Initial treatment involves ice, compression and restoration of ROM, especially extension (not immobilization) and protected weight bearing. 首次处理涉及冰、 压缩和修复的 ROM，尤其是扩展名 （而不是固定），与保护负重。 Tibial spine ACL avulsions need urgent evaluation for surgery. 胫骨棘撕 ACL 手术需要紧急的评价。 Concern exists regarding surgical management of intrasubstance ACL injuries in adolescents with open growth plates. 关于青少年开放生长板 intrasubstance ACL 损伤的外科治疗存在着关切。 Nonoperative management has shown poor results as activity modification in adolescents is difficult and bracing provides little or no protection. 非手术治疗已显示业绩不佳，为青少年活动修改是困难和支撑提供很少或没有保护。 Postoperative rehabilitation and RTP criteria are the same as adults. 术后的康复和 RTP 标准是成年人一样。Prevention:预防 Implement a sport-specific conditioning program with periodization (3,4), including these elements that have been shown to have efficacy in specific populations: 实施专项运动调节程序与分期 （3，4），包括这些已显示在特定的人群中有效果的元素： Motor control (including core and lower extremity strength, balance, and flexibility) 电机控制 （包括核心和较低的下肢力量、 平衡和灵活性） Technique training to include landing and sport-specific athletic skills programs技术培训，包括升降和专项运动竞技程序 Risk awareness education风险意识教育 Proper care of playing surfaces and selection of shoe wear适当的照顾玩曲面和鞋磨损的选择 No prophylactic bracing has been shown to reduce ACL injury risk. 没有预防性支撑已被证明能减轻 前交叉韧带 损伤的风险。It is essential that the team physician: 至关重要的是，医师团队协作： Understand the classic history and mechanism of ACL injury. 了解经典历史和前交叉韧带损伤的机制。 Perform a Lachman test.执行拉赫曼测试 Understand the poor prognosis of the ACL deficient knee, especially in the adolescent. 了解预后不良的 ACL 缺膝，尤其是在青少年中。 Identify tibial spine ACL avulsions. 确定胫骨棘 ACL。It is desirable that the team physician: 最好的医师团队协作： Recognize risk of noncontact ACL injury in adolescent female athletes and implement risk reduction strategies through the athletic care network. 认识到在青少年女子运动员的非接触式前交叉韧带损伤的风险和实施减少风险的策略，通过体育保健网络。 Understand that current surgical procedures allow for reconstruction in the skeletally immature athlete.了解当前的外科程序允许重建插管对骨未成熟的运动员。 Understand the associated injuries that may accompany or result from ACL instability. 了解相关的伤害可能伴随或从 ACL 不稳定导致。Osteochondritis dissecans (OCD) 强迫性神经官能症Pathophysiology:病理学 OCD is an acquired, potentially reversible idiopathic lesion of subchondral bone resulting in delamination and sequestration with or without articular cartilageinvolvement and instability. 强迫症是项收购，可能是可逆的特发性病变，软骨下骨中分层和封存有无软骨参与和不稳定造成。 Skeletally immature athletes with an OCD lesion and an intact articular surface have a potential for healing through cessation of repetitive impact loading. 强迫症病变与关节表面完整插管对骨未成熟运动员有潜力通过停止加载的反复冲击的愈合。 Skeletally mature athletes with an OCD lesion have a poorer prognosis. 强迫症病变插管对骨成熟运动员有较贫穷的预后。 The presence of mechanical symptoms such as locking or catching may indicate unstable osteochondral fragments. 机械的症状，如锁定或捕捉的存在可能表示不稳定的软骨碎片。Evaluation:评价History原因 Presentation is generally nonspecific and includes poorly localized knee pain.一般非特异性演示文稿，包括差本地化的膝痛。 Establish the presence of mechanical symptoms. 建立机械症状的存在。 Physical examination体格检查 There are no specific physical examination findings for OCD, although pain may be elicited with flexion, extension, internal, and external rotation and areas of tenderness may be palpated. 没有具体的体检结果的强迫症，虽然可能引起疼痛，屈、 延伸，内部，与外部的旋转和可能触及的温柔的领域。 Observe for an antalgic gait. 观察镇痛的步态。 Imaging图像描述 Standard four-view x-rays: weight-bearing AP and tunnel; lateral with knee in extension; axial patellar view at 30- or 45- of knee flexion (merchant,sunrise).标准四视图 x 射线： 负重 AP 和隧道 ；横向扩展 ； 在膝在 30 或 45 的膝关节屈曲 （商人，日出) 的轴向髌骨视图。 MRI provides useful information including lesion size and stability and articular cartilage and subchondral bone. 磁共振成像提供有用的信息，包括病变大小和稳定性和关节软骨及软骨下骨。Treatment:治疗方法 Prognostic factors guide treatment and include status of the growth plate, articular cartilage and subchondral bone, and lesion size, location and stability.预后因素指导治疗，并包括生长板、 关节软骨及软骨下骨，病变大小、 位置和稳定的状态。 Outcome of symptomatic OCD with stable lesions and open growth plates is favorable with rest from offending activities. 稳定的病变与开放的生长板的强迫症症状的结果是有利与从其他违法活动。 Surgery should be considered in skeletally immature patients with unstable lesions and in those patients approaching growth plate closure whose symptoms persist despite nonoperative management. 插管对骨不成熟不稳定的病变患者和那些接近生长板封闭其症状持续非手术治疗的病人中，应考虑手术。It is essential that the team physician: 至关重要的是，医师团队协作： Be able to diagnose OCD. 能够诊断强迫症。It is desirable that the team physician: 最好的医师团队协作：Understand the natural history and prognostic factors of OCD in the knee.了解自然史和膝关节强迫症的预后因素。 Understand nonoperative and operative treatments of OCD.了解手术和手术治疗强迫症 Work with the athletic care network to educate athletes, parents, and coaches regarding OCD. 工作与体育保健网络教育运动员、 家长及有关强迫症的教练。The Adolescent Throwers Elbow青少年运动员的手肘Pathophysiology:病理学 Valgus loads with rapid elbow extension produces: 外翻加载与快速弯头扩展生产： Tensile stress along the medial compartment restraints拉应力沿内侧隔室的限制 Shear stress in the posterior compartment在后车厢内剪应力 Compression stress on lateral structures压缩应力横向结构 These loads can come from overuse, poor kinetic chain mechanics, weak shoulder or arm muscles, and a large number of pitches. 这些负载可以来自过度使用、 可怜的动力学链力学、 弱的肩或手臂的肌肉，和一大批球场。Evaluation:评价 History原因 Determine acute versus chronic injury, location of pain, mechanical symptoms, and decline in performance. 确定急性与慢性损伤，疼痛，机械的症状，位置和性能下降。 Identify injuries in the kinetic chain. 确定动力学链中的受伤。 Measure excessive throwing by number of pitches per game or pitches per season.过度引发的每场比赛的球场或每季的摊位数的措施。 Physical examination体格检查 Perform elbow examination to include areas of tenderness, ROM, valgus stress testing, manual muscle testing, and ulnar nerve testing. 执行包括温柔、 ROM、 外翻的压力测试、 手动肌肉测试和尺神经测试领域的弯头考试。 Evaluate kinetic chain to include core stability,scapular motion and position, and GIRD评估包括核心稳定、 肩胛议案和地位，和网格的动力学链 Imaging图像描述 X-rays in two planes and consider comparison views with open growth plates.X 光片中两个飞机，并考虑比较开放的生长板的意见。 MRI with intra-articular contrast is useful to better define injury, including ligamentous and osseus injuries, and articular cartilage lesions.有必要更好地定义损伤，包括韧带和 osseus 受伤，关节软骨病变 MRI 与关节内的对比。Treatment:治疗方法 Most injuries are the result of overuse and can be successfully treated with relative rest, rehabilitation,and modification of throwing demands (4). 大多数受伤是过度使用的结果，并能成功地治疗相对休息、 康复和抛出的要求 (4) 修改。 Medial epicondylar avulsions need urgent evaluation for surgery.内侧上髁 avulsions 手术需要紧急的评价。 Elbow injuries that need evaluation for surgery may include ulnar collateral ligament injury unresponsive to conservative treatment or OCD lesions with mechanical symptoms. 手术需要评估的肘部损伤可能包括尺侧副韧带损伤保守治疗或机械的症状与强迫症病变没有响应。Prevention:预防 Decreasing exposure to overuse and preservation of musculoskeletal and biomechanical factors has been shown to be the best preventative program (9).降低曝光过度使用和保存的肌肉骨骼和生物力学因素经证明是最好的预防计划 (9)。 Enforcement of pitch counts per game and per season and limitation of specialty pitches in skeletally immature athletes (9). 沥青计数，每场比赛和每季的执法和限制的专业足球场插管对骨未成熟运动员 (9)。 Work with the athletic care network to educate athletes,parents, and coaches regarding overuse and overexposure. 工作与体育保健网络教育运动员、 家长及有关过度使用和过度的教练。It is essential that the team physician: 至关重要的是，医师团队协作