【作者】 郑超；

【导师】 伍骥；

【作者基本信息】 中国医科大学 ， 外科学， 2007， 硕士

【摘要】 目的首先，通过对空降兵部队官兵进行流行病学调查，了解空降兵在日常的地面训练和跳伞训练中着陆时各种损伤的部位、类型及发病率，特别是针对踝关节的损伤进行详细的调查，对造成踝关节损伤的原因进行归纳总结，并进行统计学分析。对统计的结果进行讨论，深入研究不同的致伤因素之间、与踝关节损伤之间的相互关系，提出预防或避免跳伞着陆损伤的方法。根据流行病学的调查结果，对10具人体踝关节标本模拟空降兵特殊着陆姿势下进行生物力学实验，测出造成踝关节韧带损伤、骨质结构损伤时所受承载力的耐限，探讨如何能够增加踝关节各结构承受着陆冲击力的能力，尽可能的减少空降兵训练时踝关节损伤的发生率，以提高空降兵部队的战斗力。方法1．到空降部队调查前，我们阅读了大量的有关空降兵跳伞着陆损伤的材料，根据文献及相关资料，设计调查问卷，问卷的内容尽量详细，以使所获资料的尽可能丰富。在调查的过程中，为保证资料的客观性，我们对调查对象所对应医院、各门诊部、卫生队的入院记录、门诊病历及接诊登记进行查对，同时与医院的领导、门诊部和卫生队负责人进行座谈，与调查对象的官兵进行座谈，详细了解部队官兵的日常训练情况、因训练所致的损伤情况、跳伞着陆的正确姿势、目前的伞型、装备等。2．资料收集完毕后，对所有数据进行整理，分别归类。分析不同条件下伞兵身体各部位的损伤情况，对造成踝关节损伤的8种常见原因进行多因素分析，找出相应的危险因素和保护因素。统计结果根据资料的性质进行X2检验和T检验，多因素分析使用SPSS软件。3．统计结果完毕后，根据空降兵着陆时踝关节处于跖屈30°左右姿势下，对10具人体新鲜踝关节标本实施生物力学的测定，了解外侧副韧带损伤、最大内翻情况下骨性结构的损伤情况，得出三种损伤的耐限值。对三组不同的数据进行方差分析，为下一步的防护实验做好充分准备。结果1．我们对某空降部队397名官兵进行了问卷调查，同时参照受伤官兵的门诊或入院病历，以明确诊断。根据调查资料进行整理，所有踝关节受伤的官兵无论损伤的次数，符合诊断标准的均记为一例，因为其他的同性质损伤均与此次受伤有关，既按病例人数进行统计。其中受伤人员为173例，包括踝关节损伤70例，膝关节损伤13例，脊柱损伤49例，其他部位损伤41例，损伤时间为2004-2006年。地面跳台训练中以脊柱损伤为主，跳伞着陆训练以四肢损伤为主。2．另外收集踝关节及胫腓骨损伤病例18人，与其同时跳伞但未损伤的士兵14人，总计32人。与伤员取得联系后，到其所在部队进行调查，将与其同时跳伞的14人作为正常对照，进行多因素分析，使用SPSS软件。结果显示地面情况(X2)、风向(X5)为危险因素，有无护踝(X3)及跳伞年限(X8)为保护因素。3．统计数据得出后，我们对10具新鲜人体踝关节标本进行生物力学测定，结果是静力学条件下，外侧副韧带损伤所需要的承载力平均为2062.62N，足部骨性结构损伤所需要的承载力平均为3755.4286N。结论1．本研究首先通过流行病学调查，了解到空降兵跳伞着陆时和地面训练时的损伤因素及机制，既着陆损伤受多种因素的影响。最主要的直接原因就是对伞具的操作不当和着陆姿势不正确，其中后者的影响更大，是主要因素。而其他几种原因则是间接影响了跳伞员的着陆姿势，另外，伞兵的心理素质、跳伞经验、以及多次的损伤都有可能对伞兵跳伞产生影响。2．对几种致伤因素的分析后，得出结论，就是跳伞次数少(小于16次)的伞兵和跳伞次数较多(大于24次)的伞兵跳伞着陆损伤的发生率相对较高。原因可能是经验不足或是跳伞难度增加。不同伞龄和不同跳伞次数的官兵在跳伞训练和地面训练所致的损伤中是没有差异的，而跳伞训练时踝关节的损伤较多，地面训练时脊柱的损伤较多。另外，凡是跳伞着陆时踝关节涉及到骨折的往往都比较严重，单纯的内或外踝骨折比较少见，这与伞兵跳伞着陆时踝关节的特殊姿势有关。3．比较几种可能的致伤因素，调查的8种致伤因素中，地面情况(X2)、风向(X5)是危险因素，护踝(X3)及跳伞年限(x8)是保护因素，其中护踝的保护意义更大。当然，这些因素只是所有因素的一部分，由于时间及经费的关系，暂无法做到全面而详细。4．生物力学试验是模拟伞兵着陆时踝关节的特殊体位进行的，由于标本的限制，只能对踝关节跖屈时最大内、外翻角度下韧带损伤所需的最小承受力，以及踝关节在中立位时骨性结构损伤的最小承受力进行测定。将新鲜踝关节标本去除皮肤、皮下软组织、肌肉等，仅保留踝关节周围的韧带和支持带。结果是外侧副韧带损伤时所需承载平均为2063.62N；骨性结构损伤所需的承载平均为3380.28N。结果表明两组的差异有统计学意义(P≤0.05)。但是，实际中的运动是动态的，它与试验的结果仍有一定的差别。更多还原

【Abstract】 ObjectiveTo investigate the positions and the types of ankle injury and the incidence of different injuries in parachuting- soldiers while they executed daily ground train and parachute train. In these inquisitions, we found out some factors of ankle injury and investigated the correlation among these factors. By carry through statistic analysis, we analyzed these outcomes and discovered the relationship of various injury factors. According to the result of the Epidemiology invigastion, we put a biomechanics experiment into practice with 10 ankle joint specimens of human in order to find out how to reduce the impress force which results in some injuries of the ankle joint ligaments and the bone structure.Methods(1) we design a questionnaire to get the messages of the positions and the types of ankle injury of all soldiers. In the process of investigate, in order to promise the objectivity of the data, we check a lot of records of the hospital, sanitation of troops. In the meantime, we, in detail, inquired about the parahuteing train, loading posture ,umbrella type and equipments, etc.(2) when we have collected all data of various injuries, a analysis will be executed to the result in 8 kinds of familiar reason that the ankle joint hurt and find out interrelated danger factor and protective factors. The statistics findings will be analyzed with X2 examination, T examination and SPSS software. (3) we gain some data from a biomechanical experiment about 10 fresh ankle joint specimens of the human body and force on these specimens to induce some injuries in ankle joints. We use a square to differ analysis to three sets of different data.Results(1)We inquired 397 soldiers and of the total,, there are 173 soldiers who had suffer from different injuries between 2004 and 2006, including 70 cases of the ankle joint hurt, 13 cases of the knee joint hurt, 49 cases of the spinal column hurt, 41 cases of other parts hurt.(2) Moreover, We inquired 32 soldiers including 18 cases whose ankle joints or the tibia and fibula hurt and 14 cases who have never suffer from injuring. We used SPSS software to analysis two groups. The result showed that the ground circumstance(X2) and the direction of wind(X5) were risk factors, the ankle bands (X3) and the prachuting years (X8) were protective factors. (3) We made use of 10 fresh ankle joints of human body to carry on the biomechanics measurement. The lateral collateral ligament would be hurt at 2062.62 Ns on average and the bone structure need 3380. 28 Ns on average when these hurts occured .Conclusion(1) These injuries can take place in different conditions. A soldier can be hurt when he land after parachuting with the error operation to the parachute and the error posture.(2) The injury of ankle joint often occur as the parachutist train on parachuting and the injury of spine more take place when training on the ground. Moreover, the degree of injury following fracture is awfully severe. The only fracture in anklebone seldom happened owing to special loading posture.(3)In 8 harm factors, the ground circumstance(X2) and the direction of wind(X5) were risk factors, the ankle bands (X3) and the parachuting years (X8) were protective factors. The ankle band must play an important role to void the injury of ankle joint.(4) The varus of ankle joint made the ligament strain so that it can be injured easily. In the condition, it need press the weight of 2603.62N on the ligament. The weight of 3380.28 N on average can lead to hurt of bone structure on the neutral site.更多还原