目的 探讨军事训练中少见或罕见部位应力性骨折的发生规律。方法 以“应力性骨折或疲劳性骨折”为关键词在图片存储与传输系统(PACS)上查询2018-01-01至2023-05-31确诊的军人应力性骨折,收集并分析患者的一般资料(性别、年龄及身份)、临床资料(现病史、体格检查及临床表现)及影像学资料(X线、CT及MRI图像)。所有病例图像均由两名高年资影像医师独立阅片,如有不一致结果相互协商后取得一致意见。纳入标准:(1)现役军人;(2)除外胫骨、跖骨、腓骨及股骨四个常见部位;(3)军事训练中发病,无明确外伤;(4)以少见或罕见部位疼痛为第一临床症状就诊,病程1 d至1年;(5)X线/CT可见骨折征象,或MRI可见骨膜或骨髓水肿伴或不伴骨折线。结果 共收集军人应力性骨折682例,其中少见/罕见部位应力性骨折49例,占比7.2%。49例中,新兵35例,占比(71.4%)最高。男47例(95.9%),女2例(4.1%)。年龄18~44岁,中位年龄21岁,平均(22.41±4.78)岁。病程≤1个月16例(32.6%),＞1个月且≤3个月26例(53.1%),＞3个月7例(14.3%)。49例,按发病部位整理如下:下肢20例,骨盆11例,腰椎4例,上肢6例,其他8例。24例经X线/CT确诊,16例经MRI确诊,9例经CT+MRI确诊。11例合并常见部位应力性骨折。7例两侧对称性发病。8例累及≥2个少见/罕见部位。结论 军事训练中少见/罕见部位应力性骨折常有特定的训练模式、特定的发病部位和较典型的影像学特征,值得进一步研究学习。

Objective To investigate the regularity of stress fractures located at rare sites in military training.Methods Using “stress fractures or fatigue fractures” as keywords,the confirmed stress fractures in soldiers from January 2018 to May 2023 on PACS were searched, and general data (gender, age and identity), clinical data(current medical history,physical examination and clinical manifestations)and imaging data(X-ray,CT and MRI images) were collected and analyzed. The images of all cases were reviewed independently by two senior imaging diagnostic physicians, and if there were any inconsistent results, a consensus was reached after consultation. Inclusion criteria: active military personnel; except four ordinary parts of tibia, metatarsus, femur and fibula; fractures during military training without clear trauma; treatment with rare sites as the first clinical symptom and the course of disease of 1 day to 1 year ; X-ray/CT evidence of fractures, or MRI evidence of periosteal or bone marrow edema with or without fracture lines.Results A total of 682 cases of stress fractures were collected, of which 49 cases (7.2%) were rare stress fractures. Among the 49 cases, 35 were new recruits,accounting for the highest proportion(71.4%). There were 47 males (95.9%) and 2 females (4.1%). The age range is 18-44 years,with a median age of 21 years and an average of (22.41±4.78) years. There were two cases (4.1%) with a course of ≤ 1 month,26 cases(53.1%) with a course of ＞1 month and ≤3 months,and 21 cases(42.8%) with a course of ＞3 months. The 49 cases were classified as follows according to the location: 20 cases in the lower limbs,11 cases in the pelvis,4 cases in the lumbar spine,and 8 other cases. Among the 49 cases, 24 cases were confirmed by X-ray/CT,16 cases were confirmed by MRI,and 9 cases were confirmed by CT+MRI. Common site stress fractures were observed in 11 cases, bilateral symmetry was found in 7 cases, and 8 cases of lesions involved two or more rare sites.Conclusions Stress fractures in rare sites during military training are often characterized by specific training patterns,specific site of incidence and typical imaging features,which are worthy of further research.