2010級運動人體科學(xué)運動損傷與恢復(fù)專業(yè)方向研究生試卷M答案.doc

2010級運動人體科學(xué)運動損傷與恢復(fù)專業(yè)方向研究生試卷Anterior cruciate ligament (ACL) 前交叉韌帶 Pathophysiology:病理學(xué) The mechanism of ACL injury in the skeletally immature is the same as in adults, with most being noncontact. 在插管對骨未成熟前交叉韌帶損傷的機制是成年人，而非接觸的大部分相同。 Females have a higher incidence of noncontact ACL injury than their male counterparts. 女性具有非接觸前交叉韌帶損傷比男性的高發(fā)病 ACL injuries in this population may be tibial spine bony avulsions as well as ligament tears. 在這一人群的 ACL 損傷可能脛骨骨棘以及韌帶撕裂。 ACL injury has been reported in up to 65% of children with acute hemarthrosis. 前交叉韌帶損傷據(jù)報在小兒急性膝關(guān)節(jié)積血的 65%。 The presence of open growth plates requires special attention in determining treatment of ACL injuries. 開放的生長板的存在需要特別注意，在確定 ACL 損傷的治療。Evaluation:評價 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. 建立損傷的機制。經(jīng)典的演示文稿是突然減速或扭曲損傷流行，立即腫脹，以及無法繼續(xù)播放。 Physical examination體格檢查 A positive Lachman test is sufficient to make the diagnosis. 積極的拉赫曼測試足以進行診斷。 Evaluate for other associated injuries, including ligamentous injury, patellofemoral instability, and meniscal injury. 其他相關(guān)的傷害，包括韌帶損傷、 髕股關(guān)節(jié)不穩(wěn)和半月板損傷的評估。 Imaging圖像描述 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). 標準四視圖 x 射線： 負重 AP 和隧道 ；橫向擴展 ； 在膝在 30 或 45 的膝關(guān)節(jié)屈曲 （商人，日出) 的軸向髕骨視圖。 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確定韌帶損傷的嚴重程度以及相關(guān)如半月板和軟骨病變的損傷。Treatment:治療方法 Initial treatment involves ice, compression and restoration of ROM, especially extension (not immobilization) and protected weight bearing. 首次處理涉及冰、 壓縮和修復(fù)的 ROM，尤其是擴展名 （而不是固定），與保護負重。 Tibial spine ACL avulsions need urgent evaluation for surgery. 脛骨棘撕 ACL 手術(shù)需要緊急的評價。 Concern exists regarding surgical management of intrasubstance ACL injuries in adolescents with open growth plates. 關(guān)于青少年開放生長板 intrasubstance ACL 損傷的外科治療存在著關(guān)切。 Nonoperative management has shown poor results as activity modification in adolescents is difficult and bracing provides little or no protection. 非手術(shù)治療已顯示業(yè)績不佳，為青少年活動修改是困難和支撐提供很少或沒有保護。 Postoperative rehabilitation and RTP criteria are the same as adults. 術(shù)后的康復(fù)和 RTP 標準是成年人一樣。Prevention:預(yù)防 Implement a sport-specific conditioning program with periodization (3,4), including these elements that have been shown to have efficacy in specific populations: 實施專項運動調(diào)節(jié)程序與分期 （3，4），包括這些已顯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) 電機控制 （包括核心和較低的下肢力量、 平衡和靈活性） Technique training to include landing and sport-specific athletic skills programs技術(shù)培訓(xùn)，包括升降和專項運動競技程序 Risk awareness education風(fēng)險意識教育 Proper care of playing surfaces and selection of shoe wear適當?shù)恼疹櫷媲婧托p的選擇 No prophylactic bracing has been shown to reduce ACL injury risk. 沒有預(yù)防性支撐已被證明能減輕 前交叉韌帶 損傷的風(fēng)險。It is essential that the team physician: 至關(guān)重要的是，醫(yī)師團隊協(xié)作： Understand the classic history and mechanism of ACL injury. 了解經(jīng)典歷史和前交叉韌帶損傷的機制。 Perform a Lachman test.執(zhí)行拉赫曼測試 Understand the poor prognosis of the ACL deficient knee, especially in the adolescent. 了解預(yù)后不良的 ACL 缺膝，尤其是在青少年中。 Identify tibial spine ACL avulsions. 確定脛骨棘 ACL。It is desirable that the team physician: 最好的醫(yī)師團隊協(xié)作： Recognize risk of noncontact ACL injury in adolescent female athletes and implement risk reduction strategies through the athletic care network. 認識到在青少年女子運動員的非接觸式前交叉韌帶損傷的風(fēng)險和實施減少風(fēng)險的策略，通過體育保健網(wǎng)絡(luò)。 Understand that current surgical procedures allow for reconstruction in the skeletally immature athlete.了解當前的外科程序允許重建插管對骨未成熟的運動員。 Understand the associated injuries that may accompany or result from ACL instability. 了解相關(guān)的傷害可能伴隨或從 ACL 不穩(wěn)定導(dǎo)致。Osteochondritis dissecans (OCD) 強迫性神經(jīng)官能癥Pathophysiology:病理學(xué) OCD is an acquired, potentially reversible idiopathic lesion of subchondral bone resulting in delamination and sequestration with or without articular cartilageinvolvement and instability. 強迫癥是項收購，可能是可逆的特發(fā)性病變，軟骨下骨中分層和封存有無軟骨參與和不穩(wěn)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. 強迫癥病變與關(guān)節(jié)表面完整插管對骨未成熟運動員有潛力通過停止加載的反復(fù)沖擊的愈合。 Skeletally mature athletes with an OCD lesion have a poorer prognosis. 強迫癥病變插管對骨成熟運動員有較貧窮的預(yù)后。 The presence of mechanical symptoms such as locking or catching may indicate unstable osteochondral fragments. 機械的癥狀，如鎖定或捕捉的存在可能表示不穩(wěn)定的軟骨碎片。Evaluation:評價History原因 Presentation is generally nonspecific and includes poorly localized knee pain.一般非特異性演示文稿，包括差本地化的膝痛。 Establish the presence of mechanical symptoms. 建立機械癥狀的存在。 Physical examination體格檢查 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. 沒有具體的體檢結(jié)果的強迫癥，雖然可能引起疼痛，屈、 延伸，內(nèi)部，與外部的旋轉(zhuǎn)和可能觸及的溫柔的領(lǐng)域。 Observe for an antalgic gait. 觀察鎮(zhèn)痛的步態(tài)。 Imaging圖像描述 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).標準四視圖 x 射線： 負重 AP 和隧道 ；橫向擴展 ； 在膝在 30 或 45 的膝關(guān)節(jié)屈曲 （商人，日出) 的軸向髕骨視圖。 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，包括病變大小和穩(wěn)定性和關(guān)節(jié)軟骨及軟骨下骨。Treatment:治療方法 Prognostic factors guide treatment and include status of the growth plate, articular cartilage and subchondral bone, and lesion size, location and stability.預(yù)后因素指導(dǎo)治療，并包括生長板、 關(guān)節(jié)軟骨及軟骨下骨，病變大小、 位置和穩(wěn)定的狀態(tài)。 Outcome of symptomatic OCD with stable lesions and open growth plates is favorable with rest from offending activities. 穩(wěn)定的病變與開放的生長板的強迫癥癥狀的結(jié)果是有利與從其他違法活動。 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. 插管對骨不成熟不穩(wěn)定的病變患者和那些接近生長板封閉其癥狀持續(xù)非手術(shù)治療的病人中，應(yīng)考慮手術(shù)。It is essential that the team physician: 至關(guān)重要的是，醫(yī)師團隊協(xié)作： Be able to diagnose OCD. 能夠診斷強迫癥。It is desirable that the team physician: 最好的醫(yī)師團隊協(xié)作：Understand the natural history and prognostic factors of OCD in the knee.了解自然史和膝關(guān)節(jié)強迫癥的預(yù)后因素。 Understand nonoperative and operative treatments of OCD.了解手術(shù)和手術(shù)治療強迫癥 Work with the athletic care network to educate athletes, parents, and coaches regarding OCD. 工作與體育保健網(wǎng)絡(luò)教育運動員、 家長及有關(guān)強迫癥的教練。The Adolescent Throwers Elbow青少年運動員的手肘Pathophysiology:病理學(xué) Valgus loads with rapid elbow extension produces: 外翻加載與快速彎頭擴展生產(chǎn)： Tensile stress along the medial compartment restraints拉應(yīng)力沿內(nèi)側(cè)隔室的限制 Shear stress in the posterior compartment在后車廂內(nèi)剪應(yīng)力 Compression stress on lateral structures壓縮應(yīng)力橫向結(jié)構(gòu) These loads can come from overuse, poor kinetic chain mechanics, weak shoulder or arm muscles, and a large number of pitches. 這些負載可以來自過度使用、 可憐的動力學(xué)鏈力學(xué)、 弱的肩或手臂的肌肉，和一大批球場。Evaluation:評價 History原因 Determine acute versus chronic injury, location of pain, mechanical symptoms, and decline in performance. 確定急性與慢性損傷，疼痛，機械的癥狀，位置和性能下降。 Identify injuries in the kinetic chain. 確定動力學(xué)鏈中的受傷。 Measure excessive throwing by number of pitches per game or pitches per season.過度引發(fā)的每場比賽的球場或每季的攤位數(shù)的措施。 Physical examination體格檢查 Perform elbow examination to include areas of tenderness, ROM, valgus stress testing, manual muscle testing, and ulnar nerve testing. 執(zhí)行包括溫柔、 ROM、 外翻的壓力測試、 手動肌肉測試和尺神經(jīng)測試領(lǐng)域的彎頭考試。 Evaluate kinetic chain to include core stability,scapular motion and position, and GIRD評估包括核心穩(wěn)定、 肩胛議案和地位，和網(wǎng)格的動力學(xué)鏈 Imaging圖像描述 X-rays in two planes and consider comparison views with open growth plates.X 光片中兩個飛機，并考慮比較開放的生長板的意見。 MRI with intra-articular contrast is useful to better define injury, including ligamentous and osseus injuries, and articular cartilage lesions.有必要更好地定義損傷，包括韌帶和 osseus 受傷，關(guān)節(jié)軟骨病變 MRI 與關(guān)節(jié)內(nèi)的對比。Treatment:治療方法 Most injuries are the result of overuse and can be successfully treated with relative rest, rehabilitation,and modification of throwing demands (4). 大多數(shù)受傷是過度使用的結(jié)果，并能成功地治療相對休息、 康復(fù)和拋出的要求 (4) 修改。 Medial epicondylar avulsions need urgent evaluation for surgery.內(nèi)側(cè)上髁 avulsions 手術(shù)需要緊急的評價。 Elbow injuries that need evaluation for surgery may include ulnar collateral ligament injury unresponsive to conservative treatment or OCD lesions with mechanical symptoms. 手術(shù)需要評估的肘部損傷可能包括尺側(cè)副韌帶損傷保守治療或機械的癥狀與強迫癥病變沒有響應(yīng)。Prevention:預(yù)防 Decreasing exposure to overuse and preservation of musculoskeletal and biomechanical factors has been shown to be the best preventative program (9).降低曝光過度使用和保存的肌肉骨骼和生物力學(xué)因素經(jīng)證明是最好的預(yù)防計劃 (9)。 Enforcement of pitch counts per game and per season and limitation of specialty pitches in skeletally immature athletes (9). 瀝青計數(shù)，每場比賽和每季的執(zhí)法和限制的專業(yè)足球場插管對骨未成熟運動員 (9)。 Work with the athletic care network to educate athletes,parents, and coaches regarding overuse and overexposure. 工作與體育保健網(wǎng)絡(luò)教育運動員、 家長及有關(guān)過度使用和過度的教練。It is essential that the team physician: 至關(guān)重要的是，醫(yī)師團隊協(xié)作