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不累及跟腱的小腿损伤

Authors
Catherine Rogers Rainbow, MD, SMCAQ
Karl B Fields, MD
Section Editor
Peter Fricker, MBBS, FACSP
Deputy Editor
Jonathan Grayzel, MD, FAAEM
Translators
高民, 主治医师

引言

小腿后方受伤较为常见，竞技运动员、业余运动者及活动量大的劳动者都可发生。小腿后方的主要肌肉包括腓肠肌、比目鱼肌、腘肌及跖肌。这些肌肉主要参与踝关节的主动跖曲，并且通常在冲击运动中受伤。小腿后方损伤患者表现为跛行、小腿后方肿胀以及损伤时严重疼痛。

本专题将总结常见和重要的小腿后方损伤，包括损伤机制、诊断及处理。跟腱损伤和其他腿部损伤将单独讨论。 (参见“跟腱病和跟腱断裂”和“踝关节扭伤”和“成人踝关节骨折概述”)

流行病学和危险因素

小腿后方肌肉拉伤可见于竞技运动员和业余运动者，但最常发生于三十多岁至五十多岁且未充分适应运动的男运动员[1-3]。小腿肌肉和肌腱损伤通常在患者突然做出需要下肢参与的冲击性动作时发生，如冲刺或跳跃，常需这些动作的运动包括网球、足球、篮球、美式橄榄球及在山上跑步[1]。运动员冲刺或短跑时，腓肠肌内侧头在产力过程中发挥的作用尤其大，因此内侧头损伤也相对常见。发生拉伤的小腿肌肉通常没有进行恰当的准备活动或者在运动期间严重疲劳。约20%的患者报告存在前驱症状，包括损伤前小腿肌肉酸痛或绷紧感[2]。

竞技性男性master跑者(定义为年龄超过40岁)的小腿损伤风险很高。针对赛跑的调查研究显示，小腿损伤是所有男性跑步者中最常见的损伤之一，且年龄较大跑者的受累比例高得出奇[4,5]。小腿损伤在网球运动员中也较常见[6]。一项关于720例运动员小腿内侧损伤的病例系列研究发现，16%的损伤是网球运动所致[7]。这类损伤中很大一部分发生在腓肠肌内侧头的肌肉骨骼连接处或者腓肠肌内侧头和比目鱼肌之间的腱膜处[7]。这种损伤通常称为“网球腿”。在“网球腿”患者中，仅有14%的损伤发生在腓肠肌外侧头[8]，1.4%涉及跖肌断裂[7]。

小腿损伤其他危险因素的相关文献不多。小腿后方肌肉拉伤史是损伤复发的危险因素[9,10]。在年龄较大的足球运动员中，第5腰(L5)神经根卡压史会增加后方腓肠肌拉伤的风险，这种情况在其他活跃的成人中可能也是一个危险因素[11]。

                           

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Literature review current through: 2017-06 . | This topic last updated: 2016-10-12.
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