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胫骨和腓骨应力性骨折

Author
Karl B Fields, MD
Section Editors
Patrice Eiff, MD
Richard G Bachur, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM
Translators
刘锋, 主任医师，副教授

引言

胫骨和腓骨应力性骨折见于许多运动员，尤其是跑步者，也见于迅速增加自身运动量或存在基础疾病使自身易发应力性骨折的非运动员。很多因素似乎可以促发这些骨折，包括运动训练的改变、特定的解剖特性、骨密度减少和疾病状态[1]。

本专题将讨论成人胫骨和腓骨的应力性骨折。应力性骨折的概述和其他特定骨折的讨论参见其他专题。 (参见“应力性骨折的概述”和“跖骨干应力性骨折”)

临床解剖

胫骨是小腿的主要承重骨(图片 1和图片 2)。胫骨平台近端构成了膝关节的下表面(图 1和图片 3)。胫骨干桥接胫骨远端，胫骨远端构成了胫距关节的踝关节上关节面以及内踝。另一关键骨性标志是胫骨粗隆，它位于膝关节线下方数厘米，充当髌腱附着点。虽然胫骨干是最常见的应力性骨折部位，但胫骨平台和内踝也可发生应力性骨折[2]。

坚韧的纤维结构，即骨间膜或韧带(图 2)，沿着胫腓骨长度连接着胫骨和腓骨。在近端，该结构得到了坚韧的前后韧带加强，形成滑膜关节，即近端胫腓关节(图片 4)。在远端，骨间膜和3处韧带(胫腓前、后和横韧带)(图 3和图 4)稳定着上部踝关节。另一纤维结构(小腿筋膜)包绕小腿的骨与肌肉。因此，虽然腓骨的负重远小于胫骨，但腓骨通过膜附着和韧带附着紧密连接于胫骨，因而腓骨易受到一些可引起胫骨应力性骨折的相同变形力所致应变[1]。

筋膜延伸部分和骨间膜将小腿的肌肉、神经和血管分为4个不同间室(图 5)。前、后和深后间室邻近胫骨；外侧间室邻近腓骨。

                 

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Literature review current through: 2017-06 . | This topic last updated: 2015-09-29.
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