空降兵跳伞着陆时踝关节损伤的流行病调查及生物力学研究

发布时间：2018-03-30 21:38

本文选题：跳伞着陆中伤　切入点：着陆冲击力　出处：《中国医科大学》2007年硕士论文

【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。
[Abstract]:objective
First of all, through the epidemiological investigation of the airborne troops, understand all kinds of damage in the daily airborne landing ground training and parachuting training in the position, type and incidence, especially detailed investigation for ankle injury, causes of ankle injury were summarized, and statistical analysis. The statistical results are discussed, and study the different injury factors, and the relationship between ankle injury, proposed to prevent or avoid the damage of the parachute landing. According to epidemiological survey results for biomechanical experiments of 10 specimens of human ankle joint simulation of airborne special landing posture, measured by the ankle joint ligament injury, the bearing capacity of the bone structure damage tolerance, discuss how to increase the bearing capacity of the ankle joint structure of the landing impact force as much as possible. To reduce the incidence of ankle injury during the training of airborne soldiers, in order to improve the combat effectiveness of the airborne troops.
Method
1. airborne troops before the survey, we read about a large number of airborne parachute landing injuries according to the materials, documents and related materials, the design of the questionnaire, the questionnaire as detailed, in order to make the information as rich as possible. In the course of the investigation, to guarantee the objectivity of data, our survey of the object the hospital outpatient department, the medical team, hospitalization records, outpatient and admissions registration check, at the same time with the leadership of the hospital, outpatient department and health team responsible person discussion, and survey and discussion, to understand the daily training of officers and men, because of injuries caused by parachuting training, right landing posture, umbrella type, current equipment and so on.
2. after data collection is complete, of all the data were collected, respectively classified. Damage analysis under different conditions of paratroopers of all parts of the body, causing 8 common causes of ankle injury for multivariate analysis, find out corresponding risk factors and protective factors. The statistical results according to the nature of the information of X2 test and T test in multivariate analysis, using SPSS software.
3. according to the statistical results after the airborne landing at the ankle plantar flexion 30 degree posture, the implementation of the biomechanical determination of 10 bodies of fresh specimens of the ankle joint, understand the lateral collateral ligament injury, injury of bony structure is the largest inverted case, obtained three kinds of damage tolerance limits. Analysis of variance on three different sets of data, fully prepared for the protection of the next experiment.
Result
1. of our 397 soldiers of certain airborne troops conducted a questionnaire survey, referring to the wounded soldiers outpatient or hospitalization record, to confirm the diagnosis. According to the survey data were collected, all the injured ankle injury with both the number of officers and soldiers, were recorded the diagnostic criteria for a case, because the same with the other property damage the number of cases related to injury, according to statistics. Of whom 173 were injured, including 70 cases of ankle joint injury, 13 cases of knee injuries, 49 cases of spinal injury, 41 cases of other injuries, injury time was 2004-2006 years. The ground station to jump training of spinal cord injury, limb injury by parachute landing training.
2. another collection of ankle and tibia injury in 18 cases, and at the same time skydiving but no damage to soldiers 14 people, a total of 32 people and wounded. After contact, to force their investigation, 14 people will jump at the same time as the normal control, multi factor analysis, using SPSS software. The result showed that the ground situation (X2), wind (X5) as a risk factor, there is no ankle support (X3) and (X8) parachuting years was a protective factor.
3., after the statistical data were obtained, we measured the biomechanics of 10 fresh human ankle joints. The result is that under static conditions, the average carrying capacity of lateral collateral ligament injury is 2062.62N, and the carrying capacity of foot bone structure damage is 3755.4286N..
conclusion
1. this study first through the epidemiological investigation, injury factors and mechanism to airborne parachute landing and ground training, both landing injury is influenced by many factors. The direct reason is mainly about the improper operation and umbrella out landing posture is not correct, and the effect of the latter is greater, and is the main factor. Several other reason is the indirect effects of the parachutist landing posture, in addition, the psychological quality, skydiving experience and many injuries are likely to have an impact on the paratroopers parachuting.
2. analysis on several injury factors, conclusion, is less (less than 16 times the number of parachute and parachute paratroopers) many times (more than 24 times) of the relatively high incidence of paratroopers landing injury. The reason may be the lack of experience or jump is more difficult. Officers and men of different ages and different times of the parachuting umbrella in the parachute training and training ground due to injury is no difference, but when the parachute training of ankle injury is more, more of the spine injury during ground training. In addition, all parachute landing ankle fractures involved are often more serious, isolated medial or lateral malleolar fractures are relatively rare, and the paratroopers parachute landing when the special posture of ankle joint.
3. comparison of several possible injury factors, 8 kinds of injury factors in the survey, the situation on the ground (X2), wind (X5) is a risk factor, ankle (X3) and parachute (x8) is a protective factor for life, which protect ankle support more. Of course, these factors are only a part of all the relationship between the factors, because of time and funds, temporarily unable to do a comprehensive and detailed.
4. biomechanical tests were carried out the special position of the ankle paratroopers landing simulation, because the specimen limit, only to the maximum ankle plantar flexion, the valgus angle of ligament injury under the minimum stress, and ankle joint in the neutral position of the minimum bearing capacity of bone structure injury were determined. The fresh ankle remove the skin specimens, subcutaneous tissue, muscle, only around the ankle ligaments and support belt. The lateral collateral ligament injury required an average of 2063.62N bearing; bearing required bone structure injury averaged 3380.28N. results showed that there were significant differences between the two groups (P < 0.05). However, the actual the movement is dynamic, and its test results still have some differences.

【学位授予单位】：中国医科大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R82

【参考文献】