การวินิจฉัยภาวะ stress fractures ของรยางค์ล่าง ด้วยเทคนิคทางเวชศาสตร์นิวเคลียร์
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เม.ย. 30, 2012
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บทคัดย่อ
ภาวะ stress fractures ส่วนใหญ่พบในนักกีฬาหรือกลุ่มทหาร-ตำรวจ ที่มีการฝึกซ้อมอย่างหนัก ซึ่งมักเกิดกับรยางค์ล่างมากกว่ารยางค์บน โดยเฉพาะการฝึกซ้อมที่เกี่ยวกับการวิ่งระยะทางไกลๆ การวินิจฉัยภาวะ stress fractures นี้ทำได้ยาก เนื่องจากภาพถ่ายรังสีมักมีความไวไม่พอ ทำให้ต้องอาศัยการตรวจที่ซับซ้อนยิ่งขึ้น ซึ่งการตรวจด้วยเครื่องเอ็มอาร์ไอ (MRI, magnetic resonance imaging) ถือเป็นวิธีมาตรฐานในการวินิจฉัย แต่การตรวจสแกนกระดูกทางเวชศาสตร์นิวเคลียร์แบบ 3 ระยะ (3-phase bone scan) ซี่งเป็นการตรวจที่มีความไวสูง ทำการตรวจง่าย ไม่มีข้อห้าม หรือผลแทรกซ้อนในการตรวจ จึงมีบทบาทในการวินิจฉัยภาวะ stress fractures และสามารถใช้เป็นการตรวจเสริมกับการตรวจด้วยเครื่องเอ็มอาร์ไอ เพื่อให้ได้ผลการตรวจที่แม่นยำยิ่งขึ้น
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นิพนธ์ต้นฉบับ
เอกสารอ้างอิง
1. Flinn SD. Changes in stress fracture distribution and current treatment. Curr Sports Med Rep 2002; 1(5): 272-7.
2. Patel DR. Stress fractures: diagnosis and management in the primary care setting. Pediatr Clin North Am 2010; 57(3): 819-27.
3. Bergman AG, Fredericson M. MR imaging of stress reactions, muscle injuries, and other overuse injuries in runners. Magn Reson Imaging Clin N Am 1999; 7(1): 151-74.
4. Protzman RR. Physiologic performance of women compared to men. Observations of cadets at the United States Military Academy. Am J Sports Med 1979; 7(3): 191-4.
5. Pester S, Smith PC. Stress fractures in the lower extremities of soldiers in basic training. Orthop Rev 1992; 21(3): 297-303.
6. Bijur PE, Horodyski M, Egerton W, Kurzon M, Lifrak S, Friedman S. Comparison of injury during cadet basic training by gender. Arch Pediatr Adolesc Med 1997; 151(5): 456-61.
7. Gam A, Goldstein L, Karmon Y, Mintser I, Grotto I, Guri A, et al. Comparison of stress fractures of male and female recruits during basic training in the Israeli anti-aircraft forces. Mil Med 2005; 170(8): 710-2.
8. Courtenay BG, Bowers DM. Stress fractures: clinical features and investigation. Med J Aust 1990; 153(3): 155-6.
9. Dixon S, Newton J, Teh J. Stress fractures in the young athlete: a pictorial review. Curr Probl Diagn Radiol 2011; 40(1): 29-44.
10. Orava S, Jormakka E, Hulkko A. Stress fractures in young athletes. Arch Orthop Trauma Surg 1981; 98(4): 271-4.
11. Daffner RH, Pavlov H. Stress fractures: current concepts. Am J Roentgenol 1992; 159(2): 245-52.
12. Bennell KL, Brukner PD. Epidemiology and site specificity of stress fractures. Clin Sports Med 1997; 16(2): 179-96.
13. Hootman JM, Macera CA, Ainsworth BE, Martin M, Addy CL, Blair SN. Predictors of lower extremity injury among recreationally active adults. Clin J Sport Med 2002; 12(2): 99-106.
14. Orava S, Puranen J, Ala-Ketola L. Stress fractures caused by physical exercise. Acta Orthop Scand 1978; 49(1): 19-27.
15. Matheson GO, Clement DB, McKenzie DC, Taunton JE, Lloyd-Smith DR, MacIntyre JG. Stress fractures in athletes. A study of 320 cases. Am J Sports Med 1987; 15(1): 46-58.
16. Zwas ST, Elkanovitch R, Frank G. Interpretation and classification of bone scintigraphic findings in stress fractures. J Nucl Med 1987; 28(4): 452-7.
17. Jones BH, Harris JM, Vinh TN, Rubin C. Exercise-induced stress fractures and stress reactions of bone: epidemiology, etiology, and classification. Exerc Sport Sci Rev 1989; 17: 379-422.
18. Key VH. Leg pain in runners. Current Opinion in Orthopaedics 2007; 18(2): 161-5.
19. Patel DS, Roth M, Kapil N. Stress fractures: diagnosis, treatment, and prevention. Am Fam Physician 2011; 83(1): 39-46.
20. Wall J, Feller JF. Imaging of stress fractures in runners. Clin Sports Med 2006; 25(4): 781-802.
21. Prather JL, Nusynowitz ML, Snowdy HA, Hughes AD, McCartney WH, Bagg RJ. Scintigraphic findings in stress fractures. J Bone Joint Surg Am 1977; 59(7): 869-74.
22. Greaney RB, Gerber FH, Laughlin RL, Kmet JP, Metz CD, Kilcheski TS, et al. Distribution and natural history of stress fractures in U.S. Marine recruits. Radiology 1983; 146(2): 339-46.
23. Mulligan ME. The "gray cortex ": an early sign of stress fracture. Skeletal Radiol 1995; 24(3): 201-3.
24. Rupani HD, Holder LE, Espinola DA, Engin SI. Three-phase radionuclide bone imaging in sports medicine. Radiology 1985; 156(1): 187-96.
25. Brukner P, Bradshaw C, Khan KM, White S, Crossley K. Stress fractures: a review of 180 cases. Clin J Sport Med 1996; 6(2): 85-9.
26. Ohta-Fukushima M, Mutoh Y, Takasugi S, Iwata H, Ishii S. Characteristics of stress fractures in young athletes under 20 years. J Sports Med Phys Fitness 2002; 42(2): 198-206.
27. Fredericson M, Bergman AG, Hoffman KL, Dillingham MS. Tibial stress reaction in runners. Correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system. Am J Sports Med 1995; 23(4): 472-81.
28. Arendt EA, Griffiths HJ. The use of MR imaging in the assessment and clinical management of stress reactions of bone in high performance athletes. Clin Sports Med 1997; 16(2): 291-306.
29. Gaeta M, Minutoli F, Scribano E, Ascenti G, Vinci S, Bruschetta D, et al. CT and MR imaging findings in athletes with early tibial stress injuries: comparison with bone scintigraphy findings and emphasis on cortical abnormalities. Radiology 2005; 235(2): 553-61.
30. Markey KL. Stress fractures. Clin Sports Med 1987; 6(2): 405-25.
31. Holder LE, Michael RH. The specific scintigraphic pattern of "shin splints in the lower leg": concise communication. J Nucl Med 1984; 25(8): 865-9.
32. Van der Wall H, Lee A, Magee M, Frater C, Wijesinghe H, Kannangara S. Radionuclide bone scintigraphy in sports injuries. Semin Nucl Med 2010; 40(1): 16-30.
33. Hirschmann MT, Davda K, Rasch H, Arnold MP, Friederich NF. Clinical value of combined single photon emission computerized tomography and conventional computer tomography (SPECT/CT) in sports medicine. Sports Med Arthrosc 2011; 19(2): 174-81.
2. Patel DR. Stress fractures: diagnosis and management in the primary care setting. Pediatr Clin North Am 2010; 57(3): 819-27.
3. Bergman AG, Fredericson M. MR imaging of stress reactions, muscle injuries, and other overuse injuries in runners. Magn Reson Imaging Clin N Am 1999; 7(1): 151-74.
4. Protzman RR. Physiologic performance of women compared to men. Observations of cadets at the United States Military Academy. Am J Sports Med 1979; 7(3): 191-4.
5. Pester S, Smith PC. Stress fractures in the lower extremities of soldiers in basic training. Orthop Rev 1992; 21(3): 297-303.
6. Bijur PE, Horodyski M, Egerton W, Kurzon M, Lifrak S, Friedman S. Comparison of injury during cadet basic training by gender. Arch Pediatr Adolesc Med 1997; 151(5): 456-61.
7. Gam A, Goldstein L, Karmon Y, Mintser I, Grotto I, Guri A, et al. Comparison of stress fractures of male and female recruits during basic training in the Israeli anti-aircraft forces. Mil Med 2005; 170(8): 710-2.
8. Courtenay BG, Bowers DM. Stress fractures: clinical features and investigation. Med J Aust 1990; 153(3): 155-6.
9. Dixon S, Newton J, Teh J. Stress fractures in the young athlete: a pictorial review. Curr Probl Diagn Radiol 2011; 40(1): 29-44.
10. Orava S, Jormakka E, Hulkko A. Stress fractures in young athletes. Arch Orthop Trauma Surg 1981; 98(4): 271-4.
11. Daffner RH, Pavlov H. Stress fractures: current concepts. Am J Roentgenol 1992; 159(2): 245-52.
12. Bennell KL, Brukner PD. Epidemiology and site specificity of stress fractures. Clin Sports Med 1997; 16(2): 179-96.
13. Hootman JM, Macera CA, Ainsworth BE, Martin M, Addy CL, Blair SN. Predictors of lower extremity injury among recreationally active adults. Clin J Sport Med 2002; 12(2): 99-106.
14. Orava S, Puranen J, Ala-Ketola L. Stress fractures caused by physical exercise. Acta Orthop Scand 1978; 49(1): 19-27.
15. Matheson GO, Clement DB, McKenzie DC, Taunton JE, Lloyd-Smith DR, MacIntyre JG. Stress fractures in athletes. A study of 320 cases. Am J Sports Med 1987; 15(1): 46-58.
16. Zwas ST, Elkanovitch R, Frank G. Interpretation and classification of bone scintigraphic findings in stress fractures. J Nucl Med 1987; 28(4): 452-7.
17. Jones BH, Harris JM, Vinh TN, Rubin C. Exercise-induced stress fractures and stress reactions of bone: epidemiology, etiology, and classification. Exerc Sport Sci Rev 1989; 17: 379-422.
18. Key VH. Leg pain in runners. Current Opinion in Orthopaedics 2007; 18(2): 161-5.
19. Patel DS, Roth M, Kapil N. Stress fractures: diagnosis, treatment, and prevention. Am Fam Physician 2011; 83(1): 39-46.
20. Wall J, Feller JF. Imaging of stress fractures in runners. Clin Sports Med 2006; 25(4): 781-802.
21. Prather JL, Nusynowitz ML, Snowdy HA, Hughes AD, McCartney WH, Bagg RJ. Scintigraphic findings in stress fractures. J Bone Joint Surg Am 1977; 59(7): 869-74.
22. Greaney RB, Gerber FH, Laughlin RL, Kmet JP, Metz CD, Kilcheski TS, et al. Distribution and natural history of stress fractures in U.S. Marine recruits. Radiology 1983; 146(2): 339-46.
23. Mulligan ME. The "gray cortex ": an early sign of stress fracture. Skeletal Radiol 1995; 24(3): 201-3.
24. Rupani HD, Holder LE, Espinola DA, Engin SI. Three-phase radionuclide bone imaging in sports medicine. Radiology 1985; 156(1): 187-96.
25. Brukner P, Bradshaw C, Khan KM, White S, Crossley K. Stress fractures: a review of 180 cases. Clin J Sport Med 1996; 6(2): 85-9.
26. Ohta-Fukushima M, Mutoh Y, Takasugi S, Iwata H, Ishii S. Characteristics of stress fractures in young athletes under 20 years. J Sports Med Phys Fitness 2002; 42(2): 198-206.
27. Fredericson M, Bergman AG, Hoffman KL, Dillingham MS. Tibial stress reaction in runners. Correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system. Am J Sports Med 1995; 23(4): 472-81.
28. Arendt EA, Griffiths HJ. The use of MR imaging in the assessment and clinical management of stress reactions of bone in high performance athletes. Clin Sports Med 1997; 16(2): 291-306.
29. Gaeta M, Minutoli F, Scribano E, Ascenti G, Vinci S, Bruschetta D, et al. CT and MR imaging findings in athletes with early tibial stress injuries: comparison with bone scintigraphy findings and emphasis on cortical abnormalities. Radiology 2005; 235(2): 553-61.
30. Markey KL. Stress fractures. Clin Sports Med 1987; 6(2): 405-25.
31. Holder LE, Michael RH. The specific scintigraphic pattern of "shin splints in the lower leg": concise communication. J Nucl Med 1984; 25(8): 865-9.
32. Van der Wall H, Lee A, Magee M, Frater C, Wijesinghe H, Kannangara S. Radionuclide bone scintigraphy in sports injuries. Semin Nucl Med 2010; 40(1): 16-30.
33. Hirschmann MT, Davda K, Rasch H, Arnold MP, Friederich NF. Clinical value of combined single photon emission computerized tomography and conventional computer tomography (SPECT/CT) in sports medicine. Sports Med Arthrosc 2011; 19(2): 174-81.
