The Applied Research For 0 Stage Diagnostic Technique Of Stress Fracture Caused By Military Training

Background: Military training injury,which directly damage personnel health,influence the military training and combat preparation process,thus resulting in a loss of time and economy.So the prevention and treatment of military training injuries is particularly important,it can greatly reduce the incidence of injury,improve refresher training after injury and reduce the rate of disability.From this perspective,the prevention and treatment of military training injury is not only a medical problem,but also an important military issue.The military training is the central task of army in peacetime,and the fundamental way to enhance the combat effectiveness.With the continuous improvement of building a modern and regular troops,to further strengthen health protection work of military training had higher requirements.After our country to implement new summer-fall recruitment in 2013,forces in disciplines,intensity and request have a new adjustment,the distribution and characteristic of military training injury also have new changes.Among the injury,stress fracture shows gradually ascendant trend in military training in recent years.Our military report about 20% incidence of stress fractures,and foreign coverage up to 31%.So,early prevention to reduce the incident rate,has become particularly important,but the detailed research rarely.Military training injury 0 period diagnosis,put forward by Professor Huang Changlin,is a technology which can predict some military training injury before it happen through some examination of the body and some auxiliary examination.The purpose of military training injury monitoring is to prevent,so military training injuries stress fracture 0 period diagnosis technology can be effective for diagnosis and prevention of military training injury.Objective: Experiment 1: Using 0 period diagnostic criteria to survey the occurrence of early-stage stress fracture in army,so as to evaluate its diagnostic performance and provide a basis for the early prevention of stress fracture.Experiment 2: Combined with magnetic resonance imaging(MRI)to survey the occurrence of early-stage stress fracture in army,explore the change and clinical significance of serum alkaline phosphatase and creatine kinase at the early of stress fracture,so as to provide a clinical basis for the early prevention and prognosis of judgment.Methods: Experiment 1: we extract 70 cases of new recruits from Henan somewhere after training for 4 weeks with cluster sampling method.The orthopaedic surgeon and primary care doctor after unified training,following the standard of military training injuries stress fracture 0 period diagnostic criteria,did the examination of the stress fracture 0 period diagnosis for new recruits who did MRI imaging after examination.With MRI imaging results as the gold standard,we evaluated the authenticity of the 0 period diagnostic method.According to the unified 0 period diagnostic method,two doctors checked the results by double-blind method,then calculated the coincidence rate and Kappa value.Experiment 2: we randomly drew 60 cases of new recruits with stress fracture from Henan somewhere troop in October 2014 to December 2014,and divided it into two groups according to MRI results and clinical symptoms: hidden fracture 30 cases and dominant fracture 30 cases,on the other hand,we randomly drew healthy recruit volunteers 30 cases from the same training period and the same troop as control group.In 6,12,24 h after injury,we took venous blood 3 ml from patients,and put them in negative pressure vacuum vessels,and then detected CK,ALP serum enzymology indexes within 2 hours.Our experiment used low speed centrifuge(KDC-1042,Zhongkezhongjia Ltd.,China)2 min to isolated serum at 4000 r/min,then,the fully automatic biochemical analyzer(AU5400,OLYMPUS Ltd.,Japan)was used to detect serum enzymology indexes,and finally we collected the test data.Results: Experiment 1: MRI results show that the stress fracture ratio was 24.3%,we calculated the sensitivity,specific,accuracy,positive forecast value,the negative forecast value,positive pseudo likelihood ratio,negative likelihood ratio,Youden index,the area under the ROC curve(AUC)were respectively 0.941,0.887,0.900,0.887,0.900,8.33,0.067,0.828,0.914;Mc Nemar test result: P = 0.125;consistent coefficient(Kappa value),k = 0.753,P = 0.000.The coincidence rate of 0 period diagnosis from orthopaedic surgeon and primary care docter was 0.900,the correlation coefficient(Kappa value)was 0.771.Experiment 2: The results of dynamic change of three groups serum CK: hidden fracture group was higher than the control group(P<0.05),dominant fracture group is higher than hidden fracture group and the control group(P< 0.05 and P<0.01).The results of dynamic change of three groups serum ALP: the difference from hidden fracture group and the control group had no statistical significance;24 h after injury,ALP of dominant fracture group began to rise,and was higher than that of hidden fracture group and the control group(P < 0.05).Conclusion: 1 The incidence of stress fractures in the boot is high;stress fracture 0 period diagnosis method have the high authenticity and reliability;this method can early diagnose stress fracture through history collection and physical examination,thereby reduce the disability rate in military training;because its simple and convenient,it can make a diagnosis and then intervene in advance at the grassroots forces.2 CK has high susceptibility to stress fracture,especially the super early fracture that general imaging have not yet found;meanwhile,it confirmed that the repeated high strength of skeletal muscle contraction is one of the important factors to cause stress fractures.At the early of stress fractures,ALP,which stands for bone reconstruction and activity of osteoblasts,began to increase.Serum ALP level,to a certain extent,reflects a stress fracture healing ability,also contributes to the early detection and judging the prognosis of a stress fracture;serum CK and ALP in Stress fractures patients increased distinctly,so they have important significance in early detection,condition judgement and prognosis judgement.