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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Landing Error Scoring System (LESS) Items are Associated with the Incidence Rate of Lower Extremity Stress Fracture
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Landing Error Scoring System (LESS) Items are Associated with the Incidence Rate of Lower Extremity Stress Fracture

机译：着陆误差评分系统（LESS）项目与下肢应力性骨折的发生率相关

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Objectives: Lower-extremity stress fracture injuries are a major cause of morbidity in physically active populations. The ability to efficiently screen for modifiable risk factors associated with injury is critical in developing and implementing effective injury prevention programs. The purpose of this study was to determine if baseline Landing Error Scoring System (LESS) scores were associated with the incidence rate of lower-extremity stress fracture during four years of follow-up. Methods: To accomplish this objective we conducted a prospective cohort study at a US Service Academy. A total of 1772 eligible subjects with complete baseline data and no history of lower-extremity stress fracture were included in this study. At baseline we conducted motion analysis during a jump landing task using the LESS. Incident lower-extremity stress fracture cases were identified during the four year follow-up period using the injury surveillance systems at our institution. The primary outcome of interest was the incidence rate of lower-extremity stress fracture during follow-up. The electronic medical records of each potential incident case were reviewed and case status was determined by an adjudication committee consisting of two sports medicine fellowship-trained orthopaedic surgeons who were blinded to baseline LESS data. The association between baseline LESS scores and the incidence rate of lower-extremity stress fracture was examined for total LESS score and for each individual LESS item. Univariate and multivariable Poisson regression models were used to estimate the association between baseline LESS scores and the incidence rate of lower-extremity stress fracture during follow-up. Results: During the follow-up period, 94 incident lower-extremity stress fractures were documented in the study cohort and the cumulative incidence of stress fracture was 5.3% (95%CI: 4.3%, 6.5%). In univariate analyses total LESS score at baseline was associated with the incidence rate of lower-extremity stress fracture during follow-up. For every additional movement error documented at baseline there was a 15% increase in the incidence rate of lower-extremity stress fracture during follow-up (IRR=1.15; 95%CI: 1.02, 1.31, p=0.025). Based on univariate analyses, several individual LESS items at baseline were also associated with the incidence rate of stress fracture during follow-up. Ankle flexion at initial contact (p=0.055), stance width at initial contact (p=0.026), asymmetrical landing at initial contact (p=0.003), trunk flexion at initial contact (p=0.036), and overall impression (p=0.021) were significantly associated with the incidence rate of stress fracture. In multivariable analyses controlling for sex and year of entry into the cohort, subjects who consistently landed flat-footed or heel-to-toe were 2.33 times (IRR=2.33; 95%CI: 1.36, 3.97, p=0.002) more likely to sustain a lower-extremity stress fracture during follow-up. Similarly, subjects who consistently demonstrated asymmetric landing at initial contact were 2.53 times (IRR=2.53; 95%CI: 1.34, 4.74, p=0.004) more likely to sustain a stress fracture during follow-up. Conclusion: These data suggest that specific LESS items may be predictive of lower-extremity stress fracture risk and may be helpful in injury screening and prevention.
机译：目的：下肢应力性骨折损伤是体育锻炼人群发病的主要原因。有效筛选与伤害相关的可修改风险因素的能力对于制定和实施有效的伤害预防计划至关重要。这项研究的目的是确定基线着陆错误评分系统（LESS）分数是否与四年随访期间下肢应力性骨折的发生率相关。方法：为了实现这一目标，我们在美国服务学院进行了一项前瞻性队列研究。本研究共纳入1772名符合条件的受试者，这些受试者具有完整的基线数据且无下肢应力性骨折的病史。在基线时，我们使用LESS在跳跃着陆任务期间进行了运动分析。使用我们机构的伤害监测系统，在四年的随访期内确定了下肢应力性骨折事件。感兴趣的主要结果是随访期间下肢应力性骨折的发生率。审查每个潜在事件病例的电子病历，并由一个由两名运动医学进修生骨科医师组成的评审委员会确定病例状态，他们对基线LESS数据不知情。检查基线LESS得分与下肢应力性骨折的发生率之间的相关性，以检查总LESS得分和每个LESS项目。使用单变量和多变量Poisson回归模型来估计基线LESS得分与随访期间下肢应力性骨折的发生率之间的关联。结果：在随访期内，研究队列记录了94例下肢应力性骨折事件，应力性骨折的累积发生率为5.3％（95％CI：4.3％，6.5％）。在单变量分析中，基线时的总LESS评分与随访期间下肢应力性骨折的发生率相关。在基线期间，每增加一个运动误差，下肢应力性骨折的发生率就会增加15％（IRR = 1.15; 95％CI：1.02、1.31，p = 0.025）。基于单变量分析，基线时几个单独的LESS项目也与随访期间应力性骨折的发生率相关。初次接触时的脚踝屈曲（p = 0.055），初次接触时的脚踝宽度（p = 0.026），初次接触时的不对称着陆（p = 0.003），初次接触时的躯干屈曲（p = 0.036）和总体印象（p = 0.021）与应力性骨折的发生率显着相关。在控制性别和进入人群的年份的多变量分析中，始终一脚踩着脚或脚跟着地的受试者的发生率是2.33倍（IRR = 2.33; 95％CI：1.36、3.97，p = 0.002）。在随访期间维持下肢应力性骨折。同样，在初次接触时始终表现出不对称着陆的受试者更有可能在随访期间承受应力性骨折的2.53倍（IRR = 2.53; 95％CI：1.34、4.74，p = 0.004）。结论：这些数据表明，特定的LESS项目可预测下肢应力性骨折的风险，并可能有助于损伤的筛查和预防。

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