本文選題：跳傘著陸中傷　切入點：著陸沖擊力　出處：《中國醫(yī)科大學》2007年碩士論文

【摘要】： 目的 首先，通過對空降兵部隊官兵進行流行病學調(diào)查，了解空降兵在日常的地面訓練和跳傘訓練中著陸時各種損傷的部位、類型及發(fā)病率，特別是針對踝關節(jié)的損傷進行詳細的調(diào)查，對造成踝關節(jié)損傷的原因進行歸納總結，并進行統(tǒng)計學分析。對統(tǒng)計的結果進行討論，深入研究不同的致傷因素之間、與踝關節(jié)損傷之間的相互關系，提出預防或避免跳傘著陸損傷的方法。根據(jù)流行病學的調(diào)查結果，對10具人體踝關節(jié)標本模擬空降兵特殊著陸姿勢下進行生物力學實驗，測出造成踝關節(jié)韌帶損傷、骨質(zhì)結構損傷時所受承載力的耐限，，探討如何能夠增加踝關節(jié)各結構承受著陸沖擊力的能力，盡可能的減少空降兵訓練時踝關節(jié)損傷的發(fā)生率，以提高空降兵部隊的戰(zhàn)斗力。 方法 1．到空降部隊調(diào)查前，我們閱讀了大量的有關空降兵跳傘著陸損傷的材料，根據(jù)文獻及相關資料，設計調(diào)查問卷，問卷的內(nèi)容盡量詳細，以使所獲資料的盡可能豐富。在調(diào)查的過程中，為保證資料的客觀性，我們對調(diào)查對象所對應醫(yī)院、各門診部、衛(wèi)生隊的入院記錄、門診病歷及接診登記進行查對，同時與醫(yī)院的領導、門診部和衛(wèi)生隊負責人進行座談，與調(diào)查對象的官兵進行座談，詳細了解部隊官兵的日常訓練情況、因訓練所致的損傷情況、跳傘著陸的正確姿勢、目前的傘型、裝備等。 2．資料收集完畢后，對所有數(shù)據(jù)進行整理，分別歸類。分析不同條件下傘兵身體各部位的損傷情況，對造成踝關節(jié)損傷的8種常見原因進行多因素分析，找出相應的危險因素和保護因素。統(tǒng)計結果根據(jù)資料的性質(zhì)進行X2檢驗和T檢驗，多因素分析使用SPSS軟件。 3．統(tǒng)計結果完畢后，根據(jù)空降兵著陸時踝關節(jié)處于跖屈30°左右姿勢下，對10具人體新鮮踝關節(jié)標本實施生物力學的測定，了解外側副韌帶損傷、最大內(nèi)翻情況下骨性結構的損傷情況，得出三種損傷的耐限值。對三組不同的數(shù)據(jù)進行方差分析，為下一步的防護實驗做好充分準備。 結果 1．我們對某空降部隊397名官兵進行了問卷調(diào)查，同時參照受傷官兵的門診或入院病歷，以明確診斷。根據(jù)調(diào)查資料進行整理，所有踝關節(jié)受傷的官兵無論損傷的次數(shù)，符合診斷標準的均記為一例，因為其他的同性質(zhì)損傷均與此次受傷有關，既按病例人數(shù)進行統(tǒng)計。其中受傷人員為173例，包括踝關節(jié)損傷70例，膝關節(jié)損傷13例，脊柱損傷49例，其他部位損傷41例，損傷時間為2004-2006年。地面跳臺訓練中以脊柱損傷為主，跳傘著陸訓練以四肢損傷為主。 2．另外收集踝關節(jié)及脛腓骨損傷病例18人，與其同時跳傘但未損傷的士兵14人，總計32人。與傷員取得聯(lián)系后，到其所在部隊進行調(diào)查，將與其同時跳傘的14人作為正常對照，進行多因素分析，使用SPSS軟件。結果顯示地面情況(X2)、風向(X5)為危險因素，有無護踝(X3)及跳傘年限(X8)為保護因素。 3．統(tǒng)計數(shù)據(jù)得出后，我們對10具新鮮人體踝關節(jié)標本進行生物力學測定，結果是靜力學條件下，外側副韌帶損傷所需要的承載力平均為2062.62N，足部骨性結構損傷所需要的承載力平均為3755.4286N。 結論 1．本研究首先通過流行病學調(diào)查，了解到空降兵跳傘著陸時和地面訓練時的損傷因素及機制，既著陸損傷受多種因素的影響。最主要的直接原因就是對傘具的操作不當和著陸姿勢不正確，其中后者的影響更大，是主要因素。而其他幾種原因則是間接影響了跳傘員的著陸姿勢，另外，傘兵的心理素質(zhì)、跳傘經(jīng)驗、以及多次的損傷都有可能對傘兵跳傘產(chǎn)生影響。 2．對幾種致傷因素的分析后，得出結論，就是跳傘次數(shù)少(小于16次)的傘兵和跳傘次數(shù)較多(大于24次)的傘兵跳傘著陸損傷的發(fā)生率相對較高。原因可能是經(jīng)驗不足或是跳傘難度增加。不同傘齡和不同跳傘次數(shù)的官兵在跳傘訓練和地面訓練所致的損傷中是沒有差異的，而跳傘訓練時踝關節(jié)的損傷較多，地面訓練時脊柱的損傷較多。另外，凡是跳傘著陸時踝關節(jié)涉及到骨折的往往都比較嚴重，單純的內(nèi)或外踝骨折比較少見，這與傘兵跳傘著陸時踝關節(jié)的特殊姿勢有關。 3．比較幾種可能的致傷因素，調(diào)查的8種致傷因素中，地面情況(X2)、風向(X5)是危險因素，護踝(X3)及跳傘年限(x8)是保護因素，其中護踝的保護意義更大。當然，這些因素只是所有因素的一部分，由于時間及經(jīng)費的關系，暫無法做到全面而詳細。 4．生物力學試驗是模擬傘兵著陸時踝關節(jié)的特殊體位進行的，由于標本的限制，只能對踝關節(jié)跖屈時最大內(nèi)、外翻角度下韌帶損傷所需的最小承受力，以及踝關節(jié)在中立位時骨性結構損傷的最小承受力進行測定。將新鮮踝關節(jié)標本去除皮膚、皮下軟組織、肌肉等，僅保留踝關節(jié)周圍的韌帶和支持帶。結果是外側副韌帶損傷時所需承載平均為2063.62N；骨性結構損傷所需的承載平均為3380.28N。結果表明兩組的差異有統(tǒng)計學意義(P≤0.05)。但是，實際中的運動是動態(tài)的，它與試驗的結果仍有一定的差別。
[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.

【學位授予單位】：中國醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2007
【分類號】：R82

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