運動相關腦震盪：敘述性縱論

Sport-Related Concussion: A Narrative Review

運動相關腦震盪可以由外力直接撞擊頭部或來自身體其他部位間接傳遞的機械力量所導致。運動相關腦震盪不只會影響腦部功能，更可能造成身體其他系統的症狀，如頸椎、前庭系統與動眼系統，且症狀可能持續達數年之久。此外，腦震盪後也可能產生慢性創傷性腦病變或二次撞擊症候群等後遺症。辨識腦震盪的個案與詳細的評估是處理運動相關腦震盪中最重要的關鍵。透過場上即時的評估並移除可能或確定腦震盪的個案，配合後續對於全身詳細的評估與檢查才能制定對腦震盪完整的治療與復健計畫。目前國外有許多運動相關腦震盪的回場流程，雖然各指引略有不同，但傷後24-48小時的休息配合漸進性的回場策略是指引的共識，透過回場策略可以有效的協助運動員安全回場。除了完整的評估與擬定後續的回場策略外，運動相關腦震盪的預防也是另一個值得被重視的議題。目前，最有效果的預防策略是從比賽的制度與規則著手。近幾年，運動相關的腦震盪在國際間已逐漸被重視，但在台灣，這個議題還未被廣泛討論。本文會由腦震盪的成因、發生率、病生理機轉著手，介紹腦震盪的基本知識；再介紹如何完整地評估腦震盪所影響到的系統，並擬定適合的回場策略與復健；最後回顧目前預防傷害的方式。希望透過本篇敘述性縱論，可以讓臨床工作者更加了解運動相關腦震盪的成因、評估與處理。

Sport-related concussion (SRC) could be caused by either direct impact to head or indirect biomechanical force transferred from other body area. SRC affects not only the brain but several systems including cervical spine, vestibular and oculomotor system. The symptoms could even last for years after the injury. Besides, some cases may also suffer from serious consequences such as chronic traumatic encephalopathy and second impact syndrome. Identification of the potential concussed athlete with a comprehensive evaluation is the key to manage SRC. A comprehensive return to play protocol and rehabilitation require on site examination to remove the possible or confirmed concussion athlete with the following thorough examination of all the affected system. Several return to play protocols have been developed by sporting bodies abroad. Though the exact details vary, initial rest for 24-48 hours followed by a graduated return to play process are the cornerstone of these protocols. Prevention of SRC is another topic needed to be addressed. Currently, the most effective way to prevent SRC is through the modification of rules. In recent years, SRC has been increasingly emphasized abroad; however, this issue has not yet been taken seriously in Taiwan. This article would cover the etiology, prevalence, and pathophysiology of SRC followed by the thorough evaluation and return to play program design and finally the current evidence of prevention. The aim of the article is to provide a deeper insight of SRC to clinical practitioners to assist the evaluation and management of SRC.