運動腦震盪對回場後下肢骨骼肌肉傷害之影響

Lower extremity musculoskeletal injury risk following Sport-related concussion and return to play

運動腦震盪近來逐漸受到運動醫學領域與研究的重視，研究發現有腦震盪病史的運動員在腦震盪傷後回到運動場的一年內，下肢骨骼肌肉傷害的風險顯著提高，約是腦震盪前的1.5倍，且是無腦震盪病史的運動員的2倍。腦震盪傷後回場之後持續存在的神經肌肉控制失能，可能是導致回場後下肢骨骼肌肉傷害風險增高的主要原因之一。本文獻回顧探討：一、運動腦震盪對下肢骨骼肌肉傷害風險的影響，與二、傷害風險提高的可能潛在機制。建議未來研究應改善目前相關文獻的研究限制，並考量可能的干擾因子，如將運動員的訓練總時數納入傷害率的計算中、招募多種運動項目的受試者，且將下肢骨骼肌肉傷害病史的數量與受傷的時間納入考量，進行前瞻性研究，以便了解選手回場後是否還有其它影響下肢骨骼肌肉傷害的風險因子，以提供具有更強證據力的數據來解釋腦震盪與回場後下肢骨骼肌肉傷害之間的關係。最後，建議未來研究應進一步改良現行的腦震盪臨床評估工具，以協助臨床工作者更全面的評估腦震盪運動員的恢復狀況，做更完善且安全的傷後回場臨床決定。

Sport-related concussion (SRC) is recognized as a growing health concern in the field of sports medicine. Previous studies have found an increased risk of lower extremity musculoskeletal (LMSK) injury among athletes with a history of SRC within the first year of return to play. The risk of LMSK injury is approximately 1.5 and 2 times greater among concussed athletes when comparing to pre-concussion and matched healthy controls, respectively. The persistent neuromuscular control deficits have been proposed a potential primary risk factor leading to the elevated risk of LMSK injury after SRC. Therefore, the purposes of this systematic review were to summarize the recent evidence, (1) in the elevated risk of LMSK injury after SRC and (2) the potential underlying mechanisms. Future studies should modify previous literature limitations and consider other potential confounding factors, including calculating injury rate with athletic exposure, recruiting participants from multiple sports, and controlling for lower extremity injury history. Lastly, future investigations are warranted to develop more well-rounded SRC evaluations for safe return to play decisions.