棒球運動的手臂傷害風險因素：文獻回顧研究之系統性評論

Risk factors for arm injuries in baseball: A systematic review of literature reviews

目前已經有許多文獻回顧研究在探討棒球運動傷害的風險因素，但每一個回顧僅是展示整個受傷風險拼圖中的一部分。本研究旨在綜合不同技能水準棒球選手受傷風險的回顧型研究，來確認與棒球選手手臂傷害有關的風險因素，以提供現有證據的概述。本研究遵循Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)的指引並利用了PubMed、SPORTDiscus和ScienceDirect三個資料庫搜索截至2024年針對各種層級棒球選手受傷風險因素的各類回顧研究，設定關鍵詞篩選出了4,605個文獻，檢視標題和摘要後留下18篇進入全文閱讀。每篇文獻都由兩名評審獨立選擇所要回顧文獻的方法學品質，結果共篩選出範域性回顧1篇、系統性回顧9篇、系統性加上統合分析4篇。歸納出五個面向的重要風險因素：工作負荷量，包括高投球量、手臂疲勞、球速快；關節活動範圍，包括肩關節活動範圍異常、盂肱關節內旋缺損、肱骨逆旋扭轉增加；個人特徵，包括擔任投手或捕手、肩或肘部疼痛史、不正常足弓；動作特性，包括肘和肩部外翻過大、過早軀幹轉動、投球時側向軀幹傾斜、快速球使用率高和球種少；肌力與平衡，包括下肢平衡與神經肌肉控制差。棒球運動的受傷機率牽涉到內在、發展、外在因素和刺激事件等條件的交互作用，而保持合理的工作負荷量、擁有較佳的下肢平衡控制與有效評估手臂疲勞程度，對於預防手肘和肩部的運動損傷是相當重要的指標。

There are many literature reviews on risk factors for injuries in baseball, but each of these reviews shows one piece of the larger injury risk puzzle. This research was to synthesize reviews investigating risk factors for injuries in baseball players of varying skill levels and to identify the major risks associated with these injuries, to provide an overview of the existing evidence. As following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA), 3 databases including PubMed, SPORTDiscus, and ScienceDirect were searched for literature reviews targeting risk factors for injuries in baseball players with different levels up to 2024. We screened 4605 titles and abstracts and read 18 reviews before retaining 14 of them. Two reviewers independently selected reviews and rated methodological quality. We included 1 scoping reviews, 9 systematic reviews, and 4 systematic and meta-analyzed reviews. The results indicated 5 higher-order risk factors including workload (high pitch volume, increased pitch velocity, arm fatigue), range of motion (shoulder range of motion deficit, glenohumeral internal rotation deficit, increased humeral retrotorsion), personal characteristics (pitcher or catcher, history of shoulder or elbow pain, abnormal foot arch), pitching technique (elbow and shoulder excessive valgus, early trunk rotation, lateral trunk tilt during pitching, high percentage of fastballs thrown, smaller pitch repertoire), and strength and balance (poor lower extremity balance and neuromuscular control). The rising injury rates seen in baseball involve an interaction of intrinsic, extrinsic, and developmental factors and inciting event. Therefore, maintaining a reasonable workload, achieving better lower limb balance control, and effectively assessing arm fatigue are crucial for preventing elbow and shoulder injuries in baseball.