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Head and Neck Characteristics as Risk Factors For and Protective Factors Against Mild Traumatic Brain Injury in Military and Sporting Populations: A Systematic Review
Sports Medicine ( IF 9.8 ) Pub Date : 2022-05-06 , DOI: 10.1007/s40279-022-01683-2
Nicholas J Cooney 1 , Paul Sowman 1 , Nathan Schilaty 2, 3 , Nathaniel Bates 4 , Timothy E Hewett 5, 6 , Tim L A Doyle 7
Affiliation  

Background

Investigators have proposed that various physical head and neck characteristics, such as neck strength and head and neck size, are associated with protection from mild traumatic brain injury (mTBI/concussion).

Objectives

To systematically review the literature and investigate potential relationships between physical head and neck characteristics and mTBI risk in athletic and military populations.

Methods

A comprehensive search of seven databases was conducted: MEDLINE, EMBASE, CINAHL, Scopus, SPORTDiscus, Cochrane Library, and Web of Science. Potential studies were systematically screened and reviewed. Studies on military and athletic cohorts were included if they assessed the relationship between physical head-neck characteristics and mTBI risk or proxy risk measures such as head impact kinematics.

Results

The systematic search yielded a total of 11,723 original records. From these, 22 studies met our inclusion criteria (10 longitudinal, 12 cross-sectional). Relevant to our PECO (Population, Exposure, Comparator, and Outcomes) question, exposures included mTBI incidence and head impact kinematics (acceleration, velocity, displacement) for impacts during sport play and training and in controlled laboratory conditions. Outcome characteristics included head and neck size (circumference, mass, length, ratios between these measures), neck strength and endurance, and rate of force development of neck muscles.

Discussion

We found mixed evidence for head and neck characteristics acting as risk factors for and protective factors against mTBI and increased susceptibility to head impacts. Head-neck strength and size variables were at times associated with protection against mTBI incidence and reduced impact kinematics (14/22 studies found one or more head-neck variable to be associated with protection); however, some studies did not find these relationships (8/22 studies found no significant associations or relationships). Interestingly, two studies found stronger and larger athletes were more at risk of sustaining high impacts during sport. Strength and size metrics may have some predictive power, but impact mitigation seems to be influenced by many other variables, such as behaviour, sex, and impact anticipation. A meta-analysis could not be performed due to heterogeneity in study design and reporting.

Conclusion

There is mixed evidence in the literature for the protective capacity of head and neck characteristics. We suggest field-based mTBI research in the future should include more dynamic anthropometric metrics, such as neck stiffness and response to perturbation. In addition, laboratory-based mTBI studies should aim to standardise design and reporting to help further uncover these complicated relationships.



中文翻译:

头颈部特征作为军事和体育人群轻度创伤性脑损伤的危险因素和保护因素:系统评价

背景

研究人员提出,各种头部和颈部的身体特征,例如颈部力量和头部和颈部大小,与轻度创伤性脑损伤(mTBI/脑震荡)的保护有关。

目标

系统地回顾文献并调查运动和军事人群中头部和颈部的身体特征与 mTBI 风险之间的潜在关系。

方法

对七个数据库进行了全面搜索:MEDLINE、EMBASE、CINAHL、Scopus、SPORTDiscus、Cochrane 图书馆和 Web of Science。系统地筛选和审查了潜在的研究。如果他们评估身体头颈特征与 mTBI 风险或代理风险措施(如头部撞击运动学)之间的关系,则包括对军事和运动队列的研究。

结果

系统检索共产生 11,723 条原始记录。其中,22 项研究符合我们的纳入标准(10 项纵向研究,12 项横断面研究)。与我们的 PECO(人口、暴露、比较器和结果)问题相关,暴露包括 mTBI 发生率和头部撞击运动学(加速度、速度、位移),用于运动和训练期间以及受控实验室条件下的撞击。结果特征包括头部和颈部大小(周长、质量、长度、这些测量值之间的比率)、颈部力量和耐力,以及颈部肌肉的力量发展速度。

讨论

我们发现头部和颈部特征作为 mTBI 的危险因素和保护因素的混合证据,以及对头部撞击的易感性增加。头颈强度和大小变量有时与防止 mTBI 发病率和减少冲击运动学相关(14/22 研究发现一个或多个头颈变量与保护相关);然而,一些研究没有发现这些关系(8/22 研究没有发现显着的关联或关系)。有趣的是,两项研究发现,更强壮和更大的运动员在运动中更容易受到高冲击。强度和规模指标可能具有一定的预测能力,但影响缓解似乎受到许多其他变量的影响,例如行为、性别和影响预期。

结论

文献中关于头部和颈部特征的保护能力的证据不一。我们建议未来基于现场的 mTBI 研究应该包括更多动态的人体测量指标,例如颈部僵硬和对扰动的响应。此外,基于实验室的 mTBI 研究应旨在标准化设计和报告,以帮助进一步揭示这些复杂的关系。

更新日期:2022-05-06
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