Injuries of the spine sustained in rugby

Between 1952 and 1982, 67 rugby players (63 rugby union, two rugby league, and two American football) sustained serious injuries of their spine. The injuries fell predominantly on the lower cervical spine. Forty eight of the players sustained serious injuries of the spinal cord, leading to paralysis and total incapacity. The incidence of such injuries appears to have increased in recent years, particularly those incurred in tackles and mauls and rucks, and particularly among schoolboys. Changes in the laws of the game and in the attitudes of the players over the past few years should improve play and lead to a lower incidence of injuries.     

Spinal injuries in rugby union, 1970-2003: lessons and responsibilities

There was an increase in the frequency of rugby union spinal injuries worldwide during the 1970s and early 1980s. The United Kingdom and Australia have since had some success in reducing this increase in spinal injuries. These changes were the result of actions by rugby union authorities in response to recommendations by medical advisors; legal action by injured players has also played a part. The frequency of spinal injuries has not decreased in New Zealand (up to 2000) and South Africa (up to 1997). Rugby union authorities' responsibilities should include establishing and maintaining national and international spinal injury registers to forge closer working relationships with medical researchers. Such registers would provide up-to-date information for enhancing and developing preventive measures. There has been no specific publicly available record of the incidence of rugby union spinal injuries in Australia since 1996, so it is uncertain whether the safety measures introduced so far have had a lasting impact.     

Cervical spine injuries in rugby players.

Nine patients with serious cervical spine injuries that occurred while they were playing rugby were seen in a British Columbia acute spinal cord injury unit during the period 1975-82. All the injuries had occurred during the "scrum" or the "tackle". Two of the patients were rendered permanently quadriplegic, and one patient died. There is a need for a central registry that would record all cervical spine injuries in rugby players as well as for changes in the rules of the game.     

A season of football injuries

All rugby and soccer players presenting to the Accident & Emergency department during the football season 1992-1993 (a total of 871) were prospectively studied to compare the injuries sustained in the two sports. The nature and site of injury, treatment required, age, fitness, experience and position of the player, situation giving rise to injury, and medical attention at the grounds were all analysed. The results show that rugby and soccer players had the same number of injuries, and while there were some differences in the nature of the injuries, there was no difference in overall severity. Rugby flankers and soccer goalkeepers are particularly at risk. Competitive matches produce more injuries than training sessions. Experience or fitness did not appear to be a factor and 45% of rugby injuries and 15% of soccer injuries were from school matches. Law changes (e.g. the rugby scrum and the use of gum-shields) have reduced some injuries, but other areas (e.g. jumping for the ball in soccer, rucks and mauls in rugby) also warrant consideration. There was one death, but no spinal cord injuries. Medical attention at the grounds was limited. Rugby injuries, therefore, do not appear to be more numerous or severe than soccer injuries. Law changes have been of benefit but they need to be enforced and perhaps more should be considered. Medical attention at sports grounds could be improved and Registers of injuries kept by the sporting bodies would be of benefit.     

Spinal-cord injuries in Australian footballers, 1960-1985

A review of 107 footballers who suffered a spinal-cord injury between 1960 and 1985 has been undertaken. Since 1977, the number of such injuries in Rugby Union, Rugby League and Australian Rules has increased, from an average of about two injuries a year before 1977 to over eight injuries a year since then. Rugby Union is clearly the most dangerous game, particularly for schoolboys; all of the injuries in schoolboy games for this code have occurred since 1977. This study has shown that collision at scrum engagement, and not at scrum collapse, is the way in which the majority of scrum injuries are sustained. These injuries are largely preventable, and suggestions for rule changes are made. Half the injured players recovered to Frankel grades D or E. The financial entitlements of those injured were grossly inadequate; this warrants action. A national register for spinal-cord injuries from football should be established to monitor the effects of desirable rule changes in Rugby Union and Rugby League.     

Transmission of herpes simplex virus type 1 infection in rugby players

Skin infections, both bacterial and viral, are endemic in contact sports such as wrestling and rugby football. In this report, we describe four cases of extensive cutaneous herpes simplex virus in players on a rugby team. All players had a prodrome of fever, malaise, and anorexia with a weight loss of 3.6 to 9.0 kg. Two players experienced ocular lesions associated with cutaneous vesicular lesions of the face. A third player, who had herpetic lesions on his lower extremity, experienced paresthesias, weakness, and intermittent urinary retention and constipation. All infected players on the team were forwards or members of the "scrum," which suggests a field-acquired infection analogous to the herpetic infections seen in wrestlers (herpes gladiatorum). Considering the serious sequelae of recurrent herpes simplex keratitis, the traumatic skin lesions in rugby football players should be cultured for herpes virus, and infected individuals should be restricted from playing until crusted lesions have disappeared.     

Sudden death due to ischaemic heart disease in young aboriginal sportsmen in the Northern Territory, 1982-1996.

OBJECTIVE: To estimate the incidence of sport-related sudden cardiac death due to ischaemic heart disease (IHD) in competitive young Aboriginal sportsmen. SETTING: Northern Territory (NT), 1982-1996. DESIGN: Retrospective case series with cases identified from Australian Bureau of Statistics cause-of-death listings and NT coronial autopsy records. MAIN OUTCOME MEASURES: Circumstances and incidence of sport-related sudden cardiac deaths due to IHD; autopsy findings. RESULTS: Between 1982 and 1996, there were eight sudden cardiac deaths due to IHD and related to sporting activity among Aboriginal sportsmen aged 15-37 years in the NT. Six were associated with games of Australian (rules) football. All occurred in the Top End of the NT in the wet season, and all occurred after the first half, or within an hour of, a game. Four of the players had macrosopic myocardial abnormalities (hypertrophy or previous infarcts) on autopsy. The estimated incidence of IHD-related sudden cardiac death among Aboriginal Australian football players in the NT was 19-24 per 100,000 player-years, compared with 0.54 per 100,000 player-years among Australian rules footballers of similar ages in Victoria. CONCLUSIONS: Incidence of sudden cardiac death attributable to underlying IHD was extremely high among young NT Aboriginal Australian footballers. Prevention will best be achieved by funding culturally appropriate long-term strategies to reduce the incidence of IHD. However, in the short-term, community-controlled programs with education of athletes, heat-stress reduction strategies, and cardiovascular screening should reduce the incidence of sudden cardiac death in sport.     

National survey of spinal injuries in hockey players

There has been an alarming increase in the number of spinal injuries in hockey players. Between 1976 and 1983, 42 were reported to the Committee on Prevention of Spinal Injuries due to Hockey. The median age of the injured players was 17 years. Of the 42 players 28 had spinal cord injuries, and 17 of them had complete paralysis below the vertebral level of the injury. Strikes from behind and collisions with the boards were common mechanisms of injury. Many of the players had suffered a burst fracture of the cervical spine following a blow to the top of the helmet when the neck was slightly flexed. The committee studied a number of possible etiologic factors and made several recommendations regarding prevention. League officials, coaches, players and equipment manufacturers can all play a role in prevention.     

脊髓损伤为主的全身多发伤相关因素研究

目的 分析因不同原因所致创伤性脊髓损伤合并其他多器官损伤的特点，了解以脊髓损伤为主的全身多发伤的受伤模式和相关因素，总结此类损伤的处理要点。方法 回顾性总结了1996年8月至2002年7月间收治的132例包含脊髓损伤的全身多发伤的临床资料，分析伤者的年龄分布，受伤原因，合并伤情况，脊髓损伤的主要节段和程度，处理方式，以及临床后果。结果 本组132例伤者中，男性94例，女性38例。年龄14～65岁，以青壮年为主。最主要的致伤原因是车祸，占62％，其次为坠落伤，占24．5％。最常见的合并伤是四肢创伤(约51．5％)，其次为头伤(约32％)和胸伤(约30％)。脊髓损伤的主要节段发生在C1-2，C6-T1，T6-T8和T12-L1。合并伤越重，后果越差，本组共死亡34例(约为26％)，主要死因是呼吸系统并发症导致呼吸衰竭和重型颅脑损伤。完全性脊髓损伤者神经功能无明显恢复，不完全脊髓损伤者中有41例(约54％)经治疗后按ASIA标准可恢复Ⅰ级以上。结论 合并伤对创伤性脊髓损伤的治疗和预后都有重要的影响，了解以脊髓损伤为主的全身多发伤的受伤模式和临床后果有助于早期判断和处理这类复杂的多发创伤，也对制定有关安全防护措施有参考意义。     

Traumatic brain injury in high school athletes.

CONTEXT: The potential seriousness of mild traumatic brain injury (MTBI) is increasingly recognized; however, information on the frequency of MTBI among high school athletes is limited. OBJECTIVE: To identify the type, frequency, and severity of MTBI in selected high school sports activities. DESIGN: Observational cohort study. SETTING AND PARTICIPANTS: Two hundred forty-six certified athletic trainers recorded injury and exposure data for high school varsity athletes participating in boys' football, wrestling, baseball and field hockey, girls' volleyball and softball, boys' and girls' basketball, and boys' and girls' soccer at 235 US high schools during 1 or more of the 1995-1997 academic years. MAIN OUTCOME MEASURES: Rates of reported MTBI, defined as a head-injured player who was removed from participation and evaluated by an athletic trainer or physician prior to returning to participation. National incidence figures for MTBI also were estimated. RESULTS: Of 23566 reported injuries in the 10 sports during the 3-year study period, 1219 (5.5%) were MTBIs. Of the MTBIs, football accounted for 773 (63.4%) of cases; wrestling, 128 (10.5%); girls' soccer, 76 (6.2%); boys' soccer, 69 (5.7%); girls' basketball, 63 (5.2%); boys' basketball, 51 (4.2%); softball, 25 (2.1%); baseball, 15 (1.2%); field hockey, 13 (1.1%); and volleyball, 6 (0.5%). The injury rates per 100 player-seasons were 3.66 for football, 1.58 for wrestling, 1.14 for girls' soccer, 1.04 for girls' basketball, 0.92 for boys' soccer, 0.75 for boys' basketball, 0.46 for softball, 0.46 for field hockey, 0.23 for baseball, and 0.14 for volleyball. The median time lost from participation for all MTBIs was 3 days. There were 6 cases of subdural hematoma and intracranial injury reported in football. Based on these data, an estimated 62816 cases of MTBI occur annually among high school varsity athletes participating in these sports, with football accounting for about 63% of cases. CONCLUSIONS: Rates of MTBI vary among sports and none of the 10 popular high school sports we studied is without the occurrence of an MTBI. Continued involvement of high school sports sponsors, researchers, medical professionals, coaches, and sports participants is essential to help minimize the risk of MTBI.     

A 10-year review of sports-related spinal injuries

Introduction

The incidence of traumatic spinal cord injury varies in different countries from 2.5 to 57.8 per million per annum, with sport accounting for 8–12.7% of these injuries. Spinal injuries associated with recreational sport often result in long-term permanent disability in otherwise active individuals.

Materials and methods

The aetiology, pattern and mechanism of the 196 sports-related spinal injuries treated in the National Spinal Injuries unit in Ireland from 1993 to 2003 is reviewed in this article.

Results

Sports-related spinal injuries accounted for 11% of all spinal injury admissions. There were 145 (74%) males and 51 (26%) females, with an average age of 30.2 years (range 14–72 years). The most common sport responsible for a spinal injury was equestrian events (41.8%), rugby (16.3%), diving (15.3%), Gaelic football and hurling (9.6%), cycling (4.2%), and miscellaneous (12.7%). Injury distribution was cervical spine (118 patients, 60%), thoracic (41 patients, 21%), lumbar spine (37 patients, 19%). In 18 patients (9.25%) more than one region was affected. In 78 patients (40%) more than one vertebral level was affected. On admission 71 patients (36%) had a neurological deficit with 46 patients (65%) incomplete and 25 (35%) complete, of which 6 patients (23%) were paraplegic and 19 (77%) were tetraplegic.

Conclusion

Sport is an important cause of spinal injury among young people in Ireland. This study contributes to our understanding of these injuries aetiology, pattern and mechanism of injury and allows constructive recommendations for injury prevention and management.     

用运动诱发电位评价急性脊髓损伤的治疗效果

目的探讨运动诱发电位对脊髓损伤疗效的评价作用。方法健康雄性猫３２只,随机分为对照组、脊髓损伤组、治疗组和假治疗组,每组８只。采用Ａｌｅｎ’ｓ重量降落冲击法制备脊髓损伤模型,用ＮｅｕｒｏｐａｃｋⅡＭＥＢ５１００型诱发电位记录仪测各组动物的运动诱发电位。直接刺激大脑皮层运动区,记录电极位于腰椎棘突间。分别测试手术前、后、损伤后立即、损伤后３０、６０、９０、１２０ｍｉｎ的运动诱发电位。采用硫代巴比妥酸法测脊髓组织中反映自由基水平的指标之一丙二醛含量。治疗组动物于致伤后立即静脉输入超氧化物歧化酶,假治疗组则给于等量的生理盐水。结果损伤组动物ＭＥＰ呈进行性恶化,损伤处脊髓组织中丙二醛含量较对照组明显升高。治疗组动物ＭＥＰ较损伤组和假治疗组有改善,尤以伤后３０ｍｉｎ和６０ｍｉｎ为明显,而后逐渐恶化,其致伤脊髓组织中丙二醛含量也较上二组明显降低而接近正常对照组。治疗组动物病理结果亦较损伤组和假治疗组有改善。结论ＳＯＤ具有保护损伤脊髓组织的作用。ＭＥＰ可以做为评价脊髓损伤后治疗效果的客观指标。     

改良胸膜外路及植骨结合侧前方减压固定治疗胸腰椎骨折并脊髓损伤的效果

目的研究改良胸膜外路及植骨结合侧前方减压固定治疗胸腰椎骨折并脊髓损伤的效果,并分析CT影像技术在围术期的应用。方法选取我院2009年至2015年收治的46例胸腰椎骨折合并脊髓损伤患者为研究对象,以上患者均采取改良胸膜外路及植骨结合侧前方减压固定治疗,于术前、术后进行多排CT三维重建及常规X线检查。结果 46例均获得随访,平均12个月(6-24个月)。除1例患者术中胸膜损伤以外均未出现损伤腰膨大血管、损伤脏器、损伤脊髓及术后内固定物松动等并发症。Frankel分级法显示神经功能明显改善,46例患者经术后CT重建扫描均显示骨折复位效果良好,椎管内无压迫。结论侧前方减压固定治疗胸腰椎骨折并脊髓损伤减压直接且彻底,CT重建技术应用于胸腰椎骨折合并脊髓损伤可实现胸腰椎骨折并脊髓损伤的准确诊断及治疗评估,临床价值较高。     

Protective effect of adenovirus-mediated BDNF gene expression on spinal axon following in rats after spinal cord injury

The routine treatments of spinal cord injury are palliative in Practice at Present. Their goal is only to preventthe secondal injeq and the complications, and then thepatients to adapt new life style under palalysis condition.The sprouting and the Plasticity of the neims in foe centlal nervous system (CNS) Of malnlnals has been ProVedll]. It is wen known that the neurntrOPhins facilitatethe renovation and regenerahon of the ne~ns in CNS after injuries. HoweVer the c~ive effect Of the ne…     

The rising incidence of childhood type 1 diabetes in New South Wales, 1990-2002

OBJECTIVES: To determine the incidence of childhood type 1 diabetes mellitus (T1DM) in New South Wales from 1997 to 2002; to compare with previously published rates (1990-1996); and to analyse trends in incidence from 1990 to 2002. DESIGN, SETTING AND PARTICIPANTS: Prospective population-based incidence study. Primary ascertainment of incident cases aged < 15 years was from the Australasian Paediatric Endocrine Group NSW children's diabetes register. Secondary ascertainment was from the National Diabetes Supply Scheme until 1999 and from the Australian Institute of Health and Welfare thereafter. Childhood population data were obtained from the Australian Bureau of Statistics. MAIN OUTCOME MEASURES: Age-standardised incidence; trends in incidence by calendar year, and sex and age at diagnosis. RESULTS: There were 3260 incident cases (1629 boys, 1631 girls) in the 13 years. Case ascertainment was 99.7% complete using the capture-recapture method. Mean age-standardised incidence per 100 000 person-years was 20.9 (95% CI, 19.9 to 21.9) from 1997 to 2002 compared with 17.8 (95% CI, 17.0 to 18.7) from 1990 to 1996; there was a plateau in incidence between 1997 and 2002. Overall, the incidence increased on average by 2.8% per year (95% CI, 1.9% to 3.8%, P < 0.001) and increased with age, being 12.2 (95% CI, 11.3 to 13.1) in 0-4 year olds; 18.9 (95% CI, 17.8 to 20.0) in 5-9 year olds and 26.7 (95% CI, 25.4 to 28.1) in 10-14 year olds. The increase per year in 0-4 year olds (3.9%) was not significantly higher than in older children. The mean incidence of T1DM was 19.8 (95% CI, 18.8 to 20.7) in girls and 18.8 (95% CI, 17.9 to 19.7) in boys (P = 0.02). CONCLUSIONS: The incidence of childhood-onset T1DM has increased significantly in all age groups in NSW since 1990. Resource planning in the management of childhood diabetes in NSW should take these findings into account.     

早期脊髓复苏在急性颈脊髓损伤治疗中的临床意义

目的评价早期脊髓复苏在急性脊髓损伤治疗中的临床意义。方法对86例急性颈脊髓损伤患者,其中脊髓完全性损伤17例,脊髓不完全性损伤69例。早期脊髓复苏方案包括：①保持呼吸道通畅和足够有效的血容量,维持平均动脉血压在100mmHg以上,血氧饱和度在95％以上。②应用大剂量甲基强的松龙或地塞米松等药物治疗。③行颅骨牵引制动或复住颈椎。④早期进行颈椎减压植骨融合内固定术。⑤术后早期应用高压氧治疗。结果死亡6例,失访4例,76例获得12～54个月的随访。随访病例中56例神经功能获得改善,其中完全性损伤组有效率为23．5％,不完全性损伤组有效率为73．9％,总有效率为65．1％。结论颈脊髓损伤后,早期复苏治疗是保留和恢复残存脊髓神经功能较为有效的措施,应在临床积极推广应用。     

Knee stability and knee ligament injuries.

Controversy exists on the relationship of knee ligament stability to knee injuries. Subjective evaluation of joint tightness or looseness has been proposed as a criterion for prescribing selective corrective strengthening or stretching exercises. Biomechanical studies of knee ligament stability were performed on 401 college football players from 1969 to 1971. Forty-three knee ligament injuries occurred during this period of time, 19 (44.2%) in "loose-jointed" players and 24 (55.8%) in "tight-jointed" players. Joint laxity tests were performed on 72 college football players; the distribution of college football players failing to perform each of the tests was quite different from that reported for professional football players. There was no relationship between the subjective joint laxity tests and the objective biomechanical tests of knee ligament stability. We conclude that it is not possible to predict knee injuries by subjective evaluations of joint laxity or by objective biomechanical knee ligament evaluations and that exercise programs based on subjective studies are therefore not sound.     

脊髓损伤修复的方法学进展

传统观念认为,脊髓损伤后由于神经元不能再生而不能修复.但近年来的基础研究结果证明,中枢轴突损伤后在一定条件下是可以再生的,几个里程碑式的研究带来了令人鼓舞的结果.这些研究涉及到器官水平、细胞水平和分子水平的修复.目前神经科学界已经达成广泛共识:脊髓损伤最终是可以修复的,但既往研究尚存在实验设计上的缺陷、实验结果不能很好的重复等问题.本文介绍了国内外有关脊髓损伤修复的方法学研究进展,为今后脊髓损伤修复的研究提供参考.     

脊髓损伤致大鼠神经源性膀胱尿动力学变化及P2Y4的表达意义

目的探讨大鼠不同平面脊髓损伤(SCI)后神经源性膀胱尿动力学变化及P2Y4的表达意义。方法健康成年SD大鼠50只,雌雄不限,体重180-220g,随机分对照组、骶髓损伤组、骶上脊髓损伤组。建立神经源性膀胱大鼠模型。28d后,进行尿动力学检测。尿动力检测完毕后,取标本用免疫组化法检测P2Y4表达情况。结果逼尿肌漏尿点压力在骶上脊髓损伤组较对照组、骶髄损伤组升高明显;逼尿肌漏尿点压在骶髄损伤组较对照组明显下降。P2Y4在骶上脊髓损伤组的表达较对照组、骶髓损伤组升高明显;P2Y4在骶髓损伤组表达较对照组明显降低。结论大鼠骶上脊髓损伤后,逼尿肌表现为反射亢进,大鼠骶髓损伤后逼尿肌表现为反射减弱。膀胱逼尿肌中P2Y4表达增高可能是引起逼尿肌反射亢进机制之一。