优秀业余拳击运动员运动创伤调查分析

目的:了解我国优秀业余拳击运动员运动创伤发病情况,探讨预防措施。方法:2006年5月至2006年9月,采用问卷对在国家拳击队集训的30名男子拳击运动员进行回顾性调查并进行临床检查。结果:共查出运动创伤37种,其中发病率居前6位的是:胸椎小关节紊乱27例,发病率为90%;颈椎小关节紊乱25例(83.3%);腰椎小关节紊乱24例(80%);踝关节内翻扭伤22例(73.3%);眉弓或眼睑裂伤18例(60%);颈部软组织损伤18例(60%)。创伤发生部位前5位的是:腰背部损伤71人次;头面部损伤52人次;掌腕部损伤46人次;颈部损伤43人次;小腿、踝、足部损伤24人次。建议:采取加强小关节肌肉力量训练、增强技战术水平、增加本体感觉训练、合理使用护具、及时处理急性期创伤等措施预防这些损伤的发生。     

运动员寰枢关节损伤诊治探讨(附53例分析)

通过对７个运动项目的５３名运动员寰枢关节损伤的诊治，分析了不同运动项目的损伤动作、机理、临床症状、体征以及本症的Ｘ线表现，提出了本症的诊断依据：①外伤为发生本病的主要原因；②具有颈活动不适、颈痛、头痛、头晕、晕车、消化道症状及前胸不适等症状；③触诊Ｃ２棘突偏歪，枕下三角，颈肌、Ｃ２棘突旁压痛；④Ｘ线开口位见Ｃ２棘突偏歪、齿侧间隙不等、侧块不等、Ｃ２上关节面延长线之交点不在轴线上以及Ｃ１外下角偏移等。并对此症的防治提出了意见。     

312名跳水运动员颈椎损伤临床调查与防治(附173例X线片分析)

312名跳水运动员颈椎损伤临床调查结果显示:完全正常256名(82.05%);有颈椎病症状56名(17.95%),主要表现为颈肩背酸痛,伴手指麻木,头晕、头痛、耳鸣,颈部活动受限,结合临床诊断为颈椎病45名(14.42%)。其中173名颈椎X线结果显示:完全正常85名(49.13%);运动适应性改变43名(24.86%);颈椎损伤45名(26.01%)。跳水运动员颈椎损伤率高与该项目以头和上肢先入水这种特殊动作密切相关。预防与治疗措施:颈椎牵引、颈肩部软组织松解、颈椎错位的整复、颈部肌力练习、定期颈椎X线检查、科学选材。     

闭合性颈椎创伤伴椎动脉损伤的临床研究

目的　研究椎动脉损伤在闭合性颈椎创伤中的发病率及其与颈椎损伤机制、类型、损伤程度的相关性 ,观察椎动脉损伤后的临床症状、体征 ,探讨早期正确诊断的方法。　方法　于2 0 0 0年 8月～ 2 0 0 2年 2月间 ,利用颈部动脉磁共振血管造影 (MRA)技术 ,连续观察 4 6例闭合性颈椎创伤患者 ,结合颈椎X线、MRI、CT检查及患者的临床症状、体征综合分析。　结果 4 6例闭合性颈椎创伤中 ,12例 (2 6 % )伴椎动脉损伤。其中 7例为双侧损伤 (4例一侧未显影、一侧狭窄 ,3例双侧狭窄 ) ,5例为单侧损伤 (均为一侧狭窄 ) ;10例椎动脉损伤患者无任何症状 ,2例出现眩晕、恶心呕吐、面部麻木、偏盲等症状。椎动脉损伤与屈曲型损伤及颈椎严重不稳定相关 (P <0 .0 5 ) ,与小关节绞锁、横突孔骨折及脊髓完全性损伤明显相关 (P <0 .0 1)。　结论　椎动脉损伤是闭合性颈椎创伤的较常见并发症 ,其临床症状体征缺乏特异性。颈椎创伤中的颈椎严重不稳定、屈曲型损伤、伴有脊髓完全性损伤、小关节绞锁和 (或 )横突孔骨折应高度怀疑椎动脉损伤。临床医师应对此类损伤有较高的警惕性 ,常规进行颈部动脉MRA检查是最有效的早期正确辅助诊断方法。     

Klippel-Feil综合征二例

例1 男,27岁.因外伤后出现恶心、呕吐10天来院就诊.患者白幼短颈,头部左偏,颈部活动受限,一直未检查.体检:颈短,后发际低,颈椎棘突压痛,椎旁肌肉紧张.颈椎屈伸、旋转活动均明显受限,四肢及躯干皮肤感觉减退,腹壁反射、提睾反射存在.     

幼儿颈3棘突巨大骨软骨瘤1例

患者 ,男 ,6岁 ,颈后部包块并逐渐增大 3个月于 2 0 0 1-0 7- 18入院。体检 :一般情况好 ,心肺正常 ,颈后皮肤正常色 ,颈后上方后突出呈丘性突起 ,颈 3棘突偏左侧可触及一约 3ｃｍ× 3ｃｍ大小包块 ,质硬 ,压痛不明显 ,包块周界清楚 ,不移动 ,颈椎活动度尚可。颈椎Ｘ线片及ＣＴ提示 :颈 3、4、5棘突后方密度较高阴影 ,密度近似颈椎棘突 ,呈椭圆形 ,根部似来源于颈 3、4、5棘突。入院初步诊断 :颈 3、4、5棘突骨软骨瘤。 2 0 0 1- 0 7- 2 0在全麻下行瘤体切除术 ,经颈后正中入路 ,见包块概位于颈 3棘突左侧分叉顶端 ,体部突向下方 ,于颈 4、5…     

自发性脊髓硬膜外血肿1例

1　病历简介患者女 ,43岁 ,因颈痛伴右侧肢体活动欠灵活 10小时而入院 ,患者于入院当日凌晨时刻睡眠过程中突然出现剧烈颈痛 ,向左肩部放散 ,随后左侧肢体活动欠灵活 ,左上肢抬举困难 ,走路不稳 ,急诊入院。内科一般检查及颅神经检查未发现异常 ,颈椎棘突 ( 1-7)有压痛 ,颈部活动受限 ,颈部以下痛觉减退 ,但触觉存在 ,左肩部感觉过敏 ,左上肢肌力 3～ 4级 ,左肱二头肌反射 ( ) ,肱三头肌反射 ( ) ,腹壁反射 ( -) ,左足趾反射( -) ,桡骨膜反射 ( -) ,左侧踝阵挛 ( ) ,双侧未引出病理反射 ,既往无高血压及糖尿病史 ;头部ＣＴ检查未见异常 ;…     

左侧椎动脉损伤致内膜瓣形成影像学诊断1例

患者头向下摔伤后,四肢、肩部不能活动,入院行颈部CT平扫及CT血管成像(CTA),显示环枢关节脱位,C5、6椎体爆裂性骨折,C5、6椎体棘突及C6椎体右侧椎弓根骨折,C5椎体水平左侧椎动脉变扁,C4椎体水平左侧椎动脉血管腔内线样低密度影——考虑内膜瓣形成;颈椎X线片仅显示颈椎骨折及椎管狭窄情况;颈椎MRI扫描除显示颈椎骨折外还能显示脊髓损伤情况及血管腔内线状长T2信号——考虑内膜瓣形成。     

寰椎前弓发育不良并齿状突前位变异一例

患者女,64岁。因头不能举、呈低垂体位7年,双手麻木1年就诊。患者否认外伤史。体检:头部呈低垂体位,C2、C3处局部压痛(+),叩痛(±),双上肢Hoffman 征(-),双下肢反射可,踝阵挛(-),Babinski 征(-)。颈椎侧位 X 线片及寰椎张口位 X 线片示:骨质疏松脱钙,下部颈椎曲度变直,寰枕间隙消失,侧位 X 线片上齿状突前移与寰椎前弓重合。枢椎体高度增大,棘突与枕骨形成假关节(图1)。诸椎小关节增生,排列紊乱。C4～5、C5～6、C6～7椎间隙变窄,椎缘增生,前纵韧带骨化。张     

强迫喂药致幼儿第二颈椎半脱位1例

父母强迫喂药致幼儿颈椎半脱位 ,我院收治一例。报告如下 :患者 ,女 ,11月。 1998年 9月 16日父母强迫喂其药后 ,出现颈部活动受限伴哭闹。 3小时后祖父母发现患儿颈僵呈低头状 ,急来诊。检查 :患儿生命体征平稳 ,头部前屈 ,略向左倾。嘱患儿旋转头颈或抬头活动 ,不配合 ,四肢活动无异常。颈椎侧位片示 :颈椎正常生理屈度消失 ,呈反弓状 ,第二颈椎椎体向前滑脱约 0 .3厘米。诊断 :第二颈椎半脱位。经枕颌颈椎牵引治疗后 ,获得复位 ,石膏颈肩固定 8周。定期随访 ,患儿颈部活动良好。分析 :第二颈椎椎体小而棘突大 ,颈椎部关节囊松驰 ,上下关…     

Significance of prevertebral soft tissue measurement in cervical spine injuries

OBJECTIVE: The objective of this study was to evaluate the diagnostic value of prevertebral soft tissue swelling in cervical spine injuries. MATERIALS AND METHODS: A group of 107 consecutive patients with suspected injuries of the cervical vertebrae were reviewed retrospectively to identify the presence of prevertebral soft tissue swelling and to investigate the association of prevertebral soft tissue swelling with the types and degrees of cervical spine injuries. RESULTS: Prevertebral soft tissue swelling occurred in 47 (43.9%) patients. Of the 47 patients, 38 were found with bony injury and nine were without. The statistic difference was significant (P < 0.05). No correlation was demonstrated between soft tissue swelling and either the injured level of the cervical vertebrae or the degree of the spinal cord injury (P > 0.05). Anterior element injuries in the cervical vertebrae had widening of the prevertebral soft tissue more than posterior element injuries (P < 0.05). CONCLUSION: The diagnostic value of prevertebral soft tissue swelling for cervical spine injuries is significant, but the absence of this sign does not mean that further image evaluation can be spared.     

跳水运动员颈椎损伤的生物力学研究

作者通过在新鲜成人颈椎标本上做了椎体静力性负荷和动力性负荷实验,表明颈椎在后伸位应力为前屈位的50%,最大应力位于颈椎4-6,是跳水运动员头颈部入水时引起颈椎致伤的生物力学因素。     

Diffusion anisotropy changes in the brains of professional boxers

BACKGROUND AND PURPOSE: Professional boxing may result in brain injury. We hypothesize that quantitative MR diffusion imaging may be useful in determining early white matter changes. METHODS: Forty-nine professional boxers (age 30 +/- 4.5 years) and 19 healthy control subjects (age 32 +/- 9.5 years) were imaged on a clinical 1.5T scanner. None of the subjects had neurologic disorder or deficit. The average diffusion constant (D(av)) and diffusion anisotropy (FA) were determined pixel by pixel. Regional diffusion measurements were done in the corpus callosum (CC) and internal capsule (IC). The whole brain diffusion constant (BD(av)) was also determined. Student t test was used to analyze the diffusion difference between boxers and the healthy control subjects. P < .05 was considered statistically significant. RESULTS: Of the 49 professional boxers, 42 had normal conventional MRIs. The remaining 7 boxers had abnormal MR imaging findings dominated by nonspecific white matter disease. There was a significant difference in diffusion and anisotropy measurements in all the boxers compared with the healthy control subjects. In the boxer group, BD(av) increased and FA decreased significantly in the CC and posterior limb of IC. The measured FA and D(av) inversely correlated in regions of CC and IC in boxers but not in healthy control subjects. BD(av) also robustly correlated with both FA and D(av) in the splenium of CC in boxers. CONCLUSION: Increased BD(av) and the decreased FA in the CC and IC may represent preclinical signs of subtle brain injury in professional boxers.     

Evaluation of vertebral artery injury from ballistic trauma to the neck

This study was conducted to assess the likelihood of vertebral artery injury after gunshot wounds to the neck in patients without and with fracture of the cervical spine. All patients presenting to the emergency department with cervical gunshot wounds were evaluated with cervical spine radiographs; if a fracture was suspected, a computed tomographic scan was obtained. All patients with cervical gunshot wounds underwent selective angiography of the cervical vessels. The images were retrospectively reviewed by three American Board of Radiology boardcertified radiologists, assessing for the presence of fracture and vascular injury.Of the 50 patients presenting with ballistic trauma to the neck, 21 patients had sustained a cervical spine fracture; of these, 9 patients had a vertebral artery injury. Only 1 of the 29 patients without a cervical spine fracture had vascular damage. In that patient, however, the bullet was lodged between the transverse processes of the cervical vertebrae at the level of vascular injury.In the absence of a cervical spine fracture or evidence that the missilés trajectory has crossed the vertebral artery, injury to the vertebral artery is unlikely after a gunshot wound to the neck. A computed tomographic scan of the neck may help in tailoring the angiogram performed after ballistic injury.     

A prospective cohort study of injury in amateur and professional boxing

Background

There is concern over the potential for a high incidence of injury in boxing. This is despite a lack of prospective data evaluating the risk for modern day participants. Updated, reliable data with a focus on potential exposure to injury for both amateur and, especially, professional boxers is required.

Aim

To determine the epidemiology of injury and exposure of amateur and professional boxers in Victoria, Australia.

Methods

A prospective cohort study with one year follow up was carried out over 2004–2005. Thirty three amateur and 14 active professional boxers registered with either Boxing Victoria Inc (amateurs) or the Professional Boxing and Combat Sports Board of Victoria (professionals) volunteered. Exposure at training and competition was measured, and any injuries sustained during this participation were recorded.

Results

Twenty one injuries were sustained by the cohort during the follow up period. Most were to the head region (71%; 95% confidence interval −3.7 to 89.4), with concussion being the most common (33%). An overall injury rate of 2.0 injuries per 1000 hours of boxing was calculated.

Conclusion

The high exposure experienced by the boxers (as a result of considerable training time) indicated that boxing has acute injury rates comparable to, and often lower than, those found in other contact and non‐contact sports. Further, acute injuries during training appear to be less common and severe than those sustained in bouts.     

Distribution of microstructural damage in the brains of professional boxers: a diffusion MRI study

PURPOSE: To investigate and localize cerebral abnormalities in professional boxers with no history of moderate or severe head trauma. MATERIALS AND METHODS: Diffusion tensor imaging (DTI) was used to determine the apparent diffusion coefficient (ADC) and fractional anisotropy (FA) in the brains of 81 professional male boxers and 12 male control subjects. Voxel-based analysis (VBA) of both the diffusion and anisotropy values was performed using statistical parametric mapping (SPM). From this objective analysis, regions of microstructural abnormalities in the brains of the boxers were located. RESULTS: Increases in the ADC, and decreases in FA were identified in deep white matter (WM), while decreases in ADC were identified in cortical gray matter (GM). Regions of positive correlation between ADC and age were also found in both the boxer and control groups, although the regions and strength of the correlation were not the same in each group. CONCLUSION: Using VBA, we localized previously unreported abnormalities in the brains of professional boxers. These abnormalities are assumed to reflect cumulative (chronic) brain injury resulting from nonsevere head trauma.     

^99Tc^m—MDP全身及断层骨显像对颈椎病变的诊断价值

目的探讨^99Tc^m-亚甲基二膦酸盐（MDP）全身及断层骨显像对颈椎良恶性病变的诊断价值。方法回顾性分析随访资料完整且临床最终诊断明确的颈椎退行性变患者19例、转移瘤患者76例,以23名无颈椎及全身其他部位病变的健康者作为对照组,分析^99Tc^m—MDP全身骨显像及颈椎骨断层显像检查结果及图像特点,用,检验评价其诊断效能。结果颈椎断层显像对颈椎退行性变的诊断灵敏度（73．7％,14／19）明显高于全身骨显像（36．8％,7／19;χ^2=5．216,P〈0．05）,颈椎断层显像诊断颈椎转移瘤的灵敏度和准确性分别为84．2％（64／76）和83．8％（83／99）,明显高于全身骨显像[56．6％（43／76）和61．6％（61／99）,χ^2=13．9和12．3,P均〈0．01]。结论对临床怀疑颈椎病变的患者同时行全身骨显像及颈椎断层显像,可进一步提高颈椎病变的检出率,亦可为颈椎良恶性病变的鉴别提供更多的信息。     

脊柱爆裂骨折的CT、MRI对照研究

目的　探讨CT、MRI对爆裂骨折的诊断价值及对临床治疗的指导作用。方法　回顾性分析 66例爆裂骨折的CT、MRI扫描资料 ,其中颈椎 6例 ,胸椎 3例 ,胸腰段 48例 ,下腰椎 9例。男 5 0例 ,女 16例 ,平均年龄 3 5岁。伤后均行CT、MRI检查。结果　CT显示椎体、附件骨折 ,椎管狭窄 ,后移骨片优于MRI。MRI显示韧带、椎间盘的损伤、撕裂及脊髓损伤受压优于CT。结论　CT、MRI二者结合 ,可详尽反映爆裂骨折的各种损伤情况 ,对决定外科手术方式有重要作用     

Prevalence of cerebral microhemorrhages in amateur boxers as detected by 3T MR imaging

BACKGROUND AND PURPOSE: The evidence for traumatic brain injury in amateur boxers is controversial. Hypothetically, sudden acceleration of the head due to the impact of the blow during the boxing fight might result in diffuse axonal injury or contusion. We wanted to determine whether cerebral microhemorrhages occur more often in amateur boxers than in nonboxers.MATERIALS AND METHODS: In 42 male, classical amateur boxers and in 37 healthy, nonboxing male volunteers we performed cranial MR imaging at 3T. The study protocol included a transverse dual spin-echo MR imaging sequence, a 3D sagittal magnetization-prepared rapid acquisition of gradient echo sequence, a coronal T2*-weighted sequence, and an axial time-of-flight MR angiography sequence. MR imaging data were made anonymous before 2 neuroradiologists independently evaluated the images. In addition, the following risk factors were assessed: total numbers of fights and knockouts, weight division, and duration of boxing. We compared the group proportions of microhemorrhages with Fisher test of exact probability.RESULTS: There was a statistically higher prevalence of cerebral microhemorrhages in the group of boxers (3 of 42; 7.1%) than in nonboxing persons (0 of 37; 0%). This difference was not statistically significant, however (P = .2479; Fisher exact test).CONCLUSION: Although we detected more microhemorrhages in amateur boxers than in nonboxing persons, this difference did not prove to be significant.

Hypothetically, sudden acceleration of the head because of the impact of a blow during a boxing fight might result in cerebral contusion involving the superficial gray matter, in diffuse axonal injury (DAI) from axonal stretching because of a movement of the overlying cerebral cortex relative to the underlying cerebral white matter, or in subcortical injury. DAI can be detected by MR imaging as multiple round or ovoid lesions of the cerebral white matter, especially at the gray/white matter interface (corticomedullary junction), the corpus callosum, and the upper brain stem, representing multifocal punctate hemorrhages. T2*- and susceptibility-weighted gradient-echo images are very useful tools for detecting small foci of hemorrhage in the brain. An additional increase in the sensitivity for detecting hemorrhagic shear injuries can be achieved using higher MR field strengths, such as 3T.¹ Because the evidence concerning traumatic brain injury in amateur boxers is controversial,^2–6 the aim of our study was to determine the prevalence of cerebral microhemorrhages in boxers as compared with nonboxers by using 3T MR imaging. Our working hypothesis was that MR imaging would show a higher prevalence of cerebral microhemorrhages in amateur boxers than in nonboxers.     

Problems in health management of professional boxers in Japan

OBJECTIVE: To investigate whether the incidence of boxing accidents is higher in Japan than in other countries. METHOD: A nationwide survey of boxers was conducted. RESULTS: A total of 632 boxers responded. Most Japanese boxers were relatively mature when they started boxing (mean starting age of 19.2 years). A high percentage of boxers was found three weight divisions higher than previously reported. Many boxers stated that losing weight was not a big problem. It was found that a punch that turns the head can cause serious physical damage, and it was clarified that only a simple punch, rather than accumulated damage from multiple punches, can cause cerebral concussion. Severe shock causing retrograde amnesia is very rare after a fight and disappears relatively quickly. Many additional symptoms are related to damage to the hearing organs, such as hearing difficulties, tinnitus, and vertigo, but these symptoms also resolve quickly. Many boxers experience memory disturbance, not just after a fight but in daily life. CONCLUSION: The approach to boxing has become more oriented towards the method of practice and scientific training, rather than psychological factors, which used to be emphasised.