Noakes T D, Jakoet I, Baalbergen E
Department of Physiology, Medical Research Council/University of Cape Town.
S Afr Med J. 1999 May;89(5):540-5.
To determine the impact of the 1990 rugby law changes in South African schoolboy rugby on the number of schoolboys suffering paralysing spinal cord injuries in the subsequent eight rugby seasons (1990-1997) in the former Cape Province (now the Western Cape, but including Port Elizabeth and East London).
The study was a retrospective analysis of all patients with rugby-related spinal cord injuries admitted to the Conradie and Libertas Spinal Units, Cape Town, between 1990 and 1997. Data were initially collected annually from patient files. From 1993 patients were interviewed in hospital and a standardised questionnaire was completed. Data were collated and analysed.
There were 67 spinal cord injuries in adult and schoolboy rugby players in the eight seasons studied. Fifty-four (80%) injuries were in adults and 13 (20%) in schoolboys, representing a 23% increase and a 46% reduction in the number of injured adults and schoolboys, respectively. Fifty-two per cent of those injuries for which the mechanism was recorded occurred in the tackle phase of the game; of these approximately equal numbers were due to vertex impact of the tackler's head with another object, or to illegal (high) tackles. Twenty-five per cent of injuries occurred in the ruck and maul and the remainder (23%) in the collapsed scrum. The only striking difference in the proportion of injuries occurring in the different phases of play was the absence of high-tackle injuries among schoolboys. The majority of injuries occurred at vertebral levels C4/5 (32%) and C5/6 (42%). Five players (8%) died, tetraplegia occurred in 48% and 35% recovered either fully or with minor residual disability. Playing position was recorded for half the injured players. Front-row forwards (props 33%, hookers 9%), locks (12%) wings and centres (21%) and loose forwards (15%), accounted for 90% of all injuries.
Introduction of rugby law changes in South African schoolboy rugby in 1990 may have led to a 46% reduction in the number of spinal cord injuries in this group. In contrast, the number of these injuries in adult rugby players increased during the same time period due either to an increase in the number of adult players or to a real increase in the incidence of these injuries. More injured schoolboy than adult rugby players made total or near-complete recoveries from initially paralysing injuries (61% v. 28%). The reduced number of schoolboy injuries could not have resulted directly from the specific law changes introduced in 1990, which targeted scrum laws. Rather, the absence of illegal (high) tackle injuries among schoolboys appears to be the principal factor explaining fewer injuries in schoolboys, who suffered a higher proportion of injuries in the ruck and maul than did adult players. Accordingly we conclude that a further reduction in spinal cord injuries in adult and schoolboy rugby players in the Western Cape requires: (i) the elimination of injuries occurring in the ruck and maul, and to the tackler; (ii) the strict application of the high-tackle rule in adult rugby; and (iii) a continuing, high level of vigilance. Concern must be expressed about the continuing number of paralysing spinal cord injuries in adult rugby players.
确定1990年南非校际橄榄球比赛规则的变化对前开普省（现为西开普省，但包括伊丽莎白港和东伦敦）随后八个橄榄球赛季（1990 - 1997年）中遭受脊髓损伤瘫痪的男学生人数的影响。
该研究是对1990年至1997年间入住开普敦康拉迪和自由脊柱治疗中心的所有与橄榄球相关的脊髓损伤患者进行的回顾性分析。数据最初每年从患者病历中收集。从1993年起，对患者进行了医院访谈并完成了一份标准化问卷。数据进行了整理和分析。
在研究的八个赛季中，成年和男学生橄榄球运动员共发生67例脊髓损伤。其中54例（80%）为成年人损伤，13例（20%）为男学生损伤，成年和男学生受伤人数分别增加了23%和减少了46%。记录了受伤机制的损伤中，52%发生在比赛的擒抱阶段；其中，大约相等数量的损伤是由于擒抱者头部与其他物体的顶点撞击，或非法（高位）擒抱。25%的损伤发生在乱堆和扭抱阶段，其余（23%）发生在倒塌的争球阶段。在比赛不同阶段发生损伤的比例中，唯一显著的差异是男学生中没有高位擒抱损伤。大多数损伤发生在C4/5（32%）和C5/6（42%）椎体水平。5名球员（8%）死亡，48%发生四肢瘫痪，35%完全康复或仅留有轻微的残余残疾。记录了一半受伤球员的比赛位置。前排前锋（支柱前锋33%，钩球员9%）、锁球员（12%）、边锋和中锋（21%）以及松散前锋（15%），占所有损伤的90%。
1990年南非校际橄榄球比赛规则的改变可能使该群体脊髓损伤人数减少了46%。相比之下，则同一时期成年橄榄球运动员的此类损伤数量有所增加，这可能是由于成年球员数量增加，或者此类损伤的发生率实际上升。与成年橄榄球运动员相比，更多受伤的男学生从最初的瘫痪性损伤中完全或接近完全康复（61%对28%）。男学生受伤人数的减少不可能直接归因于1990年引入的针对争球规则的具体规则变化。相反，男学生中没有非法（高位）擒抱损伤似乎是解释男学生受伤较少的主要因素，男学生在乱堆和扭抱中受伤的比例高于成年球员。因此，我们得出结论，要进一步减少西开普省成年和男学生橄榄球运动员的脊髓损伤，需要：（i）消除在乱堆和扭抱中以及对擒抱者造成的损伤；（ii）在成年橄榄球比赛中严格执行高位擒抱规则；（iii）持续保持高度警惕。必须对成年橄榄球运动员中持续出现的脊髓损伤瘫痪情况表示关注。
