Kurland L T, Radhakrishnan K, Smith G E, Armon C, Nemetz P N
Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905.
J Neurol Sci. 1992 Dec;113(2):133-43. doi: 10.1016/0022-510x(92)90241-c.
We have examined the relationship between mechanical injuries and the subsequent development of classic amyotrophic lateral sclerosis (ALS) through a critical review of the literature. Only prospective evaluation of a large cohort of trauma victims can provide an unbiased answer to this controversy. However, such an evaluation would be prohibitively expensive, and the results would not be available in our lifetime. The results of retrospective case-control studies are conflicting in part because of biases in the selection of patients and controls, poor definition of the nature and extent of the trauma and its chronological relationship to the onset of ALS, and a non-uniform approach to the collection of antecedent information. More rigorously designed studies show no association of ALS to antecedent trauma. The existing data thus do not suggest that mechanical trauma is a risk factor for ALS. Future case-control studies should conform to a standardized methodology. The critical analysis presented here of the research on the purported connection between mechanical injury and ALS may serve as a model for the evaluation of the role of trauma in other chronic diseases. Application of these methodological principles may bring increased scientific rigor to assessing the frequently litigated question of what constitutes a true trauma sequela.
我们通过对文献的批判性综述，研究了机械性损伤与经典肌萎缩侧索硬化症（ALS）后续发展之间的关系。只有对大量创伤受害者进行前瞻性评估，才能为这一争议提供无偏倚的答案。然而，这样的评估成本过高，而且我们这辈子都无法得到结果。回顾性病例对照研究的结果相互矛盾，部分原因在于患者和对照的选择存在偏差、创伤的性质和程度及其与ALS发病的时间关系定义不清，以及收集既往信息的方法不统一。设计更为严谨的研究表明ALS与既往创伤并无关联。因此，现有数据并未表明机械性创伤是ALS的危险因素。未来的病例对照研究应遵循标准化方法。本文对机械性损伤与ALS之间所谓联系的研究进行的批判性分析，可作为评估创伤在其他慢性疾病中作用的模型。应用这些方法学原则，可能会在评估构成真正创伤后遗症这一经常引发诉讼的问题时，提高科学严谨性。
