Albany Medical College, Latham, New York.
Sports Health. 2014 May;6(3):239-45. doi: 10.1177/1941738114528468.
Sport-related spleen and liver injuries pose a challenge for the physician. Although rare, these injuries can have serious and even life-threatening outcomes if not accurately diagnosed and managed in a timely fashion. Currently, there are no evidence-based guidelines on duration and intensity of restricted activity and return to play after spleen and liver injury. In addition, there is controversy on follow-up imaging after injury.
PubMed was searched using the terms splenic or spleen and trauma and hepatic or liver and trauma from 1980 to 2013. The citations from sentinel papers were also reviewed.
Clinical review.
Level 3.
Ultrasound is ideal in the unstable athlete. Nonoperative management of blunt splenic and hepatic injuries is recommended for hemodynamically stable patients regardless of injury grade, patient age, or presence of associated injuries. Follow-up imaging is not routinely recommended unless clinically indicated. Athletes may engage in light activity for the first 3 months after injury and then gradual return to unrestricted activity as tolerated. High-level athletes may choose splenectomy or serial imaging for faster return to play.
Intravenous contrast-enhanced computed tomography is the diagnostic imaging modality of choice in stable athletes with blunt abdominal trauma.
STRENGTH-OF-RECOMMENDATION TAXONOMY: C.
与运动相关的脾、肝损伤对医生来说是一个挑战。尽管这些损伤很少见，但如果不能及时准确地诊断和处理，它们可能会导致严重甚至危及生命的后果。目前，对于脾、肝损伤后限制活动的持续时间和强度以及重返运动，尚无基于证据的指南。此外，关于损伤后的随访影像学检查也存在争议。
使用术语“脾”或“脾脏”和“创伤”以及“肝”或“肝脏”和“创伤”，从 1980 年到 2013 年在 PubMed 上进行了搜索。还查阅了重要文献的引用。
临床综述。
3 级。
超声检查对不稳定的运动员是理想的。对于血流动力学稳定的患者，无论损伤程度、患者年龄或是否存在相关损伤，均推荐采用非手术治疗钝性脾、肝损伤。除非临床需要，否则不常规推荐随访影像学检查。运动员在受伤后前 3 个月可从事轻度活动，然后根据耐受情况逐渐恢复不受限制的活动。高水平运动员可能会选择脾切除术或连续影像学检查以更快地重返运动。
对于有钝性腹部创伤的稳定运动员，静脉内对比增强 CT 是诊断成像的首选方法。
C 级。
