Terrell Thomas R, Cox Conrad B, Bielak Ken, Casmus Robert, Laskowitz Daniel, Nichols Gregory
From the University of Tennessee, Knoxville, James A. Quillen School of Medicine, Johnson City, TN, Department of Physical Education and Athletics, Catawba College, Salisbury, North Carolina, Duke University School of Medicine, Durham, North Carolina, and Occupational Exposure and Worker Health Programs, Oak Ridge Associated Universities, Oak Ridge, Tennessee.
South Med J. 2014 Feb;107(2):126-35. doi: 10.1097/SMJ.0000000000000064.
Millions of concussions occur every year in the United States. The public interest in concussion has increased after a number of high-profile deaths in high school athletes from sports-related head trauma and in some professional athletes from chronic traumatic encephalopathy. One of the most active areas of research in sports medicine during the last decade has been the evaluation and management of concussion. In this second article of a two-part series, we provide an overview of the latest scientific advances in concussion research. This overview includes an update on the pathobiological changes that occur during concussion and the results of biomechanical studies. In addition, to aid the practicing clinician, we review the literature on proven and currently studied concussion risk factors, including a history of concussion, fatigue, and age. Genetic polymorphisms and biomarkers may provide risk-prediction capability, but at present the research remains inconclusive. Diffusion tensor imaging and functional magnetic resonance imaging are promising technologies that reveal more sophisticated data about the impact of concussion on the brain. We review the existing literature on the application of these neuroimaging modalities to sports concussion. An update from the Fourth International Conference on Concussion in Sport, with highlights of new recommendations, and the presentation of the third edition of the Sports Concussion Assessment Tool to evaluate acute concussion, concludes our review.
在美国，每年发生数百万起脑震荡事件。在一些高中运动员因与运动相关的头部创伤死亡以及一些职业运动员因慢性创伤性脑病死亡等一系列备受瞩目的事件之后，公众对脑震荡的关注度有所提高。在过去十年中，运动医学最活跃的研究领域之一一直是脑震荡的评估与管理。在这个两部分系列文章的第二篇中，我们概述了脑震荡研究的最新科学进展。这一概述包括对脑震荡期间发生的病理生物学变化以及生物力学研究结果的更新。此外，为帮助临床医生实践，我们回顾了关于已证实的和目前正在研究的脑震荡风险因素的文献，包括脑震荡病史、疲劳和年龄。基因多态性和生物标志物可能具有风险预测能力，但目前研究尚无定论。扩散张量成像和功能磁共振成像是很有前景的技术，它们能揭示关于脑震荡对大脑影响的更复杂数据。我们回顾了关于这些神经成像模式在运动性脑震荡中应用的现有文献。来自第四届国际运动性脑震荡会议的最新情况，包括新建议的要点，以及用于评估急性脑震荡的第三版运动性脑震荡评估工具的介绍，结束了我们的综述。
