Weber Christian D, Horst Klemens, Nguyen Anthony R, Bader Magdalena J, Probst Christian, Zelle Boris, Pape Hans-Christoph, Dienstknecht Thomas
*Department of Orthopaedics and Trauma, RWTH Aachen University Medical Center, Aachen, Germany;†Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia;‡Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), Private University of Witten/Herdecke, Cologne, Germany; and§Department of Orthopaedics, Health Science Center, University of Texas, San Antonio, Texas.
Clin J Sport Med. 2017 Sep;27(5):481-486. doi: 10.1097/JSM.0000000000000373.
We hypothesize that the majority of polytraumatised patients are unable to maintain their preinjury level of sporting activity, and that musculoskeletal injuries are a major contributing factor. We assessed the impact of such injuries on sporting prowess, with a focus on isolating, particularly debilitating musculoskeletal trauma.
We conducted a cohort study of 637 patients at a level 1 trauma centre, to assess the long-term outcome of severe trauma on return to sporting activities (RTS). Data collated on the multiply injured patient included preinjury physical activity, standardized outcome scores (SF-12, GOS, HASPOC), and clinical follow-up of at least 10 years duration. The return to preinjury sports participation was defined as a primary outcome parameter. Regression analyses were performed to identify specific injuries interfering with the RTS.
Prognostic study; Level of evidence, II.
Mean follow-up was 17 ± 5 years. We included 465 patients, including 207 athletic and 258 nonathletic individuals. Mean age at the time of injury was 26 ± 11.5 years and injury severity was comparable between the 2 cohorts. The deleterious effects on quality of life and the total duration of the rehabilitation process were also similar in athletes and nonathletes. Athletes were more likely to be unable to return to preinjury activities, or to return to a lower level of sporting prowess posttrauma. We identified knee injuries as the type of musculoskeletal trauma most likely to be career ending for the athlete (odds ratio 3.4, 95% confidence interval, 1.4-8.3; P = 0.008).
Our results demonstrate an enforced shift from high-impact and team sports to low-impact activities after multiple trauma. Injuries of the lower extremities, especially around the knee joint, seem to have the highest lifechanging potential, preventing individuals from returning to their previous sporting activities.
我们假设大多数多发伤患者无法维持伤前的体育活动水平，且肌肉骨骼损伤是一个主要促成因素。我们评估了此类损伤对运动能力的影响，重点是找出特别使人衰弱的肌肉骨骼创伤。
我们在一家一级创伤中心对637例患者进行了一项队列研究，以评估严重创伤对恢复体育活动（RTS）的长期影响。收集的关于多发伤患者的数据包括伤前身体活动情况、标准化结局评分（SF-12、GOS、HASPOC）以及至少为期10年的临床随访。恢复到伤前的体育参与程度被定义为主要结局参数。进行回归分析以确定影响RTS的特定损伤。
预后研究；证据等级，II级。
平均随访时间为17±5年。我们纳入了465例患者，包括207名运动员和258名非运动员个体。受伤时的平均年龄为26±11.5岁，两个队列的损伤严重程度相当。运动员和非运动员在生活质量和康复过程总时长方面受到的有害影响也相似。运动员更有可能无法恢复到伤前的活动水平，或在创伤后恢复到较低的运动能力水平。我们确定膝关节损伤是最有可能导致运动员运动生涯结束的肌肉骨骼创伤类型（优势比3.4，95%置信区间，1.4 - 8.3；P = 0.008）。
我们的结果表明，多发伤后会被迫从高强度和团队运动转向低强度活动。下肢损伤，尤其是膝关节周围的损伤，似乎具有最大的改变生活的潜力，会阻止个体恢复到先前的体育活动中。
