Bier Georg, Bongers Malte N, Othman Ahmed, Hempel Johann-Martin, Vieth Volker, Heindel Walter, Ernemann Ulrike, Burg Matthias C
a Department of Diagnostic and Interventional Neuroradiology , Eberhard Karls University Tuebingen , Tuebingen , Germany.
b Department of Clinical Radiology , University of Muenster , Muenster , Germany.
Br J Neurosurg. 2018 Feb;32(1):37-43. doi: 10.1080/02688697.2017.1409874. Epub 2017 Dec 5.
Traumatic brain injury is an important health concern in equestrian sports. Nevertheless, the use of safety helmets, especially in recreational riding, is reported to be rare. The purpose of this study was to perform the first matched-pairs analysis of traumatic brain injury with regard to the use of helmets.
In a multicenter retrospective database analysis 40 patients (mean age: 35 ± 17.13 years; 34 female & 6 male) were combined in 20 matched pairs based on age group, gender and trauma mechanism. Admission trauma computed tomography was qualitatively analyzed for the presence or absence of fractures or intracranial hemorrhage. Quantitatively, in patients with intracranial hemorrhage dedicated volumetry of the blood volume was performed. Odds ratio and relative risk were calculated for the endpoints fractures and intracranial hemorrhage. Crude risk ratio and lesion volume differences between helmeted and unhelmeted riders were compared.
Concerning skull fractures, in this cohort 6 patients (85.7% of all patients with fractures) did not wear a helmet and only one (14.3%) wore a helmet (p = .068).and fractures were considered more complex in the unhelmeted subgroup. Intracranial hemorrhage occurred significantly more often in the unhelmeted subgroup (10 vs. 2; p = .008). Moreover, the total lesion volume with 19.31 ± 23.93ml in the unhelmeted subgroup, presenting with intracranial hemorrhage, was significantly higher than in the control group (0.65 ± 0.35ml; p = .002). Odds ratios were 9 for intracranial hemorrhage (p = .014) and 8.14 for skull fractures without helmet (p = .09). Altogether, the relative risk for intracranial bleeding for unhelmeted riders was 5-fold higher and the relative risk reduction was 96% by wearing a safety helmet.
Under consideration of comparable trauma mechanisms, horseback riders that do not wear a safety helmet are at risk to suffer significantly more severe brain injury than helmeted riders. Therefore, safety helmets are recommendable for all horseback riders.
创伤性脑损伤是马术运动中一个重要的健康问题。然而，据报道，安全帽的使用很少见，尤其是在休闲骑行中。本研究的目的是首次对使用头盔与创伤性脑损伤进行配对分析。
在一项多中心回顾性数据库分析中，根据年龄组、性别和创伤机制，将40例患者（平均年龄：35±17.13岁；34例女性和6例男性）配对成20对。对入院时的创伤计算机断层扫描进行定性分析，以确定是否存在骨折或颅内出血。定量分析方面，对颅内出血患者进行专门的血容量测量。计算骨折和颅内出血终点的比值比和相对风险。比较戴头盔和未戴头盔骑手之间的粗风险比和病变体积差异。
关于颅骨骨折，在该队列中，6例患者（占所有骨折患者的85.7%）未戴头盔，只有1例（14.3%）戴了头盔（p = 0.068）。未戴头盔亚组的骨折被认为更复杂。未戴头盔亚组颅内出血的发生率明显更高（10例 vs. 2例；p = 0.008）。此外，未戴头盔亚组出现颅内出血的总病变体积为19.31±23.93ml，明显高于对照组（0.65±0.35ml；p = 0.002）。颅内出血的比值比为9（p = 0.014），未戴头盔时颅骨骨折的比值比为8.14（p = 0.09）。总体而言，未戴头盔骑手颅内出血的相对风险高出5倍，佩戴安全帽可使相对风险降低96%。
考虑到可比的创伤机制，未戴安全帽的骑手比戴头盔的骑手遭受严重脑损伤的风险要高得多。因此，建议所有骑手佩戴安全帽。
