Husky Stadium Sports Medicine Center, University of Washington Medical Center, 3800 Montlake Blvd NE, Seattle, WA 98195.
Hospital for Special Surgery, New York, NY.
PM R. 2018 Oct;10(10):1073-1082. doi: 10.1016/j.pmrj.2018.03.008. Epub 2018 Mar 14.
Common sports injuries include bone stress injuries (BSIs), anterior cruciate ligament (ACL) injuries, and concussions. Less commonly recognized are the specific sex differences in epidemiology, risk factors, and outcomes of these conditions by sex. An understanding of these factors can improve their clinical management, from prescribing appropriate prehabilitation to guiding postinjury rehabilitation and return to play. This narrative review summarizes the sex differences in the diagnosis and management of BSIs, ACL injuries, and concussions. Although BSIs are more common in female athletes, risk factors for both sexes include prior injury and relative energy deficiency in sport (RED-S). Risk factors in female athletes include smaller calf girth, femoral adduction, and higher rates of loading. Female athletes are also at greater risk for developing ACL injuries in high school and college, but their injury rate is similar in professional sports. Increased lateral tibial slope, smaller ACL size, and suboptimal landing mechanics are additional risk factors more often present in female athletes. Male athletes are more likely to have ACL surgery and have a higher rate of return to sport. Concussions occur more commonly in female athletes; however, female athletes are also more likely to report concussions. Male athletes more commonly sustain concussion through contact with another player. Female athletes more commonly sustain injury from contact with playing equipment. Managing post-concussion symptoms is important, and female athletes may have prolonged symptoms. An understanding of the sex-specific differences in these common sports injuries can help optimize their prehabilitation and rehabilitation. LEVEL OF EVIDENCE: IV.
常见的运动损伤包括骨骼应力性损伤（BSI）、前交叉韧带（ACL）损伤和脑震荡。不太为人所知的是，这些疾病在流行病学、风险因素和性别结局方面存在特定的性别差异。了解这些因素可以改善其临床管理，从适当的康复前治疗到指导损伤后的康复和重返赛场。本综述总结了 BSI、ACL 损伤和脑震荡的诊断和管理方面的性别差异。尽管女性运动员中 BSI 更为常见，但两性的风险因素均包括既往损伤和与运动相关的能量不足（RED-S）。女性运动员的风险因素包括小腿围度较小、股骨内收和更大的负荷率。女性运动员在高中和大学时也更易发生 ACL 损伤，但在职业运动中，其损伤率与男性相似。外侧胫骨斜率增加、ACL 尺寸较小和不理想的着陆力学是女性运动员中更常见的其他风险因素。男性运动员更有可能接受 ACL 手术，且重返运动的比率更高。女性运动员中脑震荡更为常见；然而，女性运动员也更有可能报告脑震荡。男性运动员更常因与其他运动员接触而发生脑震荡。女性运动员更常因与比赛设备接触而受伤。管理脑震荡后的症状很重要，女性运动员可能会出现较长时间的症状。了解这些常见运动损伤中的性别特异性差异可以帮助优化康复前和康复治疗。证据等级：IV。
