Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany.
Skane University Hospital, Department of Clinical Sciences Lund, Neurosurgery, Lund University, Lund, Sweden.
Acta Neurochir (Wien). 2019 Mar;161(3):425-433. doi: 10.1007/s00701-019-03807-6. Epub 2019 Jan 28.
When participating in contact sports, (mild) head trauma is a common incident-observed in both professional and amateur sports. When head trauma results in transient neurological impairment, a sports-related concussion has occurred. Acute concussion, repetitive concussions, as well as cumulative "sub-concussive" head impacts may increase the risk of developing cognitive and behavioral deficits for athletes, as well as accelerated cerebral degeneration. While this concept has been well established for classic contact sports like American Football, Rugby, or Boxing, there is still an awareness gap for the role of sports-related concussion in the context of the world's most popular sport-Soccer.
Here, we review the relevance of sport-related concussion for Soccer as well as its diagnosis and management. Finally, we provide insight into future directions for research in this field.
Soccer fulfills the criteria of a contact sport and is characterized by a high incidence of concussion. There is ample evidence that these events cause functional and structural cerebral disorders. Furthermore, heading, as a repeat sub-concussive impact, has been linked to structural brain changes and neurocognitive impairment. As a consequence, recommendations for the diagnosis and management of concussion in soccer have been formulated by consensus groups. In order to minimize the risk of repetitive concussion in soccer the rapid and reliable side-line diagnosis of concussion with adoption of a strict remove-from-play protocol is essential, followed by a supervised, graduated return-to-play protocol. Recent studies, however, demonstrate that adherence to these recommendations by players, coaches, clubs, and officials is insufficient, calling for stricter enforcement. In addition, future research to solidify the pathophysiological relevance of concussion for soccer athletes seems to be needed. Advanced neuroimaging and neurochemical biomarker analyses (e.g. S100β, tau and neurofilament light (NfL)) may assist in detecting concussion-related structural brain changes and selecting athletes at risk for irreversible damage.
Sports-related concussion represents a genuine neurosurgical field of interest. Given the high socioeconomic relevance, neurosurgeons should get involved in prevention and management of concussion in soccer.
在参与接触性运动时，（轻度）头部创伤是常见事件——在职业和业余运动中都有观察到。当头部创伤导致短暂的神经功能障碍时，就发生了与运动相关的脑震荡。急性脑震荡、反复脑震荡以及累积的“亚脑震荡”头部冲击可能会增加运动员出现认知和行为缺陷的风险，以及加速大脑退化。虽然这一概念在美式橄榄球、橄榄球或拳击等经典接触性运动中已经得到很好的确立，但在世界上最受欢迎的运动——足球中，运动相关脑震荡的作用仍然存在认识差距。
在这里，我们回顾了运动相关脑震荡在足球中的相关性及其诊断和管理。最后，我们提供了该领域未来研究方向的见解。
足球符合接触性运动的标准，其脑震荡发生率很高。有充分的证据表明，这些事件会导致大脑功能和结构障碍。此外，作为重复的亚脑震荡冲击，头球已被证明与结构脑变化和神经认知障碍有关。因此，共识小组制定了足球脑震荡的诊断和管理建议。为了最大限度地降低足球中重复性脑震荡的风险，快速、可靠的场外脑震荡诊断以及严格执行离场协议至关重要，随后是监督、分级重返赛场的方案。然而，最近的研究表明，球员、教练、俱乐部和官员对这些建议的遵守程度不足，需要更严格的执行。此外，似乎需要进一步研究以确定脑震荡对足球运动员的病理生理学相关性。高级神经影像学和神经化学生物标志物分析（例如 S100β、tau 和神经丝轻链（NfL））可能有助于检测与脑震荡相关的结构脑变化，并选择有不可逆损伤风险的运动员。
运动相关脑震荡是真正的神经外科领域。鉴于其高社会经济相关性，神经外科医生应该参与足球脑震荡的预防和管理。
