Cricket Australia, 60 Jolimont St, Jolimont, VIC, Australia.
ACRISP and School of Engineering, Edith Cowan University, Joondalup, WA, Australia; McIntosh Consultancy and Research, Sydney, NSW, Australia.
J Clin Neurosci. 2019 Oct;68:28-32. doi: 10.1016/j.jocn.2019.07.016. Epub 2019 Aug 6.
Experiential knowledge was collated to improve understanding of the mechanism of vertebral artery dissection (VAD) and inform recommendations for risk-reduction strategies in sport. Fourteen experts from fields of neurology, forensic pathology, biomedical engineering, radiology, physiotherapy, and sport and exercise medicine participated in semi-structured interviews. Experts were asked to provide their hypothesised mechanism of VAD, and suggest strategies to reduce the risk of VAD in non-motorised sports. Experts agreed that there is no single mechanism of VAD. Factors relating to predisposition, susceptibility, and an inciting event exist on a spectrum, as does the severity of the resulting VAD. Particularly concerning inciting events which may occur during sports participation include blunt force impact to the specific area behind and below the ear; and extreme movement of the neck, which may be facilitated by impact to the head or neck. Risk reduction strategies must be feasible within the particular sporting context. Strategies include rules, personal protective equipment, and education to reduce the risk of impact to the head or neck. Education may also serve to improve early recognition of VAD. VAD is a risk (low frequency, severe consequence) in sports in which athletes are exposed to head or neck impact from an object or opponent. Best practice risk management suggests that sports governing bodies should assess VAD risk and consider risk controls.
经验知识被整理出来，以加深对椎动脉夹层（VAD）机制的理解，并为运动中的降低风险策略提供建议。来自神经病学、法医病理学、生物医学工程、放射学、物理治疗和运动与运动医学领域的 14 名专家参与了半结构化访谈。专家们被要求提供他们假设的 VAD 机制，并提出降低非动力运动中 VAD 风险的策略。专家们一致认为，VAD 没有单一的机制。与易感性和诱发事件相关的倾向因素存在于一个范围内，由此产生的 VAD 的严重程度也是如此。在运动中可能发生的特别令人关注的诱发事件包括钝力撞击耳朵后面和下面的特定区域；以及颈部的极度运动，头部或颈部的撞击可能会导致这种运动。降低风险的策略必须在特定的运动环境中可行。策略包括规则、个人防护设备和教育，以降低头部或颈部受到撞击的风险。教育也可以提高对 VAD 的早期认识。VAD 是运动员头部或颈部受到物体或对手撞击的运动中的一种风险（低频、严重后果）。最佳实践风险管理表明，体育管理机构应评估 VAD 风险并考虑风险控制。
