Return to Play for Neurosurgical Patients
Return to Play for Neurosurgical Patients
复制标题
DOI：
10.1016/j.wneu.2014.06.043
复制
发表时间：
2014-09-01
影响因子：
2
通讯作者：
Berger, Mitchel S.
中科院分区：
文献类型：
--
作者：
Saigal, Rajiv;Batjer, H. Hunt;Berger, Mitchel S.
背景：最近，脑震荡和与运动相关的颅脑和脊柱损伤引起了媒体、公众和体育管理机构越来越多的关注。虽然脑震荡已经得到了很好的研究，但关于结构性神经外科病变的恢复数据很少。目的：我们旨在研究目前结构性神经外科病变患者恢复比赛的神经外科实践，以便最终为这些运动员建立指导方针。方法：向所有美国神经外科医师协会成员发送一份调查，邀请他们提交有关出现结构性神经外科病变的运动员的信息。这些包括手术和非手术病变。包括10例相关临床情况。对神经外科医生进行了调查，了解他们清理这些患者以恢复比赛的做法，以及患者之后的结果，包括任何临床后遗症。将回答制成表格并进行研究，以寻找当前实践的趋势。排除非结构性病例，如脑震荡和颈椎劳损病例。使用Mann-Whitney U检验来检验脊柱与颅骨、脊柱内固定与非脊柱内固定、儿童与成人病例的返回时间的统计学差异。结果：98名受访者输入了总共189名患者的数据（118名手术患者和71名非手术/意外患者）。在外科分类中，109例（41例颅脑、67例脊柱、1例周围神经病变）符合纳入标准。脊柱（88% 6个月，P < 0.001）、非固定（55% 3个月，P = 0.001）和成人（78% 6个月，P = 0.021）患者的恢复时间有显著差异。50例非手术/意外病例符合纳入标准；94%的非手术损伤的运动员没有临床后遗症的报道。所有的非手术患者和81%的手术患者需要在恢复比赛前解决缺陷。结论：本文提出的结果是对结构神经外科病变恢复治疗的当前实践的首次研究。他们为这些病人的神经外科指南奠定了早期的基础。
BACKGROUND: Concussion and sports-related cranial and spine injuries recently have garnered increased attention from the media, public, and sports' governing bodies. Although concussion has been well-studied, there are minimal data on return to play for structural neurosurgical lesions.OBJECTIVE: We aimed to study current neurosurgical practice on return to play for structural neurosurgical lesions in order to eventually establish guidelines for these athletes.METHODS: A survey was sent to all American Association of Neurological Surgeons members inviting them to submit information on athletes who presented with structural neurosurgical lesions. These included both operative and nonoperative lesions. Ten examples of relevant clinical scenarios were included. Neurosurgeons were surveyed about their practice of clearing these patients for return to play and about patient outcomes afterwards, including any clinical sequelae. Responses were tabulated and studied to search for trends in current practice. Nonstructural cases, such as concussion and cervical strain cases, were excluded. The Mann-Whitney U test was used to test for statistical difference in the time to return for spine versus cranial, instrumented versus noninstrumented spine, and pediatric versus adult cases.RESULTS: Ninety-eight respondents entered data on a total of 189 patients (118 surgical and 71 nonoperative/incidental). In the surgical category, 109 cases (41 cranial, 67 spine, and 1 peripheral nerve lesions) met inclusion criteria. There was a significant difference in time to return between spine (88% returned 6 months, P < 0.001), noninstrumented (55% returned 3 months, P = 0.001), and adult (78% returned 6 months, P = 0.021). Fifty nonoperative/incidental cases met inclusion criteria; 94% of athletes returning to play with nonoperative lesions had no reported clinical sequelae. All nonsurgical and 81% of surgical respondents required deficit resolution before return to play.CONCLUSIONS: The results presented here are the first effort to study current practice on return to play for structural neurosurgical lesions. They establish an early foundation for neurosurgical guidelines on these patients.