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为什么带头盔也没法预防脑震荡 – 译学馆
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为什么带头盔也没法预防脑震荡

Why helmets don't prevent concussions -- and what might | David Camarillo

“脑震荡”一词从未引起过如此之大的恐慌
The word concussion evokes a fear these days more so than it ever has,
我自己也患过脑震荡
and I know this personally.
我曾打过十年橄榄球
I played 10 years of football,
数千次被球打中脑袋
was struck in the head thousands of times.
但我可以告诉你
And I have to tell you, though, what was much worse than that
自行车事故中我遭受的脑震荡要更为严重
was a pair of bike accidents I had where I suffered concussions,
现如今当我站在你面前时
and I’m still dealing with the effects of the most recent one
我还在从最近的那次脑震荡中恢复
today as I stand in front of you.
对脑震荡的恐惧
There is a fear around concussion
有些是有道理的
that does have some evidence behind it.
有证据表明反复多次脑震荡
There is information that a repeated history of concussion
会导致早期痴呆 比如阿耳茨海默氏病
can lead to early dementia, such as Alzheimer’s,
也会导致慢性的创伤性脑病
and chronic traumatic encephalopathy.
这是威尔•史密斯主演的电影《震荡效应》的主题
That was the subject of the Will Smith movie “Concussion.”
几乎每个人在橄榄球比赛中 或是在部队里都会遭受脑震荡
And so everybody is caught up in football and what they see in the military,
但你可能不知道
but you may not know
对孩子们而言 骑自行车才是脑震荡的主要成因
that bike riding is the leading cause of concussion for kids,
即运动相关脑震荡
sports-related concussion, that is.
我还想告诉在座各位一件事
And so another thing that I should tell you
你们或许也不知道
that you may not know
诸如自行车和橄榄球等运动
is that the helmets that are worn in bicycling and football
所规定佩戴的头盔
and many activities,
并不是为了防止或
they’re not designed or tested
减轻脑震荡而设计的事实上
for how well they can protect your children against concussion.
此类头盔
They’re in fact designed and tested
的目的在于保护头骨
for their ability to protect against skull fracture.
预防头骨骨折 家长们总是问我这样一个问题
And so I get this question all the time from parents,
他们问我
and they ask me,
“你会让你自己的小孩儿打橄榄球吗?”
“Would you let your own child play football?”
或者“我应该让我小孩儿踢足球吗?”
Or, “Should I let my child play soccer?”
我认为从一个学科领域的角度来讲
And I think that as a field,
我们远没有信心在此回答这样一个问题
we’re a long way from giving an answer with any kind of confidence there.
所以我从另外一个角度思考了这个问题
So I look at that question from a bit of a different lens,
我想知道 我们如何预防脑震荡?
and I want to know, how can we prevent concussion?
这能做到吗?
Is that even possible?
绝大多数专家认为不能
And most experts think that it’s not,
但我的实验室目前所从事的研究
but the work that we’re doing in my lab
将揭示脑震荡的更多细节
is starting to reveal more of the details around concussion
从而我们会对脑震荡有更深刻的认知
so that we can have a better understanding.
戴头盔能预防颅骨骨折的原因非常简单
The reason we’re able to prevent skull fracture with helmets
我们知道这一原理
is because it’s pretty simple. We know how it works.
而脑震荡至今仍是未解之谜
Concussion has been much more of a mystery.
为了让在座各位对脑震荡有更直观的了解
So to give you a sense of what might be happening in a concussion,
我要放一段影片
I want to show you the video here
你可以在谷歌搜索如下字样
that you see when you type into Google,
What is a concussion?什么是脑震荡?
“What is a concussion?”
然后打开CDC(美国疾病控制与预防中心)网页
The CDC website comes up,
网页上的这段视频就会讲述脑震荡的成因
and this video essentially tells the whole story.
你可以看到:头部向前移动
What you see is the head moves forward,
脑组织移动延后
the brain lags behind,
接着脑组织跟了上来也向前移
then the brain catches up
撞向颅骨
and smashes into the skull.
被颅骨弹回
It rebounds off the skull
然后向另一边颅骨撞去
and then proceeds to run into the other side of the skull.
CDC影片中高亮的那部分
And what you’ll notice is highlighted in this video from the CDC,
顺带说一下 这一影片由NFL(美国国家橄榄球联盟)资助
which I’ll note was funded by the NFL,
是脑组织的外部边缘
is that the outer surface of the brain,
这部分脑组织之前曾撞向颅骨
where it was to have smashed into the skull,
看起来它受到了损伤所以高亮部分是在脑组织的外部边缘
looks like it’s been damaged or injured, so it’s on the outer surface of the brain.
我放这段影片
And what I’d like to do with this video
是为了告诉各位这段影片的部分内容
is to tell you that there are some aspects that are probably right,
或许确实正确地表述了科学家对脑震荡的理解
indicative of what the scientists think happens with concussion,
但这段影片更多地方是错误的
but there’s probably more that’s wrong with this video.
其中一点我个人是同意的我相信绝大多数专家也同意
So one thing that I do agree with, and I think most experts would,
那就是脑部确实有这样的动态
is that the brain does have these dynamics.
它的运动迟于颅骨
It does lag behind the skull
接着逐渐追赶上 并向前向后振动
and then catch up and move back and forth and oscillate.
这一点上我们认为它是正确的然而
That we think is true.
视频中所示的脑部的运动大小
However, the amount of motion you see in the brain in this video
可能并不准确
is probably not right at all.
颅顶的空间极小
There’s very little room in the cranial vault,
只有几微米
only a few millimeters,
同时这些空间填满了脑脊液
and it’s filled entirely with cerebral spinal fluid,
这些脑脊液对脑部来说是一个保护层所以说
which acts as a protective layer.
整体来看 脑部在颅骨内的移动极为微小
And so the brain as a whole probably moves very little inside the skull.
视频中还有另外一个问题
The other problem with this video
视频中所示的脑部
is that the brain is shown
在它移动时像是一个坚硬体
as a kind of rigid whole as it moves around,
这也是错的
and that’s not true either.
人类的大脑是人体上最柔软的物质之一
Your brain is one of the softest substances in your body,
你可以把它想象成果冻
and you can think of it kind of like jello.
所以当头部前后晃动时
So as your head is moving back and forth,
脑部在旋转、
your brain is twisting and turning and contorting,
扭曲部分组织会被拉抻
and the tissue is getting stretched.
我认为绝大多数专家都会同意这样一个观点
And so most experts, I think, would agree
脑震荡可能不是发生在
that concussion is not likely to be something that’s happening
脑部的外部边缘
on this outer surface of the brain,
而是发生在脑部的深处
but rather it’s something that’s much deeper
接近脑部中央的位置当下
towards the center of the brain.
我们通过这样一个设备研究这一问题
Now, the way that we’re approaching this problem
从而试图理解脑震荡产生机制
to try to understand the mechanisms of concussion
并确定我们是否可以防治脑震荡
and to figure out if we can prevent it
我们所采用的是这样一个设备
is we are using a device like this.
它是个牙套
It’s a mouthguard.
它里面包含了 和手机内置传感器
It has sensors in it that are essentially the same
类似的
that are in your cell phone:
加速计和陀螺仪
accelerometers, gyroscopes,
当一个人被击中头部时
and when someone is struck in the head,
它可以以每秒钟一千次的速度
it can tell you how their head moved
记录下头部的移动方式
at a thousand samples per second.
这个牙套的原理在于
The principle behind the mouthguard is this:
它固定在牙齿上
it fits onto your teeth.
而牙齿是人体内最坚硬的物质之一
Your teeth are one of the hardest substances in your body.
所以相当于它直接连接在颅骨上
So it rigidly couples to your skull
从而可以最为精确地测算出
and gives you the most precise possible measurement
颅骨的运动模式
of how the skull moves.
研究者们也曾试验过其他方法
People have tried other approaches, with helmets.
比如头盔我们也曾实验过 将传感器贴在皮肤上
We’ve looked at other sensors that go on your skin,
但是它们移动得太多了
and they all simply move around too much,
所以我们发现这是可以得到精确测算的
and so we found that this is the only reliable way
唯一可信方式
to take a good measurement.
现如今我们有了这一设备就可以不仅限于研究尸体了
So now that we’ve got this device, we can go beyond studying cadavers,
因为在尸体身上对脑震荡的研究
because you can only learn so much about concussion
已经近乎到达极限
from studying a cadaver,
我们想要进行活体实验
and we want to learn and study live humans.
在哪里才可以找到一组
So where can we find a group of willing volunteers
愿意经常出去
to go out and smash their heads into each other on a regular basis
把头乱撞从而患上脑震荡的志愿者呢?
and sustain concussion?
嗯 我就是其中一员
Well, I was one of them,
他们是你们友好的斯坦福橄榄球队
and it’s your local friendly Stanford football team.
所以这就是我们的实验室
So this is our laboratory,
我将向各位展示
and I want to show you
我们通过这一设备测量到的第一例脑震荡
the first concussion we measured with this device.
我需要指出一点:该设备中含有陀螺仪
One of the things that I should point out is the device has this gyroscope in it,
它可以测出头部的旋转
and that allows you to measure the rotation of the head.
而绝大多数专家认为 头部的旋转或许
Most experts think that that’s the critical factor
是解释脑震荡成因的关键因素
that might start to tell us what is happening in concussion.
请看这段视频解说员:
So please watch this video.
Cougars带了大批人马但是已经晚了Luck现在有机会了
Announcer: Cougars bring extra people late, but Luck has time,
Winslow被撞了
and Winslow is crushed.
希望他还好
I hope he’s all right.
(观众吼叫)
(Audience roars)
屏幕上方
Top of your screen,
你可以看到他选择了这一短程球门柱路线被分开
you’ll see him come on just this little post route,
安全了
get separation, safety.
现在您看到的是常速回放
Here it comes at you in real speed. You’ll hear this.
你会听到由–的这一击抱歉
The hit delivered by —
放了三次可能有点儿多
David Camarillo: Sorry, three times is probably a little excessive there.
但你应该会看明白
But you get the idea.
当你看这段影片时
So when you look at just the film here,
你可能只会看出 他被击打得很严重 他受伤了
pretty much the only thing you can see is he got hit really hard and he was hurt.
但当我们从他戴的牙套中
But when we extract the data
提取到数据后
out of the mouthguard that he was wearing,
我们可以看到更多细节、
we can see much more detail, much richer information.
更多信息我们可以注意到
And one of the things that we noticed here
他的左下侧面罩被击中
is that he was struck in the lower left side of his face mask.
所以有点违反直觉的是
And so that did something first that was a little counterintuitive.
他的头并没有向右移相反
His head did not move to the right.
它首先向左旋转
In fact, it rotated first to the left.
接着颈部开始弯曲
Then as the neck began to compress,
最后这一下击打的力度才让头部向右移动
the force of the blow caused it to whip back to the right.
这样的左右移动是鞭打现象的一种
So this left-right motion was sort of a whiplash-type phenomenon,
我们认为也许是这样的移动造成了脑损伤当下
and we think that is probably what led to the brain injury.
这个设备仅能测量出颅骨的运动
Now, this device is only limited in such that it can measure the skull motion,
但我们真正想知道的是脑部内部的情形
but what we really want to know is what’s happening inside of the brain.
所以我们与瑞典的Svein Kleiven团队合作
So we collaborate with Svein Kleiven’s group in Sweden.
他们研发出了一种脑部有限元素模型
They’ve developed a finite element model of the brain.
这是一个模拟图
And so this is a simulation
模拟所用数据是刚才影片中那次受伤后我们从牙套中得到的数据
using the data from our mouthguard from the injury I just showed you,
你会看到
and what you see is the brain —
如我之前所述
this is a cross-section right in the front
脑部正前方左右脑交界处发生旋转、
of the brain twisting and contorting as I mentioned.
扭曲所以这和CDC视频中所描述的并不一致
So you can see this doesn’t look a lot like the CDC video.
这里不同颜色所代表的是
Now, the colors that you’re looking at
脑组织被拉伸的程度
are how much the brain tissue is being stretched.
红色代表百分之五十
And so the red is 50 percent.
这意味着红色区域的这部分脑组织
That means the brain has been stretched to 50 percent of its original length,
被拉长了原来长度的50%
the tissue in that particular area.
值得注意的是红色点状区域的分布
And the main thing I want to draw your attention to is this red spot.
它们非常接近脑部中心
So the red spot is very close to the center of the brain,
相对而言
and relatively speaking,
和CDC影片中所示不同
you don’t see a lot of colors like that on the exterior surface
脑组织外部红色区域较少接下来
as the CDC video showed.
我会更详细地阐释
Now, to explain a little more detail
我们对脑震荡成因的观点
about how we think concussion might be happening,
值得一提的是
one thing I should mention
我们和其他同行都观察到
is that we and others have observed that a concussion is more likely
如果头部被击打 并像这样旋转更容易造成脑震荡
when you’re struck and your head rotates in this direction.
橄榄球等运动中这种情况(前后晃动)更为常见
This is more common in sports like football,
但这种(左右晃动)似乎更为危险 所以这种情况中脑部发生了什么呢?
but this seems to be more dangerous. So what might be happening there?
值得注意的是 人类大脑与其他动物的并不相同
Well, one thing that you’ll notice in the human brain
主要差异在于
that is different than other animals
我们有两块儿相当大的大脑额叶
is we have these two very large lobes.
它们是我们的右脑和左脑
We have the right brain and the left brain.
这幅图中值得注意的是
And the key thing to notice in this figure here
左右脑中间的正下方
is that right down the center of the right brain and the left brain
有一个深入脑组织的裂缝
there’s a large fissure that goes deep into the brain.
虽然这幅图中看不到
And in that fissure, what you can’t see in this image,
但你得相信我
you’ll have to trust me,
裂缝中有一层纤维化组织
there is a fibrous sheet of tissue.
它被称为脑镰
It’s called the falx,
脑镰连通头部的最前方和最后方
and it runs from the front of your head all the way to the back of your head,
它很硬
and it’s quite stiff.
当你头部被击中
And so what that allows for is when you’re struck
并左右旋转时
and your head rotates in this left-right direction,
脑镰可以让受力迅速传至脑部中央所以
forces can rapidly transmit right down to the center of your brain.
裂缝的底部有什么?
Now, what’s there at the bottom of this fissure?
那里有脑部的“线路”事实上
It’s the wiring of your brain,
裂缝底部红色的那一捆“线路”
and in fact this red bundle here at the bottom of that fissure
是最大的单个纤维束
is the single largest fiber bundle
也就是它连接着你们的左右脑
that is the wiring that connects the right and left sides of your brain.
它被称为脑胼胝体
It’s called the corpus callosum.
我们认为
And we think that this might be
这也许是脑震荡最为常见的成因
one of the most common mechanisms of concussion,
击打力向下移动 撞机脑胼胝体
and as the forces move down, they strike the corpus callosum,
导致左右脑之间的连接断裂
it causes a dissociation between your right and your left brain
这样就可以脑震荡的一些症状此外
and could explain some of the symptoms of concussion.
这项发现与我之前提过的
This finding is also consistent of what we’ve seen
脑震荡引起的诸如慢性创伤性脑病等脑部疾病的症状相符
in this brain disease that I mentioned, chronic traumatic encephalopathy.
这是一个中年前橄榄球职业运动员的脑部图片
So this is an image of a middle-aged ex-professional football player,
我想指出的是 如果你仔细观察脑胼胝体
and the thing that I want to point out is if you look at the corpus callosum,
我们看一下上一页的这张图片这是一个正常脑胼胝体的大小
and I’ll page back here so you can see the size of a normal corpus callosum
这是那位患有慢性创伤性脑病的脑胼胝体
and the size of the person here who has chronic traumatic encephalopathy,
它大幅萎缩了
it is greatly atrophied.
脑室的大小也有变化
And the same goes for all of the space in the ventricles.
然而它们却变大很多
These ventricles are much larger.
这意味着脑部中央附近的组织细胞
And so all of this tissue near the center of the brain
已经逐渐凋亡
has died off over time.
这也印证了我们的研究发现但是
So what we’re learning is indeed consistent.
这里我也要带来一些好消息
Now, there is some good news here,
希望能给在座各位一些希望
and I hope to give you a sense of hope by the end of this talk.
我们注意到一些
One of the things that we’ve noticed,
损伤机制的细节
specifically about this mechanism of injury,
虽然力在裂缝中的向下传导非常迅速
is although there’s a rapid transmission of the forces down this fissure,
它还是需要一定的时间的
it still takes a defined amount of time.
所以我们设想 如果能够减缓头部的向下移动
And what we think is that if we can slow the head down just enough
那么脑部运动就不会落后于颅骨
so that the brain does not lag behind the skull
而是与颅骨同步
but instead it moves in synchrony with the skull,
这样我们或许就能预防脑震荡
then we might be able to prevent this mechanism of concussion.
那我们该如何减缓头部的向下移动?
So how can we slow the head down?
(笑声)
(Laughter)
可以佩戴巨型头盔
A gigantic helmet.
空间变大 缓冲时间就会变长
So with more space, you have more time,
当然这是个玩笑 虽然你们有人可能见过这个
and this is a bit of a joke, but some of you may have seen this.
这是泡泡足球 而且它真是一项运动事实上
This is bubble soccer, and it’s a real sport.
前几天
In fact, I saw some young adults
我就在我家附近的街上看到一些年轻人在玩儿它
playing this sport down the street from my house the other day,
据我所知 没有这种运动中发生脑震荡的报道
and as far as I know there have been no reported concussions.
(笑声)
(Laughter)
但严肃地说 这一原则确实有效
But in all seriousness, this principle does work,
但它有点过头儿了
but this has gone too far.
毕竟对于自行车和橄榄球运动来讲
This isn’t something that’s practical for bike riding or playing football.
这不大现实目前 我们正和瑞典Hövding公司合作 研发一个产品
And so we are collaborating with a company in Sweden called Hövding.
可能有人见过它
Some of you may have seen their work,
它实际上运用了同一项原则 利用空气提供更多空间
and they’re using the same principle of air to give you some extra space
从而预防脑震荡
to prevent concussion.
小孩子请勿在家尝试
Kids, don’t try this at home please.
这个特技演员没有戴头盔
This stuntman does not have a helmet.
而是戴了一个颈环
He instead has a neck collar,
这个颈环内置传感器
and this neck collar has sensors in it,
这些传感器和我们的牙套中的传感器同属一个类型
the same type of sensors that are in our mouthguard,
当骑行者要摔倒时 它可以感测到
and it detects when he’s likely to have a fall,
并且弹出安全气囊
and there’s an airbag that explodes and triggers,
这一引发机制和汽车中的基本一致
the same way that an airbag works in your car, essentially.
我的实验室对这一设备进行了一系列实验
And in the experiments we’ve done in my lab with their device,
我们发现与普通自行车头盔相比
we found that it can greatly reduce the risk of concussion in some scenarios
这一设备在一些情境下可以大幅降低脑震荡风险
compared to a normal bicycle helmet.
这是个很令人激动的新发展
So it’s a pretty exciting development.
但为了真正利用这一可以预防脑震荡的
But in order for us to actually realize the benefits of technology
技术
that can prevent concussion,
它必须得符合监管的要求
it needs to meet regulations.
这是个现实问题
That’s a reality.
这一设备目前在欧洲出售
And this device is for sale in Europe
但目前却没有 很可能近期都不会
but is not for sale in the US, and probably won’t be any time soon.
在美国出售我会告诉各位这是为什么
So I wanted to tell you why.
有些原因很合理 而有些却不是
There are some good reasons and then there are some not so good reasons.
自行车头盔由联邦政府监管
Bike helmets are federally regulated.
美国消费品安全委员会有权
The Consumer Product Safety Commission has been given jurisdiction
批准自行车头盔产品上市
to approve any bike helmet for sale,
他们用这样的测试方法
and this is the test they use.
这又回到了我们开始时候谈到的颅骨骨折问题 而这正是这一
This is back to what I was telling you at the beginning about skull fracture.
测试的目的
That’s what this test is for.
这一测试很重要
And that’s an important thing to do.
它能挽救生命 但我得说
It can save your life, but it’s not sufficient, I would say.
它不够全面比如说 这一测试没有评估
So for example, one thing this test doesn’t evaluate
安全气囊能否在正确地时间
is it doesn’t tell you is that airbag going to trigger
地点弹出 也没有评估它在不需要弹出的情况是否会弹出
at the right time and place, and not trigger when it doesn’t need to?
同样这一测试也不能判断
Similarly, it’s not going to tell you
这一头盔是否能够预防脑震荡
is this helmet likely to prevent concussion or not?
其实橄榄球头盔虽然未被联邦政府监管
And if you look at football helmets, which aren’t regulated,
但他们的测试基本相同
they still have a very similar test.
虽然它们并未被政府监管 但如同绝大多数
They’re not regulated by the government, anyway.
行业一样有一个行业机构负责此事
They have an industry body, which is the way most industries work.
但我得说这一机构极力反对更新它们的标准
But this industry body, I can tell you, has been quite resistant
所以我们
to updating their standards.
实验室不仅研究脑震荡机制
So in my lab, we are working on not only the mechanism of concussion,
还想研究如何才能采用更好的测试标准
but we want to understand how can we have better test standards?
我们希望政府可以利用这类信息
And we hope that the government can use this type of information
鼓励创新
to encourage innovation
让消费者了解
by letting consumers know
某一特定头盔的保护能力
how protected are you with a given helmet.
最后我想要回到最初我常被问到的那个问题
And I want to bring this back finally to the original question I asked,
我会让我的小孩打橄榄球吗?
which is, would I feel comfortable letting my child play football
会让它骑自行车吗?
or ride a bicycle?
因为我自己的痛苦经历
And this might be just a result of my own traumatic experience.
当我女儿Rose骑自行车时 我会非常紧张
I’m much more nervous about my daughter, Rose, riding a bicycle.
她现在才一岁半
So she’s a year and a half old,
就已经很想冲下旧金山的街道
and she’s already, well, wants to anyway, race down the streets of San Francisco.
这张图片拍摄于某条街道的末尾
This is the bottom of one of these streets.
所以我个人的目标是进一步研发这些技术
And so my personal goal is to — and I believe this is possible —
而且我认为这一肯能行很大事实上
is to further develop these technologies,
我的实验室尤其致力于研究
and in fact, we’re working on something in my lab in particular
头盔内部空间的最佳使用方式
that really makes optimal use of the given space of a helmet.
我敢肯定我们能在我女儿可以骑两轮自行车前
And I am confident that we will be able to,
做到这一点
before she’s ready to ride a two-wheeler,
研发出能够
have something available
真正减少脑震荡风险
that can in fact really reduce the risk of concussion
且符合监管机构要求的头盔
and comply with regulatory bodies.
我希望
And so what I’d like to do —
再过
and I know that this is for some of you of more immediate nature,
几年
I’ve got a couple years here —
我可以告诉孩子家长和祖父母
is to be able to tell parents and grandparents when I’m asked,
孩子们可以安全、健康地骑自行车、
it is safe and healthy for your children to engage in these activities.
打橄榄球非常有幸我能在斯坦福有这样一个
And I’m very fortunate to have a wonderful team at Stanford
致力于研究脑震荡的团队
that’s working hard on this.
我希望过几年我可以再来讲最后的故事
So I hope to come back in a few years with the final story,
但现在我可以各位
but for now I will tell you,
当你听到脑震荡一词时不要害怕
please don’t just be afraid when you hear the word concussion.
这还有希望
There is hope.
谢谢各位
Thank you.
(掌声)
(Applause)

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https://www.youtube.com/watch?v=druJDI6hiiY

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