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1 Clinical Article The Korean Journal of Sports Medicine 2018;36(3): pissn eissn 알마티동계유니버시아드대회에서발생한한국선수들의부상및질병 연세대학교체육교육학과 1, 연세대학교연세스포츠과학 운동의학센터 2, 대한체육회의과학부 3, 진천국가대표선수촌메디컬센터 4 정희성 1,2 ㆍ이세용 1,2 ㆍ김세준 3,4 ㆍ정규연 3,4 ㆍ이은희 3,4 ㆍ김용준 3,4 ㆍ김현철 3,4 Injuries and Illnesses of Korean Athletes during the Almaty Winter Universiade Games 2017 Hee Seong Jeong 1,2, Sae Yong Lee 1,2, Sejun Kim 3,4, Kyuyeon Jeong 3,4, Eun Hee Lee 3,4, Youngjun Kim 3,4, Hyun Chul Kim 3,4 1 Department of Physical Education, Yonsei University, Seoul, 2 Yonsei Institute of Sports Science and Exercise Medicine (YISSEM), Yonsei University, Seoul, 3 Medical and Science Department, Korean Sports and Olympic Committee, Seoul, 4 Medical Center, Jincheon National Training Center, Jincheon, Korea Purpose: This study aimed to describe the pattern of injuries and illnesses among Korean athletes during the Almaty Winter Universiade Methods: All medical staffs of Korean team recorded the daily occurrence of injuries and illnesses sustained during the Almaty Winter Universiade Games by using a standardized online form via kociss.com. The design of this study was a prospective study. Results: In total, 98 athletes (68 men and 30 women) in 11 sports events from Korean Sport Olympic Committee participated in this study. Korean medical staffs reported 40 injuries (40.8%) and 26 illnesses (26.5%), equaling incidences of 6.3 injuries and 4.1 illnesses per 100 athletes. Men suffered more injury and illness than women (44.1% vs. 33.3%). The rate of Injury and illness in training was higher than the competition (13.3 vs. 2.0 athlete exposures). The risk of an athlete being injured was the highest in freestyle skiing, followed by snowboard and speed skating. Overall, the main common type and location of injury was the joint or ligaments sprain (13.3%) and knee (7.1%). The rate of main illness was 17.3% of the respiratory system with the main symptom of pain and the main cause of environment (22.4%). Conclusion: Injuries and illnesses occurred 40.8% and 26.5% during this winter game, and were higher during training than a competition. Based on the epidemiologic data of this study, it could provide the source for the injury prevention and improving the performance of the athlete and further develop scientific injury and illness surveillance systems. Keywords: Athletic Injuries, Epidemiology, Prevention, Surveillance system Received: April 25, 2018 Revised: August 22, 2018 Accepted: August 29, 2018 Correspondence: Sejun Kim Medical Center, Jincheon National Training Center, 105 Seonsuchon-ro, Gwanghyewon-myeon, Jincheon 27809, Korea Tel: , Fax: , kimsejun@sports.or.kr Copyright 2018 The Korean Society of Sports Medicine CC This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 118 대한스포츠의학회지

2 정희성외 알마티동계유니버시아드대회에서발생한한국선수들의부상및질병 서론국제대학스포츠연맹 (International University Sports Federation) 에서 2년마다개최되는유니버시아드대회는범세계적인대학스포츠경기다 년제28회동계유니버시아드대회는카자흐스탄알마티에서 1월 28일부터 2월 8일까지개최되었으며, 56개국에서 1,621명의선수들이참가하였고, 대한민국선수단은 12개종목에서 98명이참가하여총 3위라는좋은성적을얻을수있었다 2. 국제올림픽위원회 (International Olympic Committee [IOC]) 에서는선수들의건강과부상및질병예방을위해많은노력을하고있으며, 올림픽대회를포함하여많은국제대회에서선수들의부상및질병에대한원인과위험요인을파악하기위한역학연구를진행하고있다 3. IOC 의무위원회의지속적인노력으로, 현재의부상및질병감시양식 (injury and illness surveillance foam) 은 2004년아테네올림픽에서설립되어대회에참가한 8개의국제팀스포츠연맹 (International Basketball Federation, International Federation of Association Football, International Swimming Federation, International Hockey Federation, International Volleyball Federation, International Baseball Federation, International Handball Federation, International Softball Federation) 이 14개의단체스포츠경기에서부상의빈도와특성에관한연구를시작하였는데모든토너먼트경기에서 90% 가넘는응답률을보였고, 이에따른결과에서이전연구의데이터에서높은신뢰도를입증하였다 4,5. 이어서 2008년베이징올림픽에서부상감시시스템이개인및단체스포츠경기에서적용할수있도록수정되었고, 2010 년밴쿠버올림픽부터 2012년런던, 2014 소치, 2016년리오, 2018년평창올림픽에서부상뿐만아니라질병요소를모니터할수있도록제작되었다 4. 많은국제대회에서각국의국가올림픽위원회 (National Olympic Committee) 의의료진, 물리치료사및의무트레이너가대회경기및연습에서발생한부상및질병에대한보고서가이어지고있다 3,6. 선행연구에따르면국내에서도개인및단체경기에서일정시즌동안이나대회기간발생한부상에대한연구가몇몇보고되고있지만 7, 이는대부분임상적발생연구라는단점이있었고, 전체선수집단의경기및연습에따른부상발생률이나종목별평균부상발생위험을설명하기에는많이부족했으며, 2010년광저우하계아시아게임에서보고된연구에서는질병에대한결과를확인할수없다는한계가있다 8. 또한대회마다부상데이터가종이형태로수집되고연구자가 다시분석파일에직접입력하여데이터를관리해야하므로입력의오류와보안이미흡하다는지적이있어왔다 9. 본연구에서는시스템의오류와보안을고려하여온라인데이터베이스시스템을자체개발하여의료진과코치진이어디서든입력하고확인할수있는모니터링시스템으로진행되었다 10. 따라서본연구는전향적역학연구로서대한민국국가대표선수들이참여하는유니버시아드대회기간동안경기및훈련중에발생하는부상과질병의발생률, 특성, 그리고메커니즘을알아보고, 종목별차이를비교해보고자한다. 연구방법 1. 대상 2017년제28회동계유니버시아드대회에참가하는대한민국선수들로총 98명 ( 남자 68명, 여자 30명 ) 이며, 세부종목에따른참가자현황은 Table 1과같다. 2. 부상및질병의정의와보고서양식 한국선수단의료진은알마티동계유니버시아드대회기간동안 (2017년 1월 28일 2월 8일 ) 훈련과경기에참가한한국선수들이호소하는부상과질병에대해급성과만성의증상 Table 1. Demographic characteristics of Korean athletes participating in the Almaty Winter Universiade 2017 Variable Men Women Total Athlete 68 (69.4) 30 (30.6) 98 (100) Age 23.1± ± ±1.6 Sport division Alpine skiing 6 (6.1) 5 (5.1) 11 (11.2) Biathlon 2 (2.0) 0 2 (2.0) Cross-country skiing 5 (5.1) 5 (5.1) 10 (10.2) Curling 5 (5.1) 4 (4.1) 9 (9.2) Figure skating 3 (3.1) 2 (2) 5 (5.1) Freestyle skiing 4 (4.1) 0 4 (4.1) Ice hockey 20 (20.4) 0 20 (20.4) Short track 5 (5.1) 5 (5.1) 10 (10.2) speed skating Ski jumping 2 (2.0) 0 2 (2.0) Snowboard 8 (8.2) 2 (2.0) 10 (10.2) Speed skating 8 (8.2) 7 (7.1) 15 (15.3) Values are presented as number (%) or mean±standard deviation. 제 36 권제 3 호

3 HS Jeong, et al. Injuries and Illnesses of Korean Athletes during the Almaty Winter Universiade Games 2017 및징후를확인하여진단하였다 8. 선수들의신규부상은본대회기간동안새로발생했거나선수본인이부상부위에기존치료를받지않은급성부상이며, 재발부상은기존에부상이었던부위에같은종류의근 골격계부상, 뇌진탕, 그리고다른의학적부상및질병으로분류한만성부상으로구분하였다 6. IOC 부상및질병감시양식으로선수가부상시기록해야하는사항은선수고유번호, 스포츠종목및세부종목, 연습또는경기시부상을입었는지, 부상당한날짜및시간, 부상부위, 부상유형, 부상원인, 그리고부상회복예상기간 ( 부상정도 ) 이며, 선수가질병시기록해야하는사항은선수고유번호, 스포츠종목및세부종목, 질병당한날짜, 질병신체기관, 주요증상, 원인, 질병회복예상기간 ( 질병정도 ) 으로구성되었다 연구설계및자료수집본연구는전향적연구 (prospective study) 로종목별집단으로구성하여부상및질병감시시스템 (Injury and Illness Surveillance System) 으로시행하였다. 부상및질병의자료를수집하기위해 IOC에서개발된부상및질병감시양식을, 온라인모니터링데이터베이스시스템 ( 을연세스포츠과학ㆍ운동의학센터 (Yonsei Institute of Sports Science and Exercise Medicine [YISSEM]; IOC 연구센터 ) 가개발하여구축했다 11. 대한민국선수단전체의료진과의무트레이너에게개별 ID와 password를부여하고입력할수있도록사전교육하였다. 또한선수들의대회참가전에부상과질병을파악하기위해선수촌전자차트시스템과설문조사를통해사전기록을파악하였다. 대회기간동안한선수가다발성손상을입은경우각각다른진단으로분류하였고, 한부위에다른종류의부상유형이발생한경우도각각구분하여기록하였다. 본연구에수집된모든정보는온라인시스템으로저장 되고철저한보안을유지하도록하였다. 4. 통계분석본연구의모든자료분석은 SPSS ver (IBM Corp., Armonk, NY, USA) 을이용하였다. 부상및질병의대상자들에대해기술적통계분석을위하여빈도분석을시행하였다. 부상및질병발생률은참가선수대비전체부상률과각종목별, 성별, 경기및훈련으로구분하여계산하였고, 또한선수가대회기간동안경기및훈련에 100회노출 (athlete exposures [AEs]) 되는것을기준으로계산하였으며, 부상건수로공식은 [( 대회기간동안발생한부상또는질병건수 / 대회기간동안공식경기및연습에참가한횟수 ) 100] 과같이분석하였다. 최신선행연구에따르면단기간대회이고참가자가 1,000명미만일경우 100회노출로계산된것을참고하였다 4-6. 또한부상및질병의발생위험도성별비교로교차비 (odds ratio [OR]) 와 95% 신뢰구간 (95% confidence interval [CI]) 을산출하였다. 모든부상과질병에대한분석결과와관련측정치들에대한신뢰구간을 95% 로계산하였다. 결과 1. 부상및질병발생률한국선수들이대회기간중발생한부상은총 40건 ( 남자 30건, 여자 10건 ), 부상률 40.8% 로, 선수가대회기간중에경기및훈련에 100회노출됨에따른부상건수는 6.3 AEs ( 남자, 6.9 AEs; 여자, 5.0 AEs) 이며, 남자가여자보다 OR 1.58 정도부상위험이높다. 또한대회기간중발생한질병은총 26건 ( 남자 19건, 여자 7건 ), 질병률 26.5% 로나타났고, 선수가대회기간중경기및훈련에 100회노출됨에따른질병건수는총 4.1 AEs ( 남자, Table 2. Rate of injuries and illnesses of Korean athletes incurred during the Almaty Winter Universiade 2017 Variable Injury Illness Men Women Total Men Women Total Injury (n) Injury rate (%) Overall/100 AEs Competition/100 AEs Practice/100 AEs Injuries, OR (95% CI) 1.58 ( ) Reference 1.27 ( ) Reference AEs: athlete exposure, OR: odds ratio, 95% CI: 95% confidence interval. 120 대한스포츠의학회지

4 정희성외 알마티동계유니버시아드대회에서발생한한국선수들의부상및질병 4.4 AEs; 여자, 3.5 AEs) 이며, 남자가여자보다 OR 1.27 정도질병위험이높다 (Table 2). 또한코치와의무트레이너들의부상및질병보고건수는 0건, 의료진보고건수는 66건이었다. 2. 부상및질병발생률비교전체적으로참가선수대비부상및질병이가장높았던종목은프리스타일스키 (8, 200%) 며, 다음은크로스컨트리스키 (13, 130%), 그다음은스피드스케이팅 (16, 106.7%) 순으로높았다. 부상에서총 40개 (40.8%) 가발생했고가장높은종목은프리스타일스키 (8, 200%) 며, 다음은스노우보드 (7, 70%), 그다음은스피드스케이팅 (10, 66.7%) 순으로높았고, 질병에서총 26개 (26.5%) 가발생했고가장높은종목은크로스컨트리스키 (13, 130%) 이며, 다음은스피드스케이팅 (6, 40.0%), 그다음은컬링 (2, 22%) 순으로높았다. 성별비교로남자 (49건, 72.1%) 가여자 (17건, 56.7%) 보다높았다. 종목별경기및훈련시 100회노출됨을기준으로부상과질병이높았던종목은프리스타일스키 (44.4/100 AEs), 크로스컨트리스키 (20.3/100 AEs), 스피드스케이팅 (18.0/100 AEs) 순으로높았고, 경기중부상 (5.1/100 AEs) 보다훈련중부상 (19.2/100 AEs) 이더높았다 (Table 3). 3. 부상의특성부상유형에서총 39건 (39.8%) 이발생했으며, 가장높은부상유형은 관절또는인대염좌 (joint or ligaments sprain) 에서 13건 (13.3%) 이발생하였는데요추 7건, 팔꿈치 2건, 무릎 2건, 발목 1건이이전부상에서재발한부상이었고, 발목 1건이부딪침없는부상이었다. 다음은 타박상 / 혈종 / 멍 (contusion/ hematoma/bruise) 에서 5건 (5.1%) 이발생하였는데허벅지, 하지, 손가락각각 1건씩부딪침으로인한부상이었고, 어깨와무릎 1건씩부딪침없는부상이었다. 건염 / 건병증 (tendinosis/ tendinopathy) 에서각각 5건 (5.1%) 이발생하였는데팔꿈치 1 건, 하지 2건이과사용부상이었고, 어깨와발 1건씩이전부상에서재발한부상이었다. 성별에따른부상특성도전체적인부상유형, 부위, 그리고기전과유사한결과를보여주었다 (Table 4). 4. 질병의특성전체적으로주로손상입은신체기관으로호흡기 17건 (17.3%), 위장관 3건 (3.1%), 그리고근 골격계 2건 (2%) 순으로높았다. 주증상으로통증 17건 (17.3%), 호흡곤란및기침 9건 (9.2%), 그리고열 3건 (3.1%) 이높았고, 질병의원인으로 환경적인요인 22건 (22.4%) 이가장높았다 (Table 5). 고찰제28회동계유니버시아드대회에참가한한국선수들의경기와훈련시에발생한부상및질병에대해서전향적역학분석한결과를논의하고자한다. 한국선수들의참가대비총부상률 40.8%, 총질병률 26.5% 로, 경기및훈련에 100회노출됨에따른부상건수는 6.3 AEs, 질병건수는 4.1 AEs로질병보다부상이많았다. 또한남자 (49건, 72.1%) 가여자 (17건, 56.7%) 에비해부상 (OR, 1.58) 과질병 (OR, 1.27) 위험이높았다. 이는 2014년소치동계올림픽에서발생한총부상률 (14%) 과총질병률 (8.9%) 보다높으며, 2016년릴레함메르유스동계올림픽에서발생한총부상률 (9.5%) 과총질병률 (7.2%) 보다높은수치이다 5,6. 본연구에서발생한부상률과질병률은한국선수단에서발생한수치이고, 2014 소치와 2016 릴레함메르유스동계올림픽은전체참가자대비발생한수치여서직접적인비교에는차이가있을수있으나, 참가선수를대비하여비교한수치이기때문에선수단규모에따른비교는가능하다. 또한 2010 광저우하계아시안게임에서발생한스포츠부상연구에따르면, 한국선수단참가대비총부상률 (26%) 보다높은수치이다 8. 이러한수치가한국선수들의전체부상률의비교가가능하지만, 하계와동계종목이라는스포츠특성의큰차이가있기때문에부상률에차이가있는것으로생각한다. 대회기간중한국선수참가대비부상및질병이높은종목과종목별경기및훈련시 100회노출됨을기준으로부상과질병이전체적으로높았던종목은프리스타일스키, 크로스컨트리스키, 스피드스케이팅등이었으나, 부상이높은종목은프리스타일스키, 스노우보드, 스피드스케이팅등이높았는데, 프리스타일스키에서주로발생한부상부위와유형은무릎인대부분파열이었고 12, 스노우보드에서는요추염좌였고 13, 스피드스케이팅에서는하지건염및건병증이었다 14,15. 주로부상발생부위는하지와허리부상이많았는데동계스포츠특성상설상과빙상위에서하지를사용하는동작들로미끄러운경기장바닥에서근 신경을효율적으로조절해야하는스포츠이기때문에하지와허리부상이많이발생할수밖에없고 15, 이결과는기존연구에서보고된스포츠부상관련역학조사들과유사한결과를보였다 4-6,8. 또한질병이높은종목은크로스컨트리스키, 스피드스케이팅, 컬링등이높았는데, 주질병신체기관과주증상으로대부분종목에서호흡기계통의통증, 열과호흡곤란이었고, 기존동계올림픽 제 36 권제 3 호

5 HS Jeong, et al. Injuries and Illnesses of Korean Athletes during the Almaty Winter Universiade Games 2017 Table 3. Comparison of all sports injuries and illnesses of Korean athletes incurred during the Almaty Winter Universiade 2017 Sports events Participant per event (n) No. (% of athletes) No. (100 AEs, 95% CI) Total Men Women Total Injury Illness Men Women Total Competition Training No. (100 AEs) Alpine skiing (63.6) 1 (9.1) 5 (83.3) 3 (60.0) 8 (72.7) 7 (13.7, 3.56 to 23.89) 1 (4.5, 4.36 to 13.45) 8 (11.0) Cross-country (130.0) 10 (200.0) 3 (60.0) 13 (130.0) 0 13 (43.3, to 66.89) 13 (20.3) skiing Curling (22.0) 0 2 (50.0) 2 (22.0) 0 2 (11.1, 4.28 to 26.51) 2 (2.1) Freestyle skiing (200.0) 0 8 (200.0) 0 8 (200.0) 4 (66.7, 1.33 to 132) 4 (33.3, 0.67 to 66.00) 8 (44.4) Ice hockey (40.0) 4 (20.0) 12 (60.0) 0 12 (60.0) 8 (8.0, 2.46 to 13.54) 4 (10.0, 0.20 to 19.80) 12 (8.6) Snowboard (70.0) 0 5 (62.5) 2 (100.0) 7 (70.0) 0 7 (35.0, 9.07 to 60.93) 7 (16.3) Speed skating (66.7) 6 (40.0) 9 (112.5) 7 (100.0) 16 (106.7) 1 (2.3, 2.18 to 6.72) 15 (33.3, to 50.20) 16 (18.0) Total 40 (40.8) 26 (26.5) 49 (72.1) 17 (56.7) 66 (67.3) 20 (5.1, 2.87 to 7.36) 46 (19.2, to 24.71) 66 (10.5) AEs: athlete exposure, 95% CI: 95% confidence interval. Table 4. Injury site and mechanism in relation to injury type of Korean athletes incurred during the Almaty Winter Universiade 2017 Injury type No. of injuries (% of athletes) Men Injury site (#mechanism) Women Injury site (#mechanism) Total Injury site (#mechanism) Dislocation, subluxation 2 (2.9) Shoulder (1 NC), face (1 C) 0 2 (2.0) Shoulder (1 NC), face (1 C) Ligamentous rupture 2 (2.9) Knee (1 C,1 R) 1 (3.3) Ankle (1 R) 3 (3.1) Knee (1 C,1 R), ankle (1 R) Sprain (joint or ligaments) 9 (13.2) Lumbar spine (5 R), elbow (2 R,1 C), ankle (1 NC) 4 (13.3) Lumbar spine (2 R), knee (2 R), ankle (1 R) 13 (13.3) lumbar spine (7 R), elbow (2 R,1 C), knee (2 R), ankle (1 NC,1 R) Lesion of meniscus or cartilage 1 (1.5) Knee (1 R) 1 (3.3) Knee (1 R) 2 (2.0) Knee (2 R) Strain/muscle rupture/tear 3 (4.4) Thigh (2 OU), lumbar spine 0 3 (3.1) Thigh (2 OU), lumbar spine (1 OU) (1 OU) Contusion/hematoma/bruise 4 (5.9) Shoulder (1 NC), thigh (1 C), knee (1 NC), lower leg (1 C) Tendinosis/tendinopathy 3 (4.4) Shoulder (1 R), lower leg (1 OU), foot (1 R) 1 (3.3) Finger (1 C) 5 (5.1) Shoulder (1 NC), thigh (1 C), knee (1 NC), lower leg (1 C), finger (1 C) 2 (6.7) Elbow (1 OU), lower leg (1 OU) 5 (5.1) Shoulder (1 R), elbow (1 OU), lower leg (2 OU), foot (1 R) Arthritis/synovitis/bursitis 1 (1.5) Shoulder (1 OU) 0 1 (1.0) Shoulder (1 OU) Fasciitis/aponeurosis injury 1 (1.5) Lower leg (1 OU) 0 1 (1.0) lower leg (1 OU) Laceration/abrasion/skin lesion 2 (2.9) Finger (1 C), foot (1 OU) 0 2 (2.0) Finger (1 C), foot (1 OU) Muscle cramps or spasm 2 (2.9) Hip (1 R), thigh (1 OU) 0 2 (2.0) Hip (1 R), thigh (1 OU) Total 30 (44.1) 9 (30.0) 39 (39.8) NC: non-contact, C: contact, R: recurrence of previous injury, OU: overuse. 122 대한스포츠의학회지

6 정희성외 알마티동계유니버시아드대회에서발생한한국선수들의부상및질병 Table 5. Characteristics of illnesses in Korean athletes incurred during the Almaty Winter Universiade 2017 Variable No. of illnesses (% of athletes) Men Women Total Affected system Respiratory 13 (19.1) 4 (13.3) 17 (17.3) (ear, nose, throat) Gastrointestinal 3 (4.4) 0 3 (3.1) Urogenital/ 0 1 (3.3) 1 (1.0) gynaecological Allergic/ 1 (1.5) 0 1 (1.0) immunological Neurological/ 0 1 (3.3) 1 (1.0) psychiatric Musculoskeletal 2 (2.9) 0 2 (2.0) Other 0 1 (3.3) 1 (1.0) Total 19 (27.9) 7 (23.3) 26 (26.5) Main symptom Fever 2 (2.9) 1 (3.3) 3 (3.1) Pain 12 (17.6) 5 (16.7) 17 (17.3) Diarrhea, vomiting 3 (4.4) 0 3 (3.1) Dyspnea, cough 7 (10.3) 2 (6.7) 9 (9.2) Hyperthermia 0 1 (3.3) 1 (1.0) Lethargy, dizziness 0 1 (3.3) 1 (1.0) Other 4 (5.9) 0 4 (4.1) Total 28 (41.2) 10 (33.3) 38 (38.8) Cause of illness Environmental 16 (23.5) 6 (20.0) 22 (22.4) Other 5 (7.4) 2 (6.7) 7 (7.1) Total 21 (30.9) 8 (26.7) 29 (29.6) 대회에서보고된역학연구들과유사한결과를보였다 5,6. 이는추운겨울날씨와해외다른지역에서선수들이좋은성적을얻기위해단기간에극복해야하는문제로서감기, 기침, 두통으로인해호흡기계통의감염과환경적인요인들로인해통증, 열과호흡곤란이발생하기때문에동계스포츠선수들에게대회기간중훈련과경기전신체를지속적으로보온할수있는복장과따뜻한음료를적절하게섭취하고, 훈련과경기중및후에땀을잘배출할수있는복장과새옷으로바로갈아입을수있도록선수또는코치진의빠른대처와지도가필요하다 16,17. 본연구에서는경기중부상 (20건, 5.1 AEs) 보다훈련중부상 (46건, 19.2 AEs) 이더높았는데이는 2010 광저우하계아시안게임연구와비슷한결과가나타났지만 8, 2016 리오하계올림픽, 2016 릴레함메르유스동계올림픽, 2014 소치동계올림픽연구들과반대되는결과를보여주었다 4-6. 대회기간중훈련중에부상및질병이많았던크로스컨트리스키에 서호흡기계통의통증과호흡곤란으로질병이많았고, 스피드스케이팅에서하지건염및건병증부상이많았다. 또한, 프리스타일스키에서무릎인대부분파열과어깨탈구가주로발생하였다. 따라서전체적으로경기보다훈련중에부상이높았던이유는크로스컨트리스키에서호흡기계통질병과스피드스케이팅의실전과같은연습중에하지염증이높은것이었다. 또한경기중에부상이많았던프리스타일스키에서무릎인대부분파열이많았고, 알파인스키에서요추및무릎염좌가많았다. 이러한결과들로인해동계스포츠선수들과코치진이대회기간중에해당종목에서발생하는부상과질병을인지하고적절한예방프로그램을계획해야하며, 예상가능한부상과질병을초기에치료하고회복할수있도록대처해야한다 8,18. 유니버시아드동계스포츠전체종목에대한부상부위, 유형및기전을종합하여분석한결과남녀가상관없이관절또는인대의염좌가요추, 팔꿈치, 무릎, 그리고발목에서이전부상에서재발한부상이거나부딪침이없는부상이었다. 또한건염과건병증이어깨, 팔꿈치, 하지, 그리고발에서과사용과이전부상에서재발한부상이었다. 본결과에서보여주듯이과사용과과거력을동반한재발부상은대회기간전에염증과통증관리를지속적으로해야하지만유니버시아드에참가한대부분의한국대학생선수들은 귀찮음, 치료비용부담, 치료에대해잘모름 등여러이유로치료를미루거나무시하는경우가많기때문에선수와코치진의지속적인교육과지도가필요할것으로생각한다 14,16. 추가적으로모든스포츠에서흔하게나타나는타박상, 혈종, 멍으로인한부상은선수신체어디서든발생하는부상인데치료하지않고시간이지나면저절로회복된다는인식이크다. 하지만선수들은매일지속적인반복훈련을하므로이러한부상이출혈과부종을최소화하고조직의비후와염증이악화되지않도록관리및지도가필요하다 16,19. 본연구는향후예정된대한민국선수단국제대회의부상및질병조사의사전연구 (preliminary study) 의성격을가지며, 더욱정확한조사를위해온라인모니터링데이터베이스시스템을구축하고, 의료진과코치혹은의무트레이너가함께부상및질병을보고하도록고안하였으나, 실제로코치혹은의무트레이너의보고건수는 0건이었다. 프로그램사용교육은대회도착후설명서를통해교육되었으며익숙하지않은업무및시스템에대한교육부족이원인이었을수있다. 또한대회기간중선수와시합에집중해야하는상황에서추가적인입력업무가부담되었을것으로판단된다. 이는이번연구의 제 36 권제 3 호

7 HS Jeong, et al. Injuries and Illnesses of Korean Athletes during the Almaty Winter Universiade Games 2017 제한으로향후대회에서보완하고자한다. 또한본연구의결과로기존올림픽과아시안게임에서발생하는부상및질병의특성을비교하는것은선수단의규모, 연령대, 종목의특성에서확연한차이가있기때문에정확한절대비교는어려운제한이있다. 그러나스포츠부상과질병에대한전향적역학연구는이미발생한한정된부상정보로분석하는후향적역학연구와는달리, 새로기획하고제작된시스템에서얻어진부상정보로분석하는연구법으로선수들의부상과질병을예방하는치료, 운동프로그램, 그리고보호장비를개발하고계획하는데유용한증거기반자료가될것이다 8,20,21. 따라서향후한국대표선수들이참여하는모든국내ㆍ외대회를포함하여엘리트선수들의청소년국내ㆍ외대회들까지지속적인전향적인역학연구가필요하고이를바탕으로선수들에게다방면의구체적인부상및질병예방프로그램을개발하는데유용한기본정보를제공할것으로생각한다. Conflict of Interest No potential conflict of interest relevant to this article was reported. Acknowledgements This study was conducted in cooperation with the Medical and Science Department which is under Korean Sports and Olympic Committee (KSOC) and the Yonsei Institute of Sports Science and Exercise Medicine (YISSEM) which is one of the IOC research centers for prevention of injury and protection athletes health. The authors deeply appreciate the cooperation of KSOC, as well as the medical staff who volunteered their time to collect the data for this project. Also, the authors would like to thank the Team Korea staff for all practical support. References 1. International University Sports Federation. FISU history [Internet]. Lausanne (CH): International University Sports Federation [cited 2018 Aug 15]. Available from: fisu.net/about-fisu/history. 2. International University Sports Federation. Almaty Winter Universiade 2017 main results [Internet]. Lausanne (CH): International University Sports Federation [cited 2018 Aug 15]. Available from: siade/28th-winter-universiade- almaty-2017-main-results. 3. Engebretsen L, Soligard T, Steffen K, et al. Sports injuries and illnesses during the London Summer Olympic Games Br J Sports Med 2013;47: Soligard T, Steffen K, Palmer D, et al. Sports injury and illness incidence in the Rio de Janeiro 2016 Olympic Summer Games: a prospective study of athletes from 207 countries. Br J Sports Med 2017;51: Soligard T, Steffen K, Palmer-Green D, et al. Sports injuries and illnesses in the Sochi 2014 Olympic Winter Games. Br J Sports Med 2015;49: Steffen K, Moseid CH, Engebretsen L, et al. Sports injuries and illnesses in the Lillehammer 2016 Youth Olympic Winter Games. Br J Sports Med 2017;51: Yang YJ, Lee JH, Lee MJ, Suh JT, Ha KI. Injuries and illnesses of Korean athletes during 2002 Busan Asian Games. Korean J Sports Med 2004;22: Kim EK, Kang HY, Kim TG, et al. Sports injury surveillance during Summer Asian Games 2010 in Guangzhou. Korean J Sports Med 2011;29: Dick R, Agel J, Marshall SW. National Collegiate Athletic Association Injury Surveillance System commentaries: introduction and methods. J Athl Train 2007;42: Kerr ZY, Dompier TP, Snook EM, et al. National collegiate athletic association injury surveillance system: review of methods for through data collection. J Athl Train 2014;49: Korean Sport and Olympic Committee. Olympic winter games injury and illness surveillance system [Internet]. Seoul (KR): Korean Sport and Olympic Committee [cited 2018 Jan 15]. Available from: Florenes TW, Heir S, Nordsletten L, Bahr R. Injuries among World Cup freestyle skiers. Br J Sports Med 2010;44: Haider AH, Saleem T, Bilaniuk JW, Barraco RD; Eastern Association for the Surgery of Trauma Injury ControlViolence Prevention Committee. An evidence-based review: efficacy of safety helmets in the reduction of head injuries in recreational skiers and snowboarders. J Trauma Acute Care Surg 2012; 73: Gallo-Vallejo MA, de la Cruz-Marquez JC, de la Cruz- Campos A, et al. Sports injuries and illnesses during the Granada Winter Universiade BMJ Open Sport Exerc Med 2017;2:e Winter T, Beck H, Walther A, Zwipp H, Rein S. Influence of a proprioceptive training on functional ankle stability in young speed skaters: a prospective randomised study. J Sports Sci 2015;33: 대한스포츠의학회지

8 정희성외 알마티동계유니버시아드대회에서발생한한국선수들의부상및질병 16. Bambach S, Kelm J, Hopp S. Ski sport: trend, pattern of injuries, prevention. Sportverletz Sportschaden 2008;22: Hunter RE. Skiing injuries. Am J Sports Med 1999;27: Bromley SJ, Drew MK, Talpey S, McIntosh AS, Finch CF. A systematic review of prospective epidemiological research into injury and illness in Olympic combat sport. Br J Sports Med 2018;52: Brukner P, Khan K. Brukner and Khan's clinical sports medicine. 4th ed. North Ryde: McGraw-Hill; van Mechelen W, Hlobil H, Kemper HC. Incidence, severity, aetiology and prevention of sports injuries: a review of concepts. Sports Med 1992;14: Euser AM, Zoccali C, Jager KJ, Dekker FW. Cohort studies: prospective versus retrospective. Nephron Clin Pract 2009; 113:c 제 36 권제 3 호

Lumbar spine

Lumbar spine CT 32 111 DOI : 10.3831/KPI.2010.13.2.111 Lumbar Spine CT 32 Received : 10. 05. 23 Revised : 10. 06. 04 Accepted : 10. 06. 11 Key Words: Disc herniation, CT scan, Clinical analysis The Clinical