Rohrer M J, Cardullo P A, Pappas A M, Phillips D A, Wheeler H B
Division of Vascular Surgery, University of Massachusetts Medical School, Worcester.
J Vasc Surg. 1990 Jun;11(6):761-8; discussion 768-9.
A 28-year-old major league baseball pitcher sustained an axillary artery thrombosis which was successfully treated with intraarterial urokinase. Subsequent angiography and duplex scanning with the arm elevated in the pitching position demonstrated inducible compression of the axillary artery by the humeral head as well as compression at the thoracic outlet. To determine the incidence of axillary and subclavian artery compression and to investigate the mechanism of injury, brachial artery blood pressures and duplex scans of the subclavian and axillary arteries were performed in both the neutral position and the throwing position in the 92 extremities of 19 major league baseball pitchers, 16 non-pitching major league players, and 11 nonathlete controls. A drop in blood pressure of greater than 20 mm Hg was noted in the position in 56% of extremities tested, with a loss of a detectable blood pressure in 13%. Compression of the axillary artery by the humeral head was documented in 83% of extremities, but in only 7.6% was a greater than 50% stenosis inducible. No statistical difference was found in the incidence of arterial compression between the three groups tested or between their dominant and nondominant extremities. Dissection of the axillary artery in two cadavers documented that abduction and external rotation of the arm causes compression of the axillary artery by the humeral head, which acts as a fulcrum. We conclude that the repetitive mechanical trauma of the throwing motion can cause intermittent compression and contusion of the axillary artery by the humeral head and predisposes the athlete who throws to thrombosis of the axillary artery.
一名28岁的美国职业棒球大联盟投手发生了腋动脉血栓形成，经动脉内使用尿激酶成功治疗。随后的血管造影以及在投球姿势下抬高手臂进行的双功扫描显示，肱骨头可导致腋动脉受压，同时在胸廓出口处也存在压迫。为了确定腋动脉和锁骨下动脉受压的发生率并研究损伤机制，对19名美国职业棒球大联盟投手、16名非投球的大联盟球员以及11名非运动员对照的92条上肢在中立位和投球位均进行了肱动脉血压测量以及锁骨下动脉和腋动脉的双功扫描。在测试的上肢中，56%在投球位时血压下降超过20 mmHg，13%出现血压测不出。83%的上肢记录到肱骨头对腋动脉的压迫，但只有7.6%可诱发超过50%的狭窄。在测试的三组之间或其优势上肢和非优势上肢之间，动脉受压的发生率没有统计学差异。对两具尸体的腋动脉解剖表明，手臂外展和外旋会导致肱骨头对腋动脉的压迫，肱骨头起到了支点的作用。我们得出结论，投球动作的重复性机械创伤可导致肱骨头对腋动脉的间歇性压迫和挫伤，并使投掷运动员易发生腋动脉血栓形成。
