职业棒球投手肘部尺侧副韧带的超声检查：一项 10 年研究。
Stress sonography of the ulnar collateral ligament of the elbow in professional baseball pitchers: a 10-year study.
机构信息
Alfred Atanda Nemours/Alfred I. duPont Hospital for Children, Department of Orthopedics, 1600 Rockland Road, Wilmington, DE 19803, USA.
出版信息
Am J Sports Med. 2014 Mar;42(3):544-51. doi: 10.1177/0363546513516592. Epub 2014 Jan 28.
BACKGROUND
An injury to the ulnar collateral ligament (UCL) of the elbow is potentially career threatening for elite baseball pitchers. Stress ultrasound (US) of the elbow allows for evaluation of both the UCL and the ulnohumeral joint space at rest and with stress.
HYPOTHESIS
Stress US can identify morphological and functional UCL changes and may predict the risk of a UCL injury in elite pitchers.
STUDY DESIGN
Cross-sectional study; Level of evidence, 3.
METHODS
A total of 368 asymptomatic professional baseball pitchers underwent preseason stress US of their dominant and nondominant elbows over a 10-year period (2002-2012). Stress US examinations were performed in 30° of flexion at rest and with 150 N of valgus stress by a single musculoskeletal radiologist. Ligament thickness, ulnohumeral joint space width, and ligament abnormalities (hypoechoic foci and calcifications) were documented.
RESULTS
There were 736 stress US studies. The mean UCL thickness in the dominant elbow (6.15 mm) was significantly greater than that in the nondominant elbow (4.82 mm) (P < .0001). The mean stressed ulnohumeral joint space width in the dominant elbow (4.56 mm) was significantly greater than that in the nondominant elbow (3.72 mm) (P < .02). In the dominant arm, hypoechoic foci and calcifications were both significantly more prevalent (28.0% vs 3.5% and 24.9% vs 1.6%, respectively; P < .001). In the 12 players who incurred a UCL injury, there were nonsignificant (P > .05) increases in baseline ligament thickness, ulnohumeral joint space gapping with stress, and incidence of hypoechoic foci and calcifications. More than 1 stress US examination was performed in 131 players, with a mean increase of 0.78 mm in joint space gapping with subsequent evaluations.
CONCLUSION
Stress US indicates that the UCL in the dominant elbow of elite pitchers is thicker, is more likely to have hypoechoic foci and/or calcifications, and has increased laxity with valgus stress over time.
背景
肘部尺侧副韧带（UCL）的损伤可能对精英棒球投手的职业生涯构成威胁。肘部应变成像超声（US）可在休息和施压时评估 UCL 和尺肱关节间隙。
假设
应变成像超声可识别 UCL 的形态和功能变化，并可能预测精英投手中 UCL 损伤的风险。
研究设计
横断面研究；证据水平，3 级。
方法
在 10 年期间（2002-2012 年），共有 368 名无症状的职业棒球投手接受了他们的优势和非优势肘部的 preseason 应变成像超声检查。由一位肌肉骨骼放射科医生在 30°屈曲时进行休息和 150 N 外翻压力下的应变成像超声检查。记录了韧带厚度、尺肱关节间隙宽度和韧带异常（低回声焦点和钙化）。
结果
共有 736 项应变成像超声研究。优势肘 UCL 厚度（6.15 毫米）明显大于非优势肘（4.82 毫米）（P<0.0001）。优势肘受施压时的尺肱关节间隙宽度（4.56 毫米）明显大于非优势肘（3.72 毫米）（P<0.02）。在优势臂中，低回声焦点和钙化的发生率均明显更高（分别为 28.0%比 3.5%和 24.9%比 1.6%；P<0.001）。在 12 名发生 UCL 损伤的运动员中，基线韧带厚度、受施压时的关节间隙张开和低回声焦点和钙化的发生率均无显著增加（P>0.05）。在 131 名运动员中进行了超过 1 次应变成像超声检查，随后的评估中关节间隙张开的平均增加为 0.78 毫米。
结论
应变成像超声显示，精英投手优势肘的 UCL 较厚，随时间推移更有可能出现低回声焦点和/或钙化，并出现外翻应力松弛。
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