年轻职业棒球投手肘部应力超声检查发现的尺侧副韧带早期解剖学改变
Early Anatomic Changes of the Ulnar Collateral Ligament Identified by Stress Ultrasound of the Elbow in Young Professional Baseball Pitchers.
作者信息
Atanda Alfred, Buckley Patrick S, Hammoud Sommer, Cohen Steven B, Nazarian Levon N, Ciccotti Michael G
机构信息
Department of Orthopedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
Rothman Institute, Philadelphia, Pennsylvania, USA Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
出版信息
Am J Sports Med. 2015 Dec;43(12):2943-9. doi: 10.1177/0363546515605042. Epub 2015 Sep 24.
BACKGROUND
Stress ultrasound (SUS) of the elbow has demonstrated changes in the anterior band of the ulnar collateral ligament (UCL) in professional baseball pitchers. However, there have been no reports documenting the chronological appearance of these changes.
PURPOSE
To characterize the chronology of anatomic changes of the UCL in a cohort of young professional baseball pitchers.
STUDY DESIGN
Cross-sectional study; Level of evidence, 3.
METHODS
SUS of the elbow was performed on the dominant arm in 127 asymptomatic professional pitchers aged 17 to 21 years. UCL thickness was measured at rest. The width of the ulnohumeral joint was measured at 30° of elbow flexion, both at rest and with 150 N of valgus stress, using a standardized instrumented device. Any ligament heterogeneity and calcifications were documented. Players were divided into 3 groups based on the number of years of professional experience before the ultrasound examination: 0 years (n = 51), 1-2 years (n = 54), and 3-4 years (n = 22). Additionally, players were divided into 5 groups based on chronological age at the time of the first SUS examination: 17 years (n = 5), 18 years (n = 18), 19 years (n = 33), 20 years (n = 20), and 21 years (n = 51). Statistically significant differences between the groups were determined.
RESULTS
The mean UCL thickness was 5.85 ± 1.22 mm, 6.23 ± 1.32 mm, and 6.94 ± 2.12 mm in the players with 0, 1-2, and 3-4 years of professional experience, respectively. This difference was statistically significant overall (P = .024) as well as statistically significant between each consecutive group. There was no statistically significant difference in joint space width at rest or with applied stress between groups (P = .944). Additionally, there was no statistically significant difference in the presence of calcifications (27.5%, 27.8%, and 40.9%, respectively; P = .144) or heterogeneity (29.4%, 16.7%, and 40.9%, respectively; P = .502) as years of professional experience increased from 0 to 3-4 years. There were no significant differences in UCL thickness (P = .363), joint space width with stress (P = .648), or echotextural abnormalities based on chronological age (P = .871 [hypoechoic foci] and P = .520 [calcifications]).
CONCLUSION
These findings suggest that an increase in UCL thickness may be one of the first changes to develop in young professional baseball pitchers.
背景
肘部应力超声（SUS）已显示职业棒球投手尺侧副韧带（UCL）前束的变化。然而，尚无报告记录这些变化的时间顺序表现。
目的
描述一组年轻职业棒球投手UCL解剖学变化的时间顺序。
研究设计
横断面研究；证据等级，3级。
方法
对127名年龄在17至21岁的无症状职业投手的优势手臂进行肘部SUS检查。在静息状态下测量UCL厚度。使用标准化仪器设备，在静息时以及施加150 N外翻应力时，于肘部屈曲30°测量尺肱关节宽度。记录任何韧带异质性和钙化情况。根据超声检查前的职业经验年限，将球员分为3组：0年（n = 51）、1 - 2年（n = 54）和3 - 4年（n = 22）。此外，根据首次SUS检查时的实际年龄，将球员分为5组：17岁（n = 5）、18岁（n = 18）、19岁（n = 33）、20岁（n = 20）和21岁（n = 51）。确定各组之间的统计学显著差异。
结果
职业经验为0年、1 - 2年和3 - 4年的球员，其UCL平均厚度分别为5.85±1.22 mm、6.23±1.32 mm和6.94±2.12 mm。总体差异具有统计学意义（P = 0.024），且每组之间的差异也具有统计学意义。各组在静息或施加应力时的关节间隙宽度无统计学显著差异（P = 0.944）。此外，随着职业经验从0年增加到3 - 4年，钙化的存在情况（分别为27.5%、27.8%和40.9%；P = 0.144）或异质性（分别为29.4%、16.7%和40.9%；P = 0.502）均无统计学显著差异。根据实际年龄，UCL厚度（P = 0.363）、施加应力时的关节间隙宽度（P = 0.648）或回声纹理异常情况（低回声灶，P = 0.871；钙化，P = 0.520）均无显著差异。
结论
这些发现表明，UCL厚度增加可能是年轻职业棒球投手最早出现的变化之一。
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