Thompson Robert W, Dawkins Corey, Vemuri Chandu, Mulholland Michael W, Hadzinsky Tyler D, Pearl Gregory J
Center for Thoracic Outlet Syndrome and Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO.
The Micheli Center for Sports Injury Prevention and Division of Sports Medicine, Boston Children's Hospital, Waltham, MA.
Ann Vasc Surg. 2017 Feb;39:216-227. doi: 10.1016/j.avsg.2016.05.103. Epub 2016 Aug 12.
High-performance throwing athletes may be susceptible to the development of neurogenic thoracic outlet syndrome (NTOS). This condition can be career-threatening but the outcomes of treatment for NTOS in elite athletes have not been well characterized. The purpose of this study was to utilize objective performance metrics to evaluate the impact of surgical treatment for NTOS in Major League Baseball (MLB) pitchers.
Thirteen established MLB pitchers underwent operations for NTOS between July 2001 and July 2014. For those returning to MLB, traditional and advanced (PitchF/x) MLB performance metrics were acquired from public databases for various time-period scenarios before and after surgery, with comparisons made using paired t-tests, Wilcoxon matched-pair signed-rank tests, and Kruskal-Wallis analysis of variance.
Ten of 13 pitchers (77%) achieved a sustained return to MLB, with a mean age of 30.2 ± 1.4 years at the time of surgery and 10.8 ± 1.5 months of postoperative rehabilitation before the return to MLB. Pre- and postoperative career data revealed no significant differences for 15 traditional pitching metrics, including earned run average (ERA), fielding independent pitching, walks plus hits per inning pitched (WHIP), walks per 9 innings, and strikeouts to walk ratio (SO/BB). There were also no significant differences between the 3 years before and the 3 years after surgical treatment. Using PitchF/x data for 72 advanced metrics and 25 different time-period scenarios, the highest number of significant relationships (n = 18) was observed for the 8 weeks before/12 weeks after scenario. In this analysis, 54 (75%) measures were unchanged (including ERA, WHIP, and SO/BB) and 14 (19%) were significantly improved, while only 4 (6%) were significantly decreased (including hard pitch maximal velocity 93.1 ± 1.0 vs. 92.5 ± 0.9 miles/hr, P = 0.047). Six pitchers remained active in MLB during the study period, while the other 4 had retired due to factors or injuries unrelated to NTOS.
Objective performance metrics demonstrate that pitchers returning to MLB after surgery for NTOS have had capabilities equivalent to or better than before treatment. Thoracic outlet decompression coupled with an ample period of postoperative rehabilitation can provide effective treatment for professional baseball pitchers with career-threatening NTOS.
高性能投掷运动员可能易患神经源性胸廓出口综合征（NTOS）。这种情况可能危及职业生涯，但精英运动员NTOS的治疗结果尚未得到充分描述。本研究的目的是利用客观表现指标来评估美国职业棒球大联盟（MLB）投手NTOS手术治疗的影响。
2001年7月至2014年7月期间，13名已成名的MLB投手接受了NTOS手术。对于那些重返MLB的投手，从公共数据库中获取手术前后不同时间段的传统和先进（PitchF/x）MLB表现指标，使用配对t检验、Wilcoxon配对符号秩检验和Kruskal-Wallis方差分析进行比较。
13名投手中有10名（77%）持续重返MLB，手术时平均年龄为30.2±1.4岁，重返MLB前术后康复时间为10.8±1.5个月。术前和术后的职业生涯数据显示，15项传统投球指标无显著差异，包括自责分率（ERA）、投手独立防御率、每局上垒率（WHIP）、每9局保送率以及三振保送比（SO/BB）。手术治疗前3年和后3年之间也没有显著差异。使用PitchF/x数据对72项先进指标和25种不同时间段情况进行分析，在术前8周/术后12周的情况下观察到的显著关系数量最多（n = 18）。在此分析中，54项（75%）指标未改变（包括ERA、WHIP和SO/BB），14项（19%）显著改善，而只有4项（6%）显著下降（包括硬球最大速度从93.1±1.0英里/小时降至92.5±0.9英里/小时，P = 0.047）。在研究期间，6名投手仍活跃于MLB，另外4名因与NTOS无关的因素或伤病退役。
客观表现指标表明，因NTOS手术治疗后重返MLB的投手其能力等同于或优于治疗前。胸廓出口减压术加上充足的术后康复期可为患有危及职业生涯的NTOS的职业棒球投手提供有效的治疗。
