青少年运动员肘关节剥脱性骨软骨炎与尺侧副韧带损伤及对照组的影像学比较。
Radiographic comparison of adolescent athletes with elbow osteochondritis dissecans to ulnar collateral ligament injuries and controls.
作者信息
Lau Brian C, Pandya Nirav K
机构信息
Department of Orthopaedic Surgery, University of California San Francisco Medical Center, San Francisco, CA, USA.
Department of Orthopaedic Surgery, University of California San Francisco Medical Center, Children's Hospital of Oakland, Oakland, CA, USA.
出版信息
J Shoulder Elbow Surg. 2017 Apr;26(4):589-595. doi: 10.1016/j.jse.2016.09.037. Epub 2017 Jan 10.
BACKGROUND
There are excellent data supporting recommendations to prevent elbow injuries (osteochondritis dissecans [OCD] and ulnar collateral ligament [UCL] injuries), such as pitch count and pitch type in baseball, but anatomic risk factors have not been thoroughly examined. This study aimed to evaluate radiographic measurements in adolescents with elbow OCD lesions or UCL injuries and controls.
METHODS
We retrospectively identified adolescent patients between 2011 and 2016 with isolated capitellum OCD, UCL tear, or normal elbows based on magnetic resonance imaging. Nineteen patients (mean age, 13.5 years) had isolated OCD defects of the capitellum, 8 patients (mean age, 16.9 years) had isolated UCL complete tear, and the remaining 16 patients (mean age, 14.6 years) were normal controls. Radiographic measurements from corresponding anterior-posterior elbow radiographs were taken, including carrying angle, distal humeral articular surface angle, and radial neck-shaft angle. On the lateral radiograph, anterior angulation of the articular surface of distal humerus was measured.
RESULTS
Significant differences were observed in carrying angle between controls (15.7°) and OCD patients (11.6°; P = .03) as well as between controls and UCL patients (10.3°, P = .02), with the OCD and UCL patients tending to be in more varus. Significant differences were also found between controls (88.5°) and OCD patients (93.6°; P = .01) and between controls and UCL patients (93.3°; P = .03) in distal humeral articular surface angle, with OCD and UCL patients with increased valgus at the distal humerus articular surface. There were no significant differences between groups in radial neck-shaft angle or anterior angulation of articular surface of distal humerus.
CONCLUSIONS
Patients with OCD and UCL injuries have anatomic differences compared with normal controls that can be measured radiographically.
背景
有大量数据支持预防肘部损伤（剥脱性骨软骨炎[OCD]和尺侧副韧带[UCL]损伤）的建议，如棒球运动中的投球次数和投球类型，但解剖学风险因素尚未得到充分研究。本研究旨在评估患有肘部OCD病变或UCL损伤的青少年以及对照组的影像学测量结果。
方法
我们回顾性地确定了2011年至2016年间基于磁共振成像诊断为孤立性肱骨小头OCD、UCL撕裂或肘部正常的青少年患者。19例患者（平均年龄13.5岁）患有孤立性肱骨小头OCD缺损，8例患者（平均年龄16.9岁）患有孤立性UCL完全撕裂，其余16例患者（平均年龄14.6岁）为正常对照组。从相应的肘部前后位X线片上进行影像学测量，包括提携角、肱骨远端关节面角和桡骨颈干角。在侧位X线片上，测量肱骨远端关节面的前倾角。
结果
对照组（15.7°）与OCD患者（11.6°；P = 0.03）以及对照组与UCL患者（10.3°，P = 0.02）之间的提携角存在显著差异，OCD和UCL患者倾向于内翻角度更大。对照组（88.5°）与OCD患者（93.6°；P = 0.01）以及对照组与UCL患者（93.3°；P = 0.03）之间的肱骨远端关节面角也存在显著差异，OCD和UCL患者在肱骨远端关节面的外翻角度增加。各组之间在桡骨颈干角或肱骨远端关节面前倾角方面无显著差异。
结论
与正常对照组相比，患有OCD和UCL损伤的患者存在可通过影像学测量的解剖学差异。
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