Keller Robert A, Mehran Nima, Marshall Nathan E, Okoroha Kelechi R, Khalil Lafi, Tibone James E, Moutzouros Vasilios
Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI, USA.
Kerlan Jobe Orthopaedic Clinic, Los Angeles, CA, USA.
J Shoulder Elbow Surg. 2017 Feb;26(2):288-294. doi: 10.1016/j.jse.2016.11.008.
Literature has attempted to correlate pitching workload with risk of ulnar collateral ligament (UCL) injury; however, limited data are available in evaluating workload and its relationship with the need for revision reconstruction in Major League Baseball (MLB) pitchers.
We identified 29 MLB pitchers who underwent primary UCL reconstruction surgery and subsequently required revision reconstruction and compared them with 121 MLB pitchers who underwent primary reconstruction but did not later require revision surgery. Games pitched, pitch counts, and innings pitched were evaluated and compared for the seasons after returning from primary reconstruction and for the last season pitched before undergoing revision surgery.
The difference in workload between pitchers who did and did not require revision reconstruction was not statistically significant in games pitched, innings pitched, and MLB-only pitch counts. The one significant difference in workload was in total pitch counts (combined MLB and minor league), with the pitchers who required revision surgery pitching less than those who did not (primary: 1413.6 pitches vs. revision: 959.0 pitches, P = .04). In addition, pitchers who required revision surgery underwent primary reconstruction at an early age (22.9 years vs. 27.3 years, P < .001) and had less MLB experience (1.5 years vs. 5.0 years, P < .001).
There is no specific number of pitches, innings, or games that place a pitcher at an increase risk for injury after primary UCL reconstruction. However, correlations of risk may be younger age and less MLB experience at the time of the primary reconstruction.
已有文献试图将投球工作量与尺侧副韧带（UCL）损伤风险相关联；然而，在评估美国职业棒球大联盟（MLB）投手的工作量及其与翻修重建需求的关系方面，可用数据有限。
我们确定了29名接受初次UCL重建手术并随后需要翻修重建的MLB投手，并将他们与121名接受初次重建但后来不需要翻修手术的MLB投手进行比较。对初次重建恢复后的赛季以及翻修手术前的最后一个投球赛季的投球场次、投球数和投球局数进行了评估和比较。
在投球场次、投球局数和仅MLB的投球数方面，需要和不需要翻修重建的投手之间的工作量差异无统计学意义。工作量的一个显著差异在于总投球数（MLB和小联盟合计），需要翻修手术的投手投球数少于不需要翻修手术的投手（初次：1413.6次投球 vs. 翻修：959.0次投球，P = 0.04）。此外，需要翻修手术的投手初次重建时年龄较小（22.9岁 vs. 27.3岁，P < .001）且MLB经验较少（1.5年 vs. 5.0年，P < .001）。
初次UCL重建后，没有特定的投球数、局数或场次会使投手受伤风险增加。然而，风险的相关性可能在于初次重建时年龄较小和MLB经验较少。
