Tai Ryan, Bolinske Tyson, Ghazikhanian Varand, Mandell Jacob C
Department of Radiology, UMass Memorial Medical Center, 55 Lake Ave North, Worcester, MA, 01655, USA.
Department of Radiology, Radiology Associates of Durango, 1010 Three Springs Avenue, Durango, CO, 81301, USA.
Skeletal Radiol. 2018 Jun;47(6):795-803. doi: 10.1007/s00256-017-2864-6. Epub 2018 Jan 10.
To determine the prevalence of intra-articular gas (IAG) on elbow radiography and evaluate variables, including IAG, as predictors of UCL injury.
This IRB-approved retrospective study consisted of 241 consecutive elbow radiographic studies containing AP radiographs with valgus stress of both symptomatic and asymptomatic sides in 234 patients. The IAG, medial joint space (MJS), and MJS difference between the symptomatic and asymptomatic elbow (MJSD) were evaluated by two readers, as well as patient age, gender, sport played, and handedness. Primary outcomes included IAG on valgus stress radiographs and UCL injury, which was determined by intraoperative findings as the reference standard or MRI if surgery was not performed. Univariate analysis with Student's t, Fisher's exact, and chi-square tests were performed.
IAG only manifested with valgus stress and was demonstrated in 30/482 (6.2%) valgus stress radiographs in 27/234 (11.5%) patients. Overall, 21/241 (8.7%) valgus stress radiographs of the symptomatic elbow demonstrated IAG in 21 patients. A total of 128/241 (53.1%) elbow studies had evidence of UCL injury. MJS IAG (p = 0.0147) and increased MJSD (p = 0.0088) were significantly associated with UCL injury. Patient gender, age, handedness, laterality, sport played, and absolute MJS were not associated with UCL injury. MJS IAG with valgus stress demonstrates a sensitivity of 11.7% and specificity of 98.3% in detecting UCL injury for the symptomatic elbow.
MJS IAG infrequently manifests on valgus stress radiographs, but is specific for UCL injury in the symptomatic elbow of overhead throwing athletes. MJS IAG and increased MJSD are significantly associated with UCL injury.
确定肘关节X线片上关节内气体（IAG）的患病率，并评估包括IAG在内的变量作为尺侧副韧带（UCL）损伤的预测指标。
这项经机构审查委员会（IRB）批准的回顾性研究包括对234例患者连续进行的241次肘关节X线检查，其中包括双侧（有症状侧和无症状侧）在外翻应力下的前后位（AP）X线片。由两名阅片者评估IAG、内侧关节间隙（MJS）以及有症状和无症状肘关节之间的MJS差值（MJSD），同时评估患者的年龄、性别、所从事的运动和利手情况。主要结局包括外翻应力X线片上的IAG和UCL损伤，UCL损伤通过术中发现确定为参考标准，若未进行手术则通过磁共振成像（MRI）确定。采用学生t检验、Fisher精确检验和卡方检验进行单因素分析。
IAG仅在外翻应力下出现，在27/234（11.5%）例患者的30/482（6.2%）张外翻应力X线片中显示。总体而言，有症状肘关节的21/241（8.7%）张外翻应力X线片在21例患者中显示有IAG。共有128/241（53.1%）次肘关节检查有UCL损伤的证据。MJS处IAG（p = 0.01A7）和MJSD增大（p = 0.0088）与UCL损伤显著相关。患者的性别、年龄、利手、左右侧、所从事的运动以及MJS绝对值与UCL损伤无关。外翻应力下MJS处IAG在检测有症状肘关节的UCL损伤时，灵敏度为11.7%，特异度为98.3%。
MJS处IAG在外翻应力X线片上不常出现，但在过头投掷运动员有症状的肘关节中对UCL损伤具有特异性。MJS处IAG和MJSD增大与UCL损伤显著相关。
