Reconstruction of the ulnar collateral ligament in athletes.
Reconstruction of the ulnar collateral ligament in athletes.
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运动员尺侧副韧带的重建。
DOI：
10.2106/00004623-198769060-00032
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发表时间：
1987
期刊：
影响因子：
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通讯作者：
A. Wittlinger
中科院分区：
文献类型：
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作者：
A. Wittlinger
重建尺侧副韧带使用游离肌腱移植进行了16名运动员。所有参与的运动都涉及投掷（主要是职业棒球），并且都有手肘外翻不稳定。在重建和康复后，16名患者中有10名恢复到以前的运动参与水平，1名恢复到较低的参与水平，5名退出专业运动。尽管采取了预防措施，但与尺神经相关的并发症发生率很高。2例患者术后尺神经病变（1例晚期和1例早期），需要二次手术，但他们最终完全恢复。另外3例报告了沿前臂尺侧的一些一过性术后沿着感觉减退，在几周或几个月后消退。尺侧副韧带的前部是肘部的主要稳定结构59（图1）。当这个结构被拉长或撕裂时，手肘关节变得有时这样的运动员的急性撕裂可以主要缝合，但通常韧带磨损严重，必须重建。其中2例患者在重建前缝合了韧带。在1974年至1982年期间，我们重建了16名投掷运动员的尺侧副韧带，其中大多数是职业棒球投手。本报告描述了我们的修复方法，术后管理和结果。材料与方法所有患者均为男性，手术时年龄在20 ~ 31岁之间。12名患者是职业棒球投手（5名在大联盟，7名在小联盟球队）; 1名（病例16）是大学棒球投手; 1名（病例8）是大联盟棒球队的中锋; 2名（病例2和5）是标枪运动员。8例患者（病例1、2、3、5和13 - 16）的断裂是突然发生的。图1：尺侧副韧带解剖。可见前、后和斜带。图2：在投球过程中手肘受到内侧应力时手臂的位置。不稳定和疼痛，特别是如果它受到强烈的外翻应力，如在运动员谁反复投掷棒球或标枪（所谓的投掷运动员）（图2）。* 没有从与本文主题直接或间接相关的商业方获得或将获得任何形式的利益。没有收到支持这项研究的资金。t南加州大学医学院矫形外科，2025 Zonal Avenue，洛杉矶。加州90033.灾难性的事件，手肘是如此痛苦，以防止进一步投掷了一段时间。然而，几乎所有的患者，在许多个月甚至几年的时间里，都有与投掷相关的手肘内侧疼痛和压痛。其中9名患者接受了类固醇注射，以缓解尺侧副韧带内或周围的疼痛。16名患者中有5名曾在手肘接受过外科手术。一个（案例2），标枪-
Reconstruction of the ulnar collateral ligament using a free tendon graft was performed on sixteen athletes. All participated in sports that involved throwing (mostly professional baseball), and all had valgus instability of the elbow. After reconstruction and rehabilitation, ten of the sixteen patients returned to their previous level of participation in sports, one returned to a lower level of participation, and five retired from professional athletics. Despite precautions, there was a high incidence of complications related to the ulnar nerve. Two patients had postoperative ulnar neuropathy (one late and one early) that required a secondary operation, but they eventually recovered completely. Three others reported some transient postoperative hypoesthesia along the ulnar aspect of the forearm that resolved after a few weeks or months. The anterior portion of the ulnar collateral ligament is a major stabilizing structure at the elbow59 (Fig. 1). When this structure is elongated or torn, the elbow joint becomes Occasionally an acute tear in such an athlete can be sutured primarily, but usually the ligament is so badly frayed that it must be reconstructed. Two of the patients whose cases are to be described had had the ligament sutured prior to reconstruction. Between 1974 and 1982, we reconstructed the ulnar collateral ligament in sixteen throwing athletes, most of whom were professional baseball pitchers. This report describes our method of repair, postoperative management, and results. Materials and Methods All of the patients were men and, at the time of the operation, were between twenty and thirty-one years old. Twelve patients were professional baseball pitchers (five on major-league and seven on minor-league teams); one (Case 16) was a college baseball pitcher; one (Case 8), a centerfielder for a major-league baseball team; and two (Cases 2 and 5) were javelin throwers. In eight patients (Cases 1 , 2, 3, 5, and 13 through 16), the rupture occurred as a sudden Fig. 1 : Anatomy of the ulnar collateral ligament. The anterior, posterior, and oblique bands are seen. Fig. 2: The position of the arm when the elbow is subjected to medial stress during a pitch. unstable and painful, especially if it is subjected to strong valgus stress such as in athletes who repeatedly throw a baseball or a javelin (so-called throwing athletes) (Fig. 2). * No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject ofthis article. No funds were received in support of this study. t Department of Orthopaedic Surgery, University of Southern California School of Medicine, 2025 Zonal Avenue, Los Angeles. California 90033. catastrophic event, after which the elbow was so painful as to preclude further throwing for a period of weeks. Almost all of the patients, however, had had, for many months and often for several years, pain and tenderness about the medial aspect of the elbow that was associated with throwing. Nine of the patients had received injections of steroids for relief of pain in or about the ulnar collateral ligament. Five of the sixteen patients had undergone a previous surgical procedure at the elbow. One (Case 2), a javelin-