背景:尺侧副韧带(UCL)撕裂在棒球运动员中很常见。当非手术管理失败时,可能需要重建或修复以恢复身体功能。关于基于磁共振成像(MRI)撕裂特征的手术适应症尚无明确共识。或选择修复而不是重建的指征。这项研究的目的是根据MRI定义UCL手术的适应症,并阐明UCL修复与重建的适应症。
方法:对26名治疗棒球运动员的骨科医生进行了调查。审查了45个MRI:15个没有UCL眼泪,15,术中确认部分厚度的眼泪,和15个充满厚度的眼泪。调查的因素包括韧带特征(韧带周围或骨水肿,韧带肥大,钙化,部分或全厚度撕裂)和位置(近端,中间物质,或远端)。为外科医生提供了临床方案,并询问是否1)需要手术以及2)是否建议修复或重建。赔率比(OR)和95%置信区间(95CI)有助于确定两个查询的重要预测因子。
结果:与非手术治疗相比,推荐手术治疗的可能性是近端部分厚度撕裂的2.4倍,3.2x用于远端部分厚度撕裂,5.1x用于远端全厚度撕裂,和7.0x为近端全厚度撕裂(p<0.001)。修复的重要适应症包括远端部分(OR=1.6,95CI1.0,2.1,p<0.001)和全层撕裂(OR=1.7,95CI1.1,2.3,p<0.001)。对于中等物质全厚度撕裂,建议修复的可能性降低了3倍(OR=3.0,95CI-5.0,-1.0,p=0.004)。在78%的部分撕裂中要求进行超声应力测试。
结论:在接受调查的外科医生中,推荐手术治疗的最高可能性是近端全层撕裂,然后远端全厚度,远端部分厚度,和近端部分厚度撕裂。修复最适合于远端部分和全层撕裂,但相对禁忌完全中间物质UCL眼泪。经常要求对部分撕裂进行超声压力测试。鉴于外科医生之间缺乏共识,未来的前瞻性登记是必要的,以确定这些因素是否与临床结局相关.
BACKGROUND: Ulnar collateral ligament (UCL) tears are common in baseball players. When nonoperative management fails; reconstruction or repair may be necessary to restore physical function. There is no clear consensus regarding the indications for surgery based on magnetic resonance imaging (MRI)
tear characteristics or the indications for selecting repair over reconstruction. The purpose of this study was to define the indications for UCL surgery based on MRI and to elucidate indications for UCL repair vs. reconstruction.
METHODS: Twenty-six orthopedic surgeons who treat baseball players were surveyed. Forty-five MRIs were reviewed: 15 without UCL tears, 15 with intraoperatively confirmed partial-thickness tears, and 15 with full-thickness tears. Factors investigated included ligament characteristics (periligamentous or osseous edema, ligament hypertrophy, calcification, partial or full-thickness tearing) and location (proximal, midsubstance, or distal). Surgeons were given a clinical scenario and asked whether 1) surgery was indicated and 2) whether repair or reconstruction was recommended. Odds ratios (OR) and 95% confidence intervals (95% CI) helped identify significant predictors for both queries.
RESULTS: The odds of recommending surgical treatment compared to nonoperative treatment were 2.4× more likely for a proximal partial-thickness
tear, 3.2× for distal partial-thickness
tear, 5.1× for distal full-thickness
tear, and 7.0× for proximal full-thickness
tear (P < .001). Significant indications for repair included distal partial (OR = 1.6, 95% CI 1.0, 2.1, P < .001) and full-thickness tears (OR = 1.7, 95% CI 1.1, 2.3, P < .001). Repair was 3× less likely recommended for midsubstance full-thickness tears (OR = 3.0, 95% CI -5.0, -1.0, P = .004). Ultrasound stress testing was requested in 78% of partial tears.
CONCLUSIONS: Among surgeons surveyed, the highest odds for recommending operative treatment were proximal full-thickness tears, then distal full-thickness, distal partial-thickness, and proximal partial-thickness tears. Repair was most appropriate for partial and full-thickness distal tears, but relatively contraindicated for complete midsubstance UCL tears. Ultrasound stress testing was frequently requested for partial tears. Given the lack of consensus among surgeons, future prospective registries are necessary to determine whether these factors associate with clinical outcomes.