年輕病患的「Tommy John」手術迅速增加已經引起關注


  July 14, 2008(佛羅里達奧蘭多) — 根據發表於美國骨科學會運動醫學2008年會的研究報告,那些接受Tommy John手肘重建手術的運動員中,83%可以回復到原來的運動水準、甚至更好的運動水準。
  
  雖然這讓運動員感到安慰,但研究作者發現,越來越多更年輕的運動員需要手術,這是一個警訊。
  
  共同作者、美國運動醫學研究中心研究主任、Andrews運動醫學與骨科中心的E. Lyle Cain醫師在發表時表示,在1997年前,Tommy John手術的97位病患中僅有12例 (12%)是在18歲以下。
  
  在2005年,188件手術中有62件是高中運動員,佔所有此類手術的三分之一;Cain醫師表示,也許這個手術是成功的好手術,但是更年輕的小孩需要接受此一手術的趨勢著實令人擔心;此一現象應該喚醒父母親和教練,特別是棒球,小孩若沒有適當的休息將會非常危險。
  
  Tommy John手術是一種將損壞的尺側側韌帶(UCL)以身體其他部位的健康肌腱置換,這個手術是以名人堂投手Tommy John命名,在1974年,他是首位接受此一手術的病患;John在手術之後回到大聯盟,且繼續獲得164勝,在這個劃時代的手術之前,UCL損傷等於職業生涯結束。
  
  在這項研究中,743個接受Tommy John手術的病患進行追蹤評估,並完成有關恢復狀況的問卷,大部分病患是棒球選手(94.5%),其他的5.5%包括徑賽、橄欖球和其他運動。
  
  研究發現,622個病患(84%)回到之前的運動等級、甚至更高等級;對於大聯盟選手,75.5%回到同樣的運動層級。對於小聯盟選手,56%回到之前的運動等級、甚至更高等級。根據研究結果,從手術到完全恢復的平均時間為11.6個月,共有10% 的病患發生併發症,但是大多輕微。
  
  Cain醫師表示,造成UCL重建手術增加的因素有很多,包括診斷技術改善、警覺提高、也或許是目前手術技術的正面結果,但主要是因為年輕投擲手臂的過度運用。
  
  他表示,在過去10年間,整年球季的的棒球聯盟越來越多,所以,最好的年輕投手投球數量也越來越多,也學習更難的球路;手術成功是很好,但預防傷害應該才是根本目標,應鼓勵這些年輕選手讓他們的手臂獲得充分休息以及善加保護,如此才可以避免他們在年輕就有長期的問題。
  
  Cain醫師向Medscape Orthopaedics表示,年輕運動員和成年人不同,軟骨生長板的損傷會造成這些年輕人在未來出現關節健康的影響。
  
  紐約大學醫學中心骨科副主任Joseph Bosco醫師表示,他不認為UCL的損傷件數有實際增加。
  
  他指出,他不認為有過多的診斷,這些運動員有觀念認為,如果他們進行這個手術,恢復後會更強壯。
  
  研究者宣稱沒有相關資金上的往來。
  
  美國骨科學會運動醫學(AOSSM)2008年會。發表於2008年7月12日。

Dramatic Increase in "Tommy John" Surgery in Young Patients Cause for Concern

By Stephanie Doyle
Medscape Medical News

July 14, 2008 (Orlando, Florida) — Of all athletes who had "Tommy John" elbow reconstruction surgery, 83% were able to return to the same or a better level of play, according to a study presented here at the American Orthopaedic Society for Sports Medicine 2008 Annual Meeting.

Although reassuring to athletes, the study authors find the trend of more and more young athletes requiring the surgery alarming.

"Before 1997, Tommy John surgery was performed on only 12 of 97 patients (12%) who were 18 years or younger," coauthor E. Lyle Cain, MD, fellowship director for the American Sports Medicine Institute, Andrews Sports Medicine and Orthopaedic Center, in Birmingham, Alabama, said during his presentation.

"In 2005 alone, 62 of the 188 operations performed were on high-school athletes, a third of the surgical group,'' Cain said. "The reality is that this surgery is successful and that's good. But a disturbing trend of younger kids needing the surgery is troubling. This should be a wake-up call to parents and coaches that specialization in baseball where kids don't get adequate time off is very dangerous."

Tommy John surgery is a procedure where the damaged ulnar collateral ligament (UCL) is replaced with a tendon from elsewhere in the body. The surgery is named for Hall of Fame pitcher Tommy John, who, in 1974, was the first person to have the surgery. John returned to the major leagues and went on to win 164 games after the surgery. Before this historic surgery, a UCL injury was career ending.

In this study, 743 patients who had the Tommy John surgery were contacted for follow-up evaluations and completed a questionnaire about their recovery. The majority of the patients were baseball players (94.5%), the remaining 5.5% were involved in track, football, or other sports.

The study found that 622 patients (84%) returned to the previous or a higher level of competition. For major league players, 75.5% returned to the same level of play. For minor league players, 56% returned to the same level or higher. The average time from surgery to full competition was 11.6 months, according to study results. A total of 10% of the patients had complications, but most of them were minor.

The increase in the number of UCL reconstructions being done can be attributed to many factors, including improved diagnostic techniques, heightened awareness, and the probability of a positive outcome with current surgical techniques, but it is primarily due to the overuse of young throwing arms, Cain said.

"In the past 10 years, year-round baseball leagues have proliferated," he said, "so the best young pitchers are throwing many more pitches and learning to throw more difficult pitches. It's great that the surgery is successful, but prevention of the injury should be the goal. Kids should be urged to rest and be careful about saving their arms, [so that they can avoid] long-term problems at a young age."

Youth athletes are not the same as small adults, Cain told Medscape Orthopaedics. "Injuries that occur to the cartilage growth plates can cause damage in these young people that can affect the future health of their joints,'' he said.

Joseph Bosco, MD, vice chair of orthopaedics at New York University Medical Center, in New York, said he does not think the number of UCL injuries is actually on the rise.

"I do think we're diagnosing more," he said. "And these athletes have a perception that if they have this surgery they will come back stronger."

The researchers have disclosed no relevant financial relationships.

American Orthopaedic Society for Sports Medicine (AOSSM) 2008 Annual Meeting. Presented July 12, 2008.

    
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