174例运动员尺骨近端骨不连和应力性骨折手术和非手术治疗后的恢复率相似

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2025-02-01 DOI:10.1016/j.asmr.2024.101019

Jacob S. Borgida B.S. , Rik J. Molenaars M.D. , Huub H. de Klerk B.S. , Bert Berenschot M.S. , Job N. Doornberg M.D., Ph.D. , Denise Eygendaal M.D., Ph.D. , Thuan V. Ly M.D. , Michel P.J. van den Bekerom M.D., Ph.D.

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引用次数: 0

摘要

目的分析运动员持续尺近端应力性损伤的临床和人口统计学表现、治疗策略和结局，并阐明现有的治疗证据和解剖变异。方法在医学数据库MEDLINE/PubMed和Embase上进行文献检索。报道运动相关的物理损伤和尺骨近端应力性骨折的文章符合纳入条件。结果变量包括临床表现、影像学评估、管理和并发症。结果共纳入40项研究，174名运动员发生了骨性损伤或尺骨近端应力性骨折。74例骨性损伤和100例应力性骨折患者的年龄分别为11 ~ 26岁和14 ~ 30岁。在报道临床症状的研究中，运动员最常见的表现是鹰嘴触痛和肿胀。所有有物理损伤的运动员都接受了x线平片诊断，而有47名运动员接受了鹰嘴应力性骨折的x线平片检查，需要额外的高级影像学检查。非手术治疗的研究报告显示，恢复率为67%至100%（中位数为100%[四分位数范围为100-100%]），报告了2例并发症（滑车切迹软骨软化症和偶有症状）。126例患者接受手术治疗，40项研究中有15项报告保守治疗失败，其中包括61名运动员。比赛恢复率从67%到100%（中位数为100%[四分位数范围100-100%]），报告了20例并发症，最常见的是硬件刺激（n = 15）。结论运动员尺骨近端应力性损伤非手术治疗和手术治疗均可获得满意的康复效果。尽管手术治疗更为常见，但这些运动员中几乎有一半在非手术治疗的初始试验中失败。证据水平：IV级，III-IV级研究的系统评价。

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Similar Rates of Return to Play After Operative and Nonoperative Management of Physeal Nonunions and Stress Fractures of the Proximal Ulna in Athletes: A Systematic Review of 174 Patients

Purpose

To analyze the clinical and demographic presentation, treatment strategies, and outcomes of athletes who sustained proximal ulna stress injuries and elucidate the available evidence on management and anatomic variation.

Methods

A literature search was performed on the basis of the medical databases MEDLINE/PubMed and Embase. Articles reporting on sports-related physeal injuries and stress fractures of the proximal ulna were eligible for inclusion. Outcome variables included clinical presentation, imaging assessments, management, and complications.

Results

A total of 40 studies were included with 174 athletes who sustained physeal injuries or stress fractures of the proximal ulna. The age ranges of the 74 patients with physeal injuries and 100 patients with stress fractures were 11-26 years and 14-30 years, respectively. Of the studies reporting on clinical symptoms, athletes most commonly presented with olecranon tenderness to palpation and swelling. All athletes with physeal injuries were diagnosed with plain radiographs, whereas 47 athletes who underwent radiography for olecranon stress fractures required additional advanced imaging. Studies on nonoperative management reported return to play rates from 67% to 100% (median, 100% [interquartile range, 100-100%]) and 2 complications were reported (chondromalacia of the trochlear notch and occasional symptomology). One hundred twenty-six patients were treated operatively, of which failure of conservative management was reported in 15 of 40 studies, including 61 athletes. The return to play rates ranged from 67% to 100% (median, 100% [interquartile range, 100-100%]) and 20 complications were reported, most commonly hardware irritation (n = 15).

Conclusions

Proximal ulna stress injuries in athletes can be managed either nonoperatively or operatively, with both showing satisfactory rates of return to play. Although operative management was more common, almost one half of these athletes failed an initial trial of nonoperative management.