事件记录
面试官: 是的. So, 如果你在投球时肘部疼痛, 你可以做一些事情，实际上你应该做一些事情. 有一种新的手术可能是你需要的.
Dr. 彼得·查尔默斯是一名整形外科医生. 他是肘部专家. He's also the current team physician for University of Utah baseball and Salt Lake City Bees Triple-A baseball. 所以如果有人在投球时肘部疼痛, 你从哪里开始诊断呢, Dr. 查尔默斯?
Dr. 查尔莫斯: 是的. 绝对. So elbow pain during pitching, it's not normal to have really, really a sore elbow with pitching. 可能有几个不同的原因, 其中一些可能会对投手的未来造成问题. So, 肯定, 我觉得值得, 休息一段时间后, 如果疼痛没有消失, 看到一个能被充分评估的人, 你知道, 让人检查一下肘部, and then potentially getting an MRI to take a look at the cartilage and the ligaments within the elbow.
面试官: 好吧. And if the condition happens to be something called an ulnar collateral ligament injury, 还有一种已经使用了很长时间的手术叫做汤米·约翰手术. 跟我说说这个吧, 然后大发娱乐会讨论另一种选择, 哪一种对某些患者更好.
Dr. 查尔莫斯: 是的. 绝对. So, 很长一段时间, 如果你的尺侧副韧带撕裂了, the ligament on the inside of the elbow that basically holds the upper arm and the lower bones together when you pitch a baseball, 如果你没有韧带, 那些骨头试图分解, 而且基本上是不可能投球的. 从历史上看，如果你撕裂了韧带，那么你的职业生涯就结束了.
有一个叫汤米·约翰的投手, 谁受伤了？, 他去找一位外科医生，医生说, “嗯, 大发娱乐一定能做点什么," and they invented this procedure to reconstruct or rebuild the ligament using a tendon graft. 这实际上很有效，但恢复时间很长. It takes about a year to get back to play because the new tendon has to become a ligament over the top of the old ligament. 这个过程非常缓慢.
这就是大发娱乐治疗尺侧副韧带损伤的历史方法, 以及第一个接受这种治疗的投手, 他叫汤米·约翰. 所以它们通常被称为汤米约翰韧带或汤米约翰手术.
面试官: 现在有一个新的程序. 我听说这被称为重建, and now there's a new procedure that actually just repairs the ligament and has some better outcomes. 跟我说说这个吧.
Dr. 查尔莫斯: The good thing about many of these ligament tears is often the ligament is torn right off of either the upper arm bone or lower arm bone side. 韧带本身仍然是很好的组织. 所以，从历史上看，大发娱乐会用新的肌腱移植来替换整个韧带.
The new procedure is to repair the patient's own ligament and allow their own ligament to serve as their ligament going forward. 这样可以更快的恢复，并且可以让投手在六个月内恢复比赛. 所以这是大发娱乐治疗这种损伤的巨大进步, 对大发娱乐的很多球员来说, granted them ability to get back to another season or even sometimes to get two seasons in depending on the timing.
面试官: So, 当你和投手一起工作时, 你怎么决定你要用这两个中的哪一个?
Dr. 查尔莫斯: 大发娱乐面有很多因素. 当然, 韧带在MRI上的外观和撕裂的位置起作用, 但在手术过程中, 大发娱乐还会评估组织的质量. And if the tissue is robust enough, then we can use the patient's own tissue to do the repair.
面试官: 如果这是一种选择，那么它和汤米·约翰手术一样好吗? 你肯定说过，你可以更快地回到赛场. 它是一种坚固的修复吗?
Dr. 查尔莫斯: 这样可能会更好.
面试官: Oh.
Dr. 查尔莫斯: Some of our early data suggests that the rates of return to play may be higher after repair than they are after reconstruction.
面试官: And I understand another advantage of the ligament repair is if you have a younger athlete, 这将是一个选择汤米约翰手术将不会是一个选择. 跟我说说.
Dr. 查尔莫斯: 是的. 毫无疑问，年轻运动员的康复能力最强. 所以, 在年轻运动员身上, 这个手术很有效, 很好, 到目前为止，这个实验主要是在他们身上进行的. 但在一个非常年轻的人身上, 如果它们有开放的生长板, 你可能会担心做韧带移植手术, where we may have to drill tunnels in the bone that may disrupt the growth in the future. 所以这对病人来说是个不错的选择.
面试官: 那么经济复苏是什么样子的呢? 你说恢复得更快. 汤米·约翰的手术可能要花一年时间. 康复的速度有多快，康复的过程是怎样的?
Dr. 查尔莫斯: 所以早在手术后两周，病人就开始活动他们的肘部. 手术后大约一个月，他们开始加强. And the whole goal here is that you have to start strengthening early because as early as three months out from surgery, 投手们又要开始投球了.
面试官: 哇.
Dr. 查尔莫斯: And the goal then is to get back to full play with full velocity, pitching full games by six months.
面试官: 听起来很神奇. 从你作为整形外科医生的角度来看，这很神奇吗?
Dr. 查尔莫斯: 这是一个巨大的进步. 这是一年来的巨大变化, 有时18个月的恢复期大发娱乐以前看到过重建手术.
面试官: 这种类型的修复有缺点吗?
Dr. 查尔莫斯: 好吧, it's a relatively new option, and so we don't have 5 or 10-year outcomes with it so far. 但到目前为止，与重建相比，它似乎没有什么缺点. 有人担心如果你做这个手术, 这可能会使以后的手术更加困难. 到目前为止, 这些说法似乎并不属实, 但很少有人这样做，因为它的效果非常好.
面试官: 听起来这仍然是一个非常专业的程序. What advice would you have for somebody choosing an orthopedic surgeon to do this type of procedure?
Dr. 查尔莫斯: 好吧, I think that one of the most important things patients need to understand is that surgery itself is a technical skill, and it's important to find a surgeon that you feel like performs enough of those procedures to feel competent at it. So, 结果是, 我想当你寻找一个不太常见的手术时, 你需要找一个感觉舒服的外科医生，做足够多的手术, that they'll have already worked through the kinks and make sure that they're not going to have any problems performing this procedure for you.
这是来到犹他大学这样的地方的好处之一, 哪里有很多领域的专家. 它让大发娱乐每个医生都能找到更小的利基，然后, 结果是, 让大发娱乐做得更好.
面试官: 我想谈谈这个过程. So what is, in your mind, the youngest patient that you would do this type of a procedure on?
Dr. 查尔莫斯: One of the things that is unique about this area of the elbow is that right above the ligament is a growth plate. So for people who are skeletally immature, it's very rare to have the ligament be injured. 而且绝大多数都是骨骼不成熟的, 生长板本身看到了大部分的损伤, 如果受伤了. As a result, we very rarely perform this procedure for anyone under the age of 14 really.
面试官: Is there anything else about this procedure that you feel that a patient or a patient's parents would be interested in hearing that I missed?
Dr. 查尔莫斯: One of the things that I think is really interesting about this procedure and really important for people to understand is that we've talked historically about the reconstruction and the tissue within the reconstruction as though we can make you a new ligament. But I will tell you that the tissue that we bring in from somewhere else is not the same as what you were born with. 它没有相同的神经纤维. 它没有相同的压力纤维.
And we demonstrated that actually pretty elegantly recently in a study we did with the Angels, where we looked at the changes in reconstructed ligaments as compared to non-reconstructed ligaments over the course of a single season or off-season on ultrasound, and found actually that the ligaments that had undergone a prior reconstruction respond differently to stress than native ligaments. And I think that's probably because they don't have all of their normal sensors within them.
所以这个手术最大的好处之一就是它保留了所有这些. It preserves all the normal pressure sensors and nerve fibers within your own ligament and allows it to respond normally to stress in the future. 这是这个手术相对于重建手术的真正好处, and one reason why I think we're probably going to head more and more in this direction in probably a lot of areas of our field in the future.