Skip to content

Patients › Elbow

尺侧副韧带损伤(汤米·约翰损伤)

The medial elbow ligament injury of throwers — how it presents, when rehab is enough, and what Tommy John reconstruction involves.

一名棒球投手在投球动作的后期蓄力阶段,肘部内侧疼痛明显。
尺侧副韧带(汤米·约翰)损伤:投掷过程中反复的外翻应力导致肘关节内侧韧带发生拉伤。 Kieran Hirpara 4.0

本页面由机器翻译,尚未经临床医生审核。英文版本为权威版本。

您正在感受到的症状

如果您经常进行投掷运动(棒球、标枪,或任何涉及高强度过头顶投掷的运动),您可能会注意到肘部内侧出现酸痛或疼痛。这种疼痛通常在最大发力时刻出现,即手臂向前挥动释放物体之前。许多投掷者将其描述为肘部内侧骨性突起正上方的深层、持续性的酸痛。

另一个常见的迹象是您的投掷表现发生变化。您的投掷速度略有下降,投掷失去惯常的准确性或“爆发力”,或者您根本无法像以前那样用力或长时间投掷。有时疼痛会在一个赛季中逐渐累积;偶尔,单次投掷会导致尖锐的疼痛或“弹响”,随后肘部突然感觉不稳定或无法使用。

有些人还会注意到无名指和小指出现刺痛、麻木或蚁走感。这是因为有一根神经恰好经过肘部内侧后方,该区域的肿胀或不稳可能会刺激该神经。

实际发生了什么

在肘关节内侧,有一条强韧的组织带,称为尺侧副韧带(UCL)。它的作用是防止肘关节在受到向内侧推力时在内侧张开,这种运动称为外翻。投掷动作会对该韧带施加巨大的反复应力。每一次强力投掷都会使其轻微拉伸,经过数千次投掷后,韧带可能逐渐磨损、变细并减弱。较少见的情况是,单次剧烈的投掷动作会导致其撕裂。

当UCL受损时,它无法再牢固地固定肘关节,因此在投掷负荷下关节会变得略微松弛。这种松弛正是导致疼痛、球速和控制力下降,以及有时出现神经症状的原因。这种损伤因“汤米·约翰”(Tommy John)而闻名,该名称源自第一位接受该韧带手术重建并重返投掷的棒球投手。

值得注意的是,这几乎完全是一种投掷运动员的损伤。对于不进行重复性过头投掷动作的人来说,受损的UCL很少会在日常生活中引起问题,因为普通活动不像投球那样对该韧带施加负荷。

我们能做什么

在我们的诊所,Kieran Hirpara 医生会指导您的整个诊疗过程,从最初的转诊到量身定制的治疗方案。我们首先进行全面的评估,以了解您损伤的程度以及您的康复目标。

正确的治疗方案取决于韧带损伤的严重程度,同时也取决于您是否需要重返高水平投掷运动。

对于部分撕裂或低级别撕裂,以及任何不需要进行竞技投掷的人,首选非手术治疗。这意味着需要一段停止投掷的休息期,随后进行精心分阶段的康复计划,以重建前臂、肩部和核心肌群的力量,纠正投掷力学机制,并通过结构化的“投掷计划”逐步恢复投掷。有时会提供富含血小板血浆(PRP)等物质的注射以促进愈合,但关于其有效性的证据目前仍不确定。

当韧带完全撕裂,或者良好的康复未能使一名坚定的投掷手重返投手丘时,会考虑手术。主要有两种手术方式:

  • UCL 重建术(“汤米·约翰手术”)。 使用肌腱移植物重建受损的韧带,通常取自患者自身的前臂或腿部,通过钻出的小骨隧道穿过,以重建一条新的、强壮的韧带。这是投掷手长期确立且经过验证的手术方式。
  • UCL 修复术配合内部支架。 对于选定的年轻运动员,如果其韧带在一端从骨头上干净利落地撕脱(而不是整体磨损),外科医生可以将韧带缝合回去,并用强力的带状物进行加固。这通常能允许更快地恢复投掷,且仅适用于特定类型的撕裂。

在这两种手术中,外科医生还会检查肘部内侧的神经,如果该神经受到刺激,则会对其进行保护或移位。

预期情况

对于大多数接受手术投掷者而言,预后确实良好:绝大多数人能够恢复到术前的投掷水平,但这需要耐心。重建手术(Tommy John 手术)通常意味着在恢复竞技性投掷之前,需要经历大约一年或更长时间的阶段性康复过程;而在合适的患者中,采用内部支架的修复手术可能恢复得更快。无论哪种方式,重返赛场都依赖于长期、结构化的康复计划,而非仅靠手术本身;急于复出是导致挫折的主要原因。

康复并非普遍保证:少数运动员无法恢复到相同水平,且神经症状或移植物有时需要持续的关注。但只要有明确的诊断、正确的治疗选择以及坚定的康复投入,该损伤的治疗效果是运动外科中最具回报的之一。

何时就医

  • 投掷时肘内侧疼痛,尤其是如果疼痛反复出现或在一个赛季中逐渐加重。
  • 投掷速度、准确性或耐力下降,且无法通过休息缓解。
  • 投掷过程中肘内侧突然感到“啪”的一声或剧烈疼痛,随后手臂感觉无力或不稳。
  • 无名指和小指出现麻木、刺痛或无力。
  • 年轻或处于生长发育期的投掷者出现肘内侧疼痛:儿童的生长板可能因相同的投掷应力而受伤,需要尽快评估。

深入探讨

Advanced reading: the deeper science (optional)

本节内容超出了您自身治疗决策所需的范围。尺侧副韧带损伤值得额外阅读,因为广为人知的“汤米·约翰手术”已不再是唯一的实际选择,而较新的替代方案以另一种“货币”进行权衡:不是疗效,而是时间。

重建术是标准术式,且其疗效确切

重建术以肌腱移植物替代撕裂的韧带,通常采用取自患者自身前臂的掌长肌腱。在6,671例患者中,大多数外科医生采用改良Jobe技术,以“8”字形构型植入掌长肌自体移植物,且使用同种异体移植物时的翻修率似乎高于使用自体移植物,尽管作者指出这可能反映了同种异体移植物文献数量较少,而非真实的差异 [1]。

在1,104例患者的中期随访中,重建术取得了良好的患者报告结局和临床疗效,并发症和翻修率较低,棒球运动员报告了高比例的恢复至伤前水平参赛率以及职业生涯 longevity [2]。恢复参赛率介于80%至90%之间,大多数运动员在12至18个月后重返完全竞技状态 [3]。

替代方案更快,而这正是全部论点所在

当韧带从一端撕脱且组织本身质量良好时,可以进行修复而非重建,且越来越多地采用内部支架来增强修复效果。

区别在于时间线。增强修复术平均在6个月即可恢复运动,在适当筛选的候选人中,重返赛场的比例很高;而重建术则需要12至18个月 [4]。2025年的一项综述发现修复术的受欢迎程度正在上升,并报告其安全有效,并发症率低,重返运动率高 [5]。

对于具有明确竞争窗口的高中生或大学生运动员来说,将停赛时间减半并非次要考量,它可能是失去一个赛季与改变职业生涯之间的区别。但“适当筛选”这句话中承载着真正的分量:修复术依赖于具有健康剩余韧带的撕脱模式,这属于少数损伤类型,且由影像学检查及手术中所见决定,而非由偏好决定。

并非所有撕裂都需要手术

治疗方案取决于撕裂的类型。低级别部分撕裂采用非手术治疗,而重建手术作为完全撕裂的标准治疗[3]。韧带几乎完全承受过头投掷时产生的外翻应力,因此部分撕裂可以无限期地与日常普通活动相容,只有在恢复投掷时才会显现症状。

翻修手术无法重现初次手术的效果

如果重建手术失败,对第二次手术的预期应相应降低。翻修重建是一种罕见的手术,其预后不如初次重建手术乐观,且诊断、技术及康复要求均更为严格 [6]。

这种不对称性是确保初次手术及其康复过程正确的最强论据,包括完成一个对于已置换韧带的患者而言显得过长的康复计划。移植物必须重塑为韧带,而这一过程遵循生物学时间,而非取决于肘部的感觉。

参考文献

[1] Hones KM, Simcox T, Hao KA, Portnoff B, Buchanan TR, Kamarajugadda S, 等. 过去20年肘关节尺侧副韧带重建中移植物选择及所采用的技术:系统综述. J Shoulder Elbow Surg. 2024;33(5):1185-99. https://doi.org/10.1016/j.jse.2023.10.023

[2] Davey MS, Hurley ET, Gaafar M, Galbraith JG, Mullett H, Pauzenberger L. 平均随访至少48个月的肘关节尺侧副韧带重建显示出高比例的恢复运动水平且并发症发生率低. J ISAKOS. 2021;6(5):290-4. https://doi.org/10.1136/jisakos-2021-000614

[3] Carr JB, Camp CL, Dines JS. 肘关节尺侧副韧带损伤:适应证、管理及预后. Arthroscopy. 2020;36(5):1221-2. https://doi.org/10.1016/j.arthro.2020.02.022

[4] Spears TM, Luchinni P, Camp CL, Bowman EN. 肘关节内侧尺侧副韧带损伤外科治疗的当前概念. J Am Acad Orthop Surg. 2024;33(13):703-10. https://doi.org/10.5435/JAAOS-D-24-00839

[5] Puga TB, Box MW, Pautler B, Perleberg T, Poffenbarger M, Riehl JT. 肘关节尺侧副韧带修复:趋势与预后的系统综述. JSES Rev Rep Tech. 2025;5(4):960-7. https://doi.org/10.1016/j.xrrt.2025.05.020

[6] Bruce JR, ElAttrache NS, Andrews JR. 尺侧副韧带翻修重建. J Am Acad Orthop Surg. 2018;26(11):377-85. https://doi.org/10.5435/JAAOS-D-16-00341


Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International


Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees


Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.


Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.