Wada Takuro, Moriya Tamami, Iba Kosuke, Ozasa Yasuhiro, Sonoda Tomoko, Aoki Mitsuhiro, Yamashita Toshihiko
Department of Orthopaedic Surgery, Sapporo Medical University, South 1, West 16, Sapporo, 060-8543, Japan.
J Orthop Sci. 2009 Mar;14(2):167-74. doi: 10.1007/s00776-008-1304-9. Epub 2009 Apr 1.
The purpose of this study was to evaluate surgical outcomes of arthroscopic débridement for lateral epicondylitis using a validated, patient-assessed scoring system as well as conventional outcome measures. We also wanted to identify potential predictive factors that may be associated with the outcomes.
A total of 20 elbows in 18 patients with chronic lateral epicondylitis who underwent arthroscopic surgery were included. There were nine men and nine women with a mean age of 54 years (range 42-71 years). Operative treatment consisted of débridement of the extensor carpi radialis brevis (ECRB) origin and resection of the radiocapitellar synovial plica interposed in the joint. Outcomes were assessed using a patient rating, visual analogue scale (VAS) pain score, the Japanese Orthopaedic Association (JOA) elbow score, and the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire. The average length of follow-up was 28 months (range 24-40 months).
After surgery, according to the patients' reports, 14 of 20 elbows were much better, and 6 elbows were better. A mean preoperative VAS pain score at rest of 3.9 points improved to 0.3 points (P < 0.0001), and that during activity improved from 7.8 points to 0.9 points (P < 0.0001). The mean preoperative JOA elbow score of 29 points was improved to 90 points (P < 0.0001). The mean postoperative DASH score was 10.6 (range 0-50). Absent of T2-weighted high signal focus of the ECRB origin on preoperative magnetic resonance imaging (MRI) (P = 0.02) and receiving public assistance (P = 0.01) were significantly associated with worse DASH scores.
Arthroscopic release was a satisfactory procedure for chronic lateral epicondylitis. Preoperative MRI of the ECRB origin and socioeconomic factors were significantly associated with postoperative residual symptoms evaluated with the DASH score.
本研究的目的是使用经过验证的患者评估评分系统以及传统的疗效指标，评估关节镜下清创术治疗外侧上髁炎的手术效果。我们还想确定可能与手术效果相关的潜在预测因素。
本研究共纳入18例慢性外侧上髁炎患者的20个肘部，均接受了关节镜手术。其中男性9例，女性9例，平均年龄54岁（范围42 - 71岁）。手术治疗包括桡侧腕短伸肌（ECRB）起点清创术以及切除关节内的桡骨头滑膜皱襞。采用患者自评、视觉模拟量表（VAS）疼痛评分、日本骨科协会（JOA）肘部评分以及上肢、肩部和手部功能障碍（DASH）问卷对手术效果进行评估。平均随访时间为28个月（范围24 - 40个月）。
术后，根据患者报告，20个肘部中有14个明显改善，6个有所改善。术前静息时VAS疼痛评分平均为3.9分，术后改善至0.3分（P < 0.0001）；活动时评分从7.8分改善至0.9分（P < 0.0001）。术前JOA肘部评分平均为29分，术后提高至90分（P < 0.000！）。术后DASH评分平均为10.6（范围0 - 50）。术前磁共振成像（MRI）显示ECRB起点无T2加权高信号灶（P = 0.02）以及接受公共援助（P = 0.01）与术后较差的DASH评分显著相关。
关节镜下松解术治疗慢性外侧上髁炎效果良好。术前ECRB起点的MRI表现以及社会经济因素与术后用DASH评分评估的残留症状显著相关。
