冲击波治疗职业运动员慢性近端腘绳肌腱病。
Shockwave therapy for the treatment of chronic proximal hamstring tendinopathy in professional athletes.
机构信息
Department of Physical Medicine and Rehabilitation, University of Rome "La Sapienza," Italy.
出版信息
Am J Sports Med. 2011 Jan;39(1):146-53. doi: 10.1177/0363546510379324. Epub 2010 Sep 20.
BACKGROUND
Chronic proximal hamstring tendinopathy is an overuse syndrome that is usually managed by nonoperative methods. Shockwave therapy has proved to be effective in many tendinopathies.
HYPOTHESIS
Shockwave therapy may be more effective than other nonoperative treatments for chronic proximal hamstring tendinopathy.
STUDY DESIGN
Randomized controlled clinical study; Level of evidence, 1.
METHODS
Forty professional athletes with chronic proximal hamstring tendinopathy were enrolled between February 1, 2004, and September 30, 2006. Patients were randomly assigned to receive either shockwave therapy, consisting of 2500 impulses per session at a 0.18 mJ/mm² energy flux density without anesthesia, for 4 weeks (SWT group, n = 20), or traditional conservative treatment consisting of nonsteroidal anti-inflammatory drugs, physiotherapy, and an exercise program for hamstring muscles (TCT group, n = 20). Patients were evaluated before treatment, and 1 week and 3, 6, and 12 months after the end of treatment. The visual analog scale (VAS) score for pain and Nirschl phase rating scale (NPRS) were used as primary outcome measures.
RESULTS
The patients were observed for a mean of 10.7 months (range, 1-12 months). Six patients were lost to follow-up because they underwent a surgical intervention: 3 (all in TCT group) were lost at 3 months; 2 (1 in each group), at 6 months; and 1 (in the TCT group), at 12 months. Primary follow-up was at 3 months after the beginning of treatment. The VAS scores in the SWT and TCT groups were 7 points before treatment (P = .84), and 2 points and 5 points, respectively, 3 months after treatment (P < .001). The NPRS scores in the SWT and TCT groups were 5 points in either group before treatment (P = .48), and 2 points and 6 points, respectively, 3 months after treatment (P < .001). At 3 months after treatment, 17 of the 20 patients (85%) in the SWT group and 2 of the 20 patients (10%) in the TCT group achieved a reduction of at least 50% in pain (P < .001). There were no serious complications in the SWT group.
CONCLUSION
Shockwave therapy is a safe and effective treatment for patients with chronic proximal hamstring tendinopathy.
背景
慢性近端腘绳肌腱病是一种过度使用综合征，通常采用非手术方法治疗。冲击波疗法已被证明对许多肌腱病有效。
假设
冲击波疗法可能比其他非手术治疗慢性近端腘绳肌腱病更有效。
研究设计
随机对照临床试验；证据水平，1。
方法
2004 年 2 月 1 日至 2006 年 9 月 30 日期间共纳入 40 名患有慢性近端腘绳肌腱病的职业运动员。患者随机分为冲击波治疗组（SWT 组，n = 20）和传统保守治疗组（TCT 组，n = 20）。SWT 组接受 4 周的 2500 次冲击，每次冲击的能量通量密度为 0.18 mJ/mm²，无麻醉；TCT 组接受非甾体抗炎药、物理治疗和腘绳肌运动方案。治疗前、治疗结束后 1 周及 3、6 和 12 个月对患者进行评估。疼痛的视觉模拟量表（VAS）评分和 Nirschl 分期评定量表（NPRS）为主要观察指标。
结果
患者平均随访 10.7 个月（1~12 个月）。6 名患者因接受手术干预而失访：3 名（均在 TCT 组）于 3 个月时失访；2 名（每组 1 名）于 6 个月时失访；1 名（在 TCT 组）于 12 个月时失访。主要随访时间为治疗开始后 3 个月。SWT 组和 TCT 组治疗前 VAS 评分为 7 分（P =.84），治疗后 3 个月分别为 2 分和 5 分（P <.001）。SWT 组和 TCT 组治疗前 NPRS 评分为 5 分（P =.48），治疗后 3 个月分别为 2 分和 6 分（P <.001）。治疗后 3 个月，SWT 组 20 例患者中有 17 例（85%）和 TCT 组 20 例患者中有 2 例（10%）疼痛减轻至少 50%（P <.001）。SWT 组无严重并发症。
结论
冲击波疗法是治疗慢性近端腘绳肌腱病患者的一种安全有效的方法。
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