Department of Orthopaedics, National Cheng Kung University Hospital, No. 138 Sheng-Li Road, Tainan City, Taiwan.
Am J Sports Med. 2011 Nov;39(11):2429-35. doi: 10.1177/0363546511417096. Epub 2011 Aug 11.
In patients with lateral epicondylitis recalcitrant to nonsurgical treatments, surgical intervention is considered. Despite the numerous therapies reported, the current trend of treatment places particular emphasis on minimally invasive techniques.
The authors present a newly developed minimally invasive procedure, ultrasonographically guided percutaneous radiofrequency thermal lesioning (RTL), and its clinical efficacy in treating recalcitrant lateral epicondylitis.
Level of evidence, 4.
Thirty-four patients (35 elbows), with a mean age of 52.1 years (range, 35-65 years), suffered from symptomatic lateral epicondylitis for more than 6 months and had exhausted nonoperative therapies. They were treated with ultrasonographically guided RTL. Patients were followed up at least 6 months by physical examination and 12 months by interview. The intensity of pain was recorded with a visual analog scale (VAS) score. The functional outcome was evaluated using grip strength, the upper limb Disability of Arm, Shoulder and Hand (QuickDASH) outcome measure, and the Modified Mayo Clinic Performance Index (MMCPI) for the elbow. The ultrasonographic findings regarding the extensor tendon origin were recorded, as were the complications.
At the time of the 6-month follow-up, the average VAS score in resting (from 4.9 to 0.9), palpation (from 7.6 to 2.5), and grip (from 8.2 to 2.9) had improved significantly compared with the preoperative condition (P < .01). The grip strength (from 20.6 to 27.0 kg) and QuickDASH score (from 54.3 to 21.0) had also improved significantly (P < .01). The MMCPI score improved from "poor" to "excellent." The ultrasonographic finding revealed that the thickness of the common extensor tendon origin did not change significantly. At the final follow-up (mean, 14.3 months; range, 12-21 months), the patients reported a 78% reduction in pain compared with the preoperative status. No major complications were noted in any patient.
Ultrasonographically guided RTL for recalcitrant lateral epicondylitis was found to be a minimally invasive treatment with satisfactory results in this pilot investigation. This innovative method can be considered as an alternative treatment of recalcitrant lateral epicondylitis before further surgical intervention.
对于经非手术治疗无效的外侧肱骨上髁炎患者，可考虑手术干预。尽管有许多治疗方法被报道，但目前的治疗趋势特别强调微创技术。
作者介绍了一种新开发的微创程序，超声引导经皮射频热损伤（RTL）及其治疗难治性外侧肱骨上髁炎的临床疗效。
证据水平，4 级。
34 例（35 个肘部）患者，平均年龄 52.1 岁（范围，35-65 岁），患有症状性外侧肱骨上髁炎超过 6 个月，且已用尽非手术治疗。他们接受了超声引导下的 RTL 治疗。患者通过体格检查和 12 个月的访谈至少随访 6 个月。疼痛强度用视觉模拟量表（VAS）评分记录。使用握力、上肢残疾手臂、肩和手（QuickDASH）测量结果和改良 Mayo 诊所肘部活动度指数（MMCPI）评估功能结果。记录伸肌腱起点的超声表现以及并发症。
在 6 个月的随访时，静息时（从 4.9 降至 0.9）、触诊时（从 7.6 降至 2.5）和握力时（从 8.2 降至 2.9）的平均 VAS 评分与术前相比显著改善（P<.01）。握力（从 20.6 至 27.0kg）和 QuickDASH 评分（从 54.3 至 21.0）也显著改善（P<.01）。MMCPI 评分从“差”改善为“优”。超声检查发现，普通伸肌腱起点的厚度无明显变化。在最终随访（平均 14.3 个月；范围，12-21 个月）时，患者报告疼痛比术前减轻了 78%。没有患者出现重大并发症。
在本初步研究中，超声引导 RTL 治疗难治性外侧肱骨上髁炎被发现是一种微创治疗方法，效果满意。这种创新方法可以被视为难治性外侧肱骨上髁炎进一步手术干预前的替代治疗方法。
