Diagnostic Centre, Region Hospital Silkeborg, Silkeborg, Denmark.
Am J Sports Med. 2013 Mar;41(3):625-35. doi: 10.1177/0363546512472975. Epub 2013 Jan 17.
Lateral epicondylitis (LE) is a common musculoskeletal disorder for which an effective treatment strategy remains unknown.
To examine whether a single injection of platelet-rich plasma (PRP) is more effective than placebo (saline) or glucocorticoid in reducing pain in adults with LE after 3 months.
Randomized controlled trial; Level of evidence, 1.
A total of 60 patients with chronic LE were randomized (1:1:1) to receive either a blinded injection of PRP, saline, or glucocorticoid. The primary end point was a change in pain using the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire at 3 months. Secondary outcomes were ultrasonographic changes in tendon thickness and color Doppler activity.
Pain reduction at 3 months (primary end point) was observed in all 3 groups, with no statistically significant difference between the groups; mean differences were the following: glucocorticoid versus saline: -3.8 (95% CI, -9.9 to 2.4); PRP versus saline: -2.7 (95% CI, -8.8 to 3.5); and glucocorticoid versus PRP: -1.1 (95% CI, -7.2 to 5.0). At 1 month, however, glucocorticoid reduced pain more effectively than did both saline and PRP; mean differences were the following: glucocorticoid versus saline: -8.1 (95% CI, -14.3 to -1.9); and glucocorticoid versus PRP: -9.3 (95% CI, -15.4 to -3.2). Among the secondary outcomes, at 3 months, glucocorticoid was more effective than PRP and saline in reducing color Doppler activity and tendon thickness. For color Doppler activity, mean differences were the following: glucocorticoid versus PRP: -2.6 (95% CI, -3.1 to -2.2); and glucocorticoid versus saline: -2.0 (95% CI, -2.5 to -1.6). For tendon thickness, mean differences were the following: glucocorticoid versus PRP: -0.5 (95% CI, -0.8 to -0.2); and glucocorticoid versus saline: -0.8 (95% CI, -1.2 to -0.5).
Neither injection of PRP nor glucocorticoid was superior to saline with regard to pain reduction in LE at the primary end point at 3 months. However, injection of glucocorticoid had a short-term pain-reducing effect at 1 month in contrast to the other therapies. Injection of glucocorticoid in LE reduces both color Doppler activity and tendon thickness compared with PRP and saline.
外侧肱骨上髁炎（LE）是一种常见的肌肉骨骼疾病，目前仍缺乏有效的治疗策略。
研究对于 LE 成人患者，相较于安慰剂（生理盐水）或糖皮质激素，富血小板血浆（PRP）单次注射能否在 3 个月时更有效地减轻疼痛。
随机对照试验；证据等级，1 级。
共纳入 60 例慢性 LE 患者，按 1:1:1 比例随机分配至接受 PRP、生理盐水或糖皮质激素盲注治疗。主要终点为 3 个月时采用患者自评网球肘评估（PRTEE）问卷评估的疼痛变化。次要结局为肌腱厚度和彩色多普勒活动的超声变化。
3 组患者在 3 个月时均观察到疼痛减轻（主要终点），组间差异无统计学意义；平均差值如下：糖皮质激素组与生理盐水组：-3.8（95%CI，-9.9 至 2.4）；PRP 组与生理盐水组：-2.7（95%CI，-8.8 至 3.5）；糖皮质激素组与 PRP 组：-1.1（95%CI，-7.2 至 5.0）。然而，1 个月时糖皮质激素治疗比生理盐水和 PRP 更有效地减轻疼痛；平均差值如下：糖皮质激素组与生理盐水组：-8.1（95%CI，-14.3 至 -1.9）；糖皮质激素组与 PRP 组：-9.3（95%CI，-15.4 至 -3.2）。在次要结局中，3 个月时，糖皮质激素在降低彩色多普勒活动和肌腱厚度方面优于 PRP 和生理盐水。彩色多普勒活动方面，平均差值如下：糖皮质激素组与 PRP 组：-2.6（95%CI，-3.1 至 -2.2）；糖皮质激素组与生理盐水组：-2.0（95%CI，-2.5 至 -1.6）。肌腱厚度方面，平均差值如下：糖皮质激素组与 PRP 组：-0.5（95%CI，-0.8 至 -0.2）；糖皮质激素组与生理盐水组：-0.8（95%CI，-1.2 至 -0.5）。
在主要终点（3 个月时），PRP 或糖皮质激素注射均不比 LE 中的生理盐水注射在减轻疼痛方面更具优势。然而，与其他治疗相比，糖皮质激素在 1 个月时有短期的止痛效果。与 PRP 和生理盐水相比，LE 中糖皮质激素注射可降低彩色多普勒活动和肌腱厚度。
