Pierce Todd P, Issa Kimona, Gilbert Benjamin T, Hanly Brian, Festa Anthony, McInerney Vincent K, Scillia Anthony J
Department of Orthopaedics, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, U.S.A.
Department of Orthopaedics, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, U.S.A..
Arthroscopy. 2017 Jun;33(6):1260-1268.e2. doi: 10.1016/j.arthro.2017.01.042. Epub 2017 Apr 12.
To compare complications, function, pain, and patient satisfaction after conventional open, percutaneous, or arthroscopic release of the extensor origin for the treatment of lateral epicondylitis.
A thorough review of 4 databases-PubMed, EBSCOhost, CINAHL (Cumulative Index to Nursing and Allied Health Literature) Plus, and Scopus-was performed to identify all studies that addressed surgical management of lateral epicondylitis. We included (1) studies published between 2000 and 2015 and (2) studies with clearly defined surgical techniques. We excluded (1) non-English-language manuscripts, (2) isolated case reports, (3) studies with fewer than 10 subjects, (4) animal studies, (5) studies with additional adjunctive procedures aside from release of the extensor origin, (6) clinical or systematic review manuscripts, (7) studies with a follow-up period of 6 months or less, and (8) studies in which less than 80% of patients completed follow-up. Each study was analyzed for complication rates, functional outcomes, pain, and patient satisfaction.
Thirty reports were identified that included 848 open, 578 arthroscopic, and 178 percutaneous releases. Patients within each release group had a similar age (46 years vs 46 years vs 48 years; P = .9 and P = .4, respectively), whereas there was a longer follow-up time in patients who underwent surgery by an open technique (49.4 months vs 42.6 months vs 23 months, P < .001). There were no differences in complication rates among these techniques (3.8% vs 2.9% vs 3.9%; P = .5 and P = .9, respectively). However, open techniques were correlated with higher surgical-site infection rates than arthroscopic techniques (0.7% vs 0%, P = .04). Mean Disabilities of the Arm, Shoulder and Hand scores were substantially better with both open and arthroscopic techniques than with percutaneous release (19.9 points vs 21.3 points vs 29 points, P < .001). In addition, there was less pain reported in the arthroscopic and percutaneous release groups as opposed to their open counterparts (1.9 points vs 1.4 points vs 1.3 points, P < .0001). There were no differences among the techniques in patient satisfaction rate (93.7% vs 89% vs 88%; P = .08 and P = .07, respectively).
Functional outcomes of open and arthroscopic releases may be superior to those of percutaneous release. In addition, patients may report less pain with arthroscopic and percutaneous techniques. Although the risk of complications is similar regardless of technique, patients may be counseled that their risk of infectious complications may be slightly higher with open releases. However, it is important to note that this statistical difference may not necessarily portend noticeable clinical differences.
Level IV, systematic review of Level III and IV evidence.
比较传统开放性、经皮或关节镜下伸肌起点松解术治疗外侧肱骨髁炎后的并发症、功能、疼痛及患者满意度。
全面检索4个数据库——PubMed、EBSCOhost、CINAHL（护理学与健康相关文献累积索引）Plus和Scopus，以识别所有涉及外侧肱骨髁炎手术治疗的研究。我们纳入了（1）2000年至2015年发表的研究，以及（2）手术技术明确界定的研究。我们排除了（1）非英文手稿，（2）孤立的病例报告，（3）受试者少于10例的研究，（4）动物研究，（5）除伸肌起点松解术外还进行了其他辅助手术的研究，（6）临床或系统评价手稿，（7）随访期为6个月或更短的研究，以及（8）患者随访完成率低于80%的研究。对每项研究的并发症发生率、功能结局、疼痛及患者满意度进行分析。
共识别出30篇报告，包括848例开放性、578例关节镜下和178例经皮松解术。每个松解术组的患者年龄相似（分别为46岁、46岁和48岁；P = 0.9和P = 0.4），而采用开放技术手术的患者随访时间更长（49.4个月、42.6个月和23个月，P < 0.001）。这些技术的并发症发生率无差异（分别为3.8%、2.9%和3.9%；P = 0.5和P = 0.9）。然而，开放技术的手术部位感染率高于关节镜技术（0.7%对0%，P = 0.04）。与经皮松解术相比，开放性和关节镜下技术的手臂、肩部和手部平均功能障碍评分明显更好（分别为19.9分、21.3分和29分，P < 0.001）。此外，与开放性手术组相比，关节镜下和经皮松解术组报告的疼痛更少（分别为1.9分、1.4分和1.3分，P < 0.0001）。各技术在患者满意度方面无差异（分别为93.7%、89%和88%；P = 0.08和P = 0.07）。
开放性和关节镜下松解术的功能结局可能优于经皮松解术。此外，患者采用关节镜和经皮技术时报告的疼痛可能更少。尽管无论采用何种技术并发症风险相似，但可告知患者开放性手术的感染并发症风险可能略高。然而，需要注意的是，这种统计学差异不一定预示着明显的临床差异。
IV级，对III级和IV级证据的系统评价。
