Degen Ryan M, Cancienne Jourdan M, Camp Christopher L, Altchek David W, Dines Joshua S, Werner Brian C
a Sports Medicine and Shoulder Surgery , Hospital for Special Surgery , New York , NY , USA.
b Department of Orthopedic Surgery , University of Virginia Health System , Charlottesville , VA , USA.
Phys Sportsmed. 2017 Nov;45(4):433-437. doi: 10.1080/00913847.2017.1374811. Epub 2017 Sep 8.
To identify risk factors for failure of a therapeutic injection leading to operative management of both medial and lateral epicondylitis.
A national database was used to query Medicare Standard Analytic Files from 2005-2012 for patients treated with therapeutic injections for medial or lateral epicondylitis using CPT codes for injections associated with corresponding ICD-9 diagnostic codes (726.31 and 726.32, respectively). Those who subsequently underwent surgical treatment following injection were identified. A multivariate binomial logistic regression analysis was utilized to evaluate patient-related risk factors for requiring surgery within 2 years after therapeutic injection.
1,837 patients received therapeutic injections for medial epicondylitis. 52 (2.8%) required ipsilateral surgery at a mean of 429 ± 28 days post-injection. Risk factors for requiring surgical intervention included age <65, obesity, and morbid obesity. 6,561 patients received therapeutic injections for lateral epicondylitis. 201 (3.1%) required subsequent surgery at a mean of 383 ± 128 days' post-injection. Risk factors included age <65, tobacco use, diabetes mellitus and peripheral vascular disease.
The incidence of surgical intervention following a failed therapeutic injection for medial or lateral epicondylitis is low (~3%). Risk factors for failing a therapeutic injection include age <65 years and obesity (BMI > 30) for medial epicondylitis and age <65 years, smoking, diabetes mellitus and peripheral vascular disease for lateral epicondylitis. Patients with these identified risk factors presenting with medial or lateral epicondylitis should be cautioned that they carry a higher risk of subsequent surgical treatment.
Therapeutic, III.
确定导致内侧和外侧上髁炎均需手术治疗的治疗性注射失败的危险因素。
使用国家数据库查询2005 - 2012年医疗保险标准分析文件中使用与相应ICD - 9诊断代码（分别为726.31和726.32）相关的注射CPT代码治疗内侧或外侧上髁炎的患者。确定那些注射后随后接受手术治疗的患者。采用多变量二项逻辑回归分析来评估治疗性注射后2年内需要手术的患者相关危险因素。
1837例患者接受了内侧上髁炎的治疗性注射。52例（2.8%）在注射后平均429±28天需要同侧手术。需要手术干预的危险因素包括年龄<65岁、肥胖和病态肥胖。6561例患者接受了外侧上髁炎的治疗性注射。201例（3.1%）在注射后平均383±128天需要后续手术。危险因素包括年龄<65岁、吸烟、糖尿病和周围血管疾病。
内侧或外侧上髁炎治疗性注射失败后手术干预的发生率较低（约3%）。治疗性注射失败的危险因素包括内侧上髁炎患者年龄<65岁和肥胖（BMI>30），以及外侧上髁炎患者年龄<65岁、吸烟、糖尿病和周围血管疾病。患有这些已确定危险因素的内侧或外侧上髁炎患者应被告知他们后续手术治疗的风险较高。
治疗性，III级。
