Gaspar Michael P, Motto Michael A, Lewis Sarah, Jacoby Sidney M, Culp Randall W, Lee Osterman A, Kane Patrick M
Philadelphia Hand to Shoulder Center, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Darden School of Business, University of Virginia, Charlottesville, Virginia, USA.
Orthop J Sports Med. 2017 Dec 6;5(12):2325967117742077. doi: 10.1177/2325967117742077. eCollection 2017 Dec.
Recalcitrant lateral epicondylitis (LE) is a common debilitating condition, with numerous treatment options of varying success. An injection of platelet-rich plasma (PRP) has been shown to improve LE, although it is unclear whether the method of needling used in conjunction with a PRP injection is of clinical importance.
To determine whether percutaneous needle tenotomy is superior to percutaneous needle fenestration when each is combined with a PRP injection for the treatment of recalcitrant LE.
Cohort study; Level of evidence, 3.
A total of 93 patients with recalcitrant LE were treated with a PRP injection and percutaneous needle fenestration (n = 45) or percutaneous needle tenotomy (n = 48) over a 5-year study interval. Preoperative patient data, including visual analog scale for pain (VAS-P), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Patient-Rated Tennis Elbow Evaluation (PRTEE) scores and grip strength, were obtained from a chart review and compared with postoperative values obtained prospectively. Secondary outcomes included the incidence of complications, need for additional interventions, return to work, and patient satisfaction.
At a mean follow-up of 40 months, significant improvements in VAS-P (mean, -6.1; 95% CI, -6.8 to -5.5; < .0001), QuickDASH (mean, -46; 95% CI, -52 to -40; < .0001), and PRTEE (mean, -57; 95% CI, -64 to -50; < .0001) scores and grip strength (mean, +6.1 kg; 95% CI, 4.9 to 7.3; < .0001) were observed across the entire study cohort, with no significant differences noted between the fenestration and tenotomy groups. Nine of 45 patients (22%) underwent additional procedures to treat recurrent symptoms in the fenestration group compared with 5 of 48 patients (10%) in the tenotomy group ( = .05). No complications occurred in any patients, and no patients expressed dissatisfaction with their treatment course.
A PRP injection with concomitant percutaneous needling is an effective treatment for recalcitrant LE, with sustained improvements in pain, strength, and function demonstrated at a mean follow-up of longer than 3 years. Although the method of concomitant needling does not appear to have a significant effect on treatment outcomes, more aggressive needle tenotomy is less likely to require conversion to open tenotomy than needle fenestration in the short term to midterm.
顽固性外侧上髁炎（LE）是一种常见的使人衰弱的病症，有多种治疗方法，但效果各异。尽管尚不清楚与富血小板血浆（PRP）注射联合使用的针刺方法是否具有临床重要性，但已证明注射PRP可改善LE。
确定在与PRP注射联合用于治疗顽固性LE时，经皮针状腱切断术是否优于经皮针状开窗术。
队列研究；证据等级，3级。
在一项为期5年的研究期间，共有93例顽固性LE患者接受了PRP注射和经皮针状开窗术（n = 45）或经皮针状腱切断术（n = 48）治疗。术前患者数据，包括疼痛视觉模拟量表（VAS-P）、手臂、肩部和手部快速残疾评定量表（QuickDASH）、患者自评网球肘评估（PRTEE）评分和握力，通过病历回顾获得，并与前瞻性获得的术后值进行比较。次要结局包括并发症发生率、额外干预需求、恢复工作情况和患者满意度。
平均随访40个月时，整个研究队列的VAS-P（平均值，-6.1；95%可信区间，-6.8至-5.5；P <.0001）、QuickDASH（平均值，-46；95%可信区间，-52至-40；P <.0001）和PRTEE（平均值，-57；95%可信区间，-64至-50；P <.0001）评分以及握力（平均值，+6.1 kg；95%可信区间，4.9至7.3；P <.0001）均有显著改善，开窗术组和腱切断术组之间未观察到显著差异。开窗术组45例患者中有9例（22%）因复发性症状接受了额外手术，而腱切断术组48例患者中有5例（10%）（P = 0.05）。所有患者均未发生并发症，也没有患者对其治疗过程表示不满。
PRP注射联合经皮针刺是治疗顽固性LE的有效方法，在平均超过3年的随访中，疼痛、力量和功能持续改善。尽管联合针刺方法似乎对治疗结果没有显著影响，但在短期至中期，更积极的针状腱切断术比针状开窗术更不容易需要转为开放性腱切断术。
