Wu Victor J, Thon Stephen, Finley Zachary, Bohlen Hunter, Schwartz Zachary, O'Brien Michael J, Savoie Felix H
Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
Orthop J Sports Med. 2019 Dec 23;7(12):2325967119885608. doi: 10.1177/2325967119885608. eCollection 2019 Dec.
Various techniques have been described for surgical treatment of recalcitrant medial epicondylitis (ME). No single technique has yet to be proven the most effective.
To evaluate the clinical outcomes of a double-row repair for ME.
Case series; Level of evidence, 4.
A retrospective review was performed on 31 consecutive patients (33 elbows) treated surgically for ME with a minimum clinical follow-up of 2 years. All patients were initially managed nonoperatively with anti-inflammatories, steroid injections, topical creams, and physical therapy. Outcome measures at final follow-up included visual analog scale (VAS) scores (scale, 0-10), time to completely pain-free state, time to full range of motion (FROM), Mayo Elbow Performance Scores (MEPS), and Oxford Elbow Scores (OES). Patients were contacted by telephone to determine current functional outcomes, pain, activity, functional limitations, and MEPS/OES. Successful and unsuccessful outcomes were determined by the Nirschl grading system.
The mean clinical and telephone follow-up periods were 2.3 and 3.6 years, respectively, and 31 of 33 (94%) elbows were found to have a successful outcome. The mean VAS improvement was 4.9 points, from 5.8 preoperatively to 0.9 postoperatively ( < .001). The mean MEPS and OES at final follow-up were 95.1 and 45.3, respectively. The mean time to pain-free state and time to FROM were 87.4 and 96 days, respectively. Unlike prior studies, no difference in outcome was found between those with and without ulnar neuritis preoperatively ( = .67).
A double-row repair is effective in decreasing pain and improving the overall function for recalcitrant ME. Uniquely, the presence of preoperative ulnar neuritis was associated with higher patient-reported preoperative pain scores but not with poor outcomes using this protocol.
针对顽固性内侧上髁炎（ME）的手术治疗，已有多种技术被描述。但尚无单一技术被证明是最有效的。
评估ME双排修复术的临床疗效。
病例系列；证据等级，4级。
对31例连续接受ME手术治疗的患者（33个肘部）进行回顾性研究，临床随访至少2年。所有患者最初均采用非手术治疗，包括使用抗炎药、类固醇注射、外用乳膏和物理治疗。最终随访时的结局指标包括视觉模拟量表（VAS）评分（范围0 - 10）、达到完全无痛状态的时间、达到全关节活动范围（FROM）的时间、梅奥肘关节功能评分（MEPS）和牛津肘关节评分（OES）。通过电话联系患者以确定当前的功能结局、疼痛、活动、功能受限情况以及MEPS/OES。采用Nirschl分级系统确定成功和失败的结局。
平均临床随访期和电话随访期分别为2.3年和3.6年，33个肘部中有31个（94%）结局成功。VAS评分平均改善4.9分，从术前的5.8分降至术后的0.9分（P <.001）。最终随访时MEPS和OES的平均分分别为95.1和45.3。达到无痛状态的平均时间和达到FROM的平均时间分别为87.4天和96天。与先前研究不同，术前有无尺神经炎的患者在结局上未发现差异（P =.67）。
双排修复术可有效减轻顽固性ME的疼痛并改善整体功能。独特的是，术前存在尺神经炎与患者报告的术前疼痛评分较高相关，但采用该方案时与不良结局无关。
