Bhandari Laxminarayan, Bouri Fadi, Ozyurekoglu Tuna
Christine M Kleinert Institute of Hand and Microsurgery, Louisville, KY, U.S.A.
Arthrosc Sports Med Rehabil. 2020 Nov 15;2(6):e771-e778. doi: 10.1016/j.asmr.2020.07.010. eCollection 2020 Dec.
To compare the short-term outcomes between arthroscopic and open procedures for the treatment of lateral epicondylitis. Because a significant portion of patients have worker's compensation (WC), the outcomes in these subgroups were separately analyzed.
A retrospective analysis of patients who had surgical treatment of lateral epicondylitis by a single surgeon from 2010 to 2017 was performed. Patients who were symptomatic after 9 months of conservative treatments including nonsteroidal medications, steroid injections, and physical therapy were offered surgical intervention. The type of surgery was selected after detailed consultation with the patient. Charts were reviewed for preoperative pain, grip strength as measured by dynamometer, smoking status, and WC status. Postoperative assessments included pain and grip strength at 6 weeks and time taken to return to full duty. Two groups were compared using unpaired test and chi-squared tests. Results were compared with similar studies in the literature.
The study included 30 patients in the arthroscopic debridement group and 42 patients in the open tenotomy and reinsertion group. Eighteen patients (25%) had WC. Compared with the open group, the arthroscopic group had earlier return to full duty (mean 7.13 weeks, confidence interval [CI] 6.21 to 8.05 versu mean of 12.22 weeks, CI 11.21 to 13.24; < .001) and less time for complete pain relief (mean 7.4 weeks, CI 7.02 to 7.93 versus 9.5 , CI 8.68 to 10.44; = .043). No difference was seen among the groups in terms of unfavorable outcome (persistent pain and recurrence of pain), JAMAR hand dynamometer score at 6 weeks, and visual analog score at 6 weeks. A total of 11 patients (15%) had unfavorable outcome. Incidence of unfavorable outcomes was more in patients with WC insurance (36% in WC versus 7% in non-WC; = .023). No association was seen with smoking status. WC patients also had a longer time to return to full duty (16.68 weeks for WC versus 7.65 weeks for non-WC; < .001) and a longer time to get complete pain relief (12.4 weeks for WC versus 7.5 weeks for non-WC; < .001).
The arthroscopic technique offers advantages of earlier return to work and shorter recovery period along with additional advantages of joint inspection and ability to treat coexisting pathologies. WC patients had a longer time to return to full duty and time for complete pain relief.
Level III, retrospective comparative study.
比较关节镜手术与开放手术治疗外侧上髁炎的短期疗效。由于相当一部分患者有工伤赔偿（WC），因此对这些亚组的疗效进行了单独分析。
对2010年至2017年由同一位外科医生进行外侧上髁炎手术治疗的患者进行回顾性分析。经过包括非甾体类药物、类固醇注射和物理治疗在内的9个月保守治疗后仍有症状的患者接受手术干预。手术类型在与患者详细咨询后选定。查阅病历以了解术前疼痛情况、用握力计测量的握力、吸烟状况和WC状态。术后评估包括6周时的疼痛和握力以及恢复全职工作所需的时间。使用不成对t检验和卡方检验对两组进行比较。将结果与文献中的类似研究进行比较。
研究包括30例关节镜清创组患者和42例开放腱切断术和重新植入组患者。18例患者（25%）有WC。与开放组相比，关节镜组恢复全职工作更早（平均7.13周，置信区间[CI]6.21至8.05，而开放组平均为12.22周，CI 11.21至13.24；P<0.001），完全缓解疼痛所需时间更短（平均7.4周，CI 7.02至7.93，而开放组为9.5周，CI 8.68至10.44；P = 0.043）。两组在不良结局（持续疼痛和疼痛复发）、6周时的JAMAR握力计评分和6周时的视觉模拟评分方面没有差异。共有11例患者（15%）出现不良结局。有WC保险的患者不良结局发生率更高（WC组为36%，非WC组为7%；P = 0.023）。与吸烟状况无关。WC患者恢复全职工作的时间也更长（WC患者为16.68周，非WC患者为7.65周；P<0.001），完全缓解疼痛的时间也更长（WC患者为12.4周，非WC患者为7.5周；P<0.001）。
关节镜技术具有更早恢复工作和更短恢复期的优势，同时还具有关节检查以及治疗并存病变的额外优势。WC患者恢复全职工作和完全缓解疼痛的时间更长。
III级，回顾性比较研究。
