肉毒杆菌毒素注射作为挽救疗法对髌股关节疼痛综合征的治疗有益。
Botulinum toxin injections as salvage therapy is beneficial for management of patellofemoral pain syndrome.
作者信息
Kesary Yuval, Singh Vivek, Frenkel-Rutenberg Tal, Greenberg Arie, Dekel Shmuel, Schwarzkopf Ran, Snir Nimrod
机构信息
Sackler Faculty of Medicine, Tel Aviv University, P. O. Box 39040, 6997801, Tel Aviv, Israel.
Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA.
出版信息
Knee Surg Relat Res. 2021 Oct 29;33(1):39. doi: 10.1186/s43019-021-00121-3.
PURPOSE
Patellofemoral pain syndrome (PFPS) is a common pathology usually presenting with anterior or retropatellar pain. It is associated with a relative imbalance between the vastus medialis oblique (VMO) and the vastus lateralis (VL) muscles. This can lead to considerable morbidity and reduced quality of life (QOL). This study aims to assess the long-term functional outcome of PFPS treated with VL muscle botulinum toxin A (BoNT-A) injection.
MATERIALS AND METHODS
A retrospective review was performed on 26 consecutive patients (31 knees) with a mean age of 50.1 years (± 19.7 years) who were treated with BoNT-A injections to the VL muscle followed by physiotherapy between 2008 and 2015. Pre- and post-treatment pain levels (numerical rating scale, NRS), QOL (SF-6D), and functional scores (Kujala and Lysholm questionnaires) were measured. Demographics, physical therapy compliance, previous surgeries, perioperative complications, and patient satisfaction levels were collected.
RESULTS
The mean follow-up time was 58.8 ± 36.4 months. There were significant improvements in all the examined domains. The average pain score (NRS) decreased from 7.6 to 3.2 (P < 0.01), and the Kujala, Lysholm, and SF-6D scores improved from 58.9 to 82.7 (P < 0.001), 56.2 to 83.2 (P < 0.001), and 0.6 to 0.8 (P < 0.001), respectively. Similar delta improvement was achieved irrespective of gender, age, compliance to post-treatment physical therapy, or coexisting osteoarthritis. Patients who presented with a worse pre-treatment clinical status achieved greater improvement. Prior to BoNT-A intervention, 16 patients (18 knees) were scheduled for surgery, of whom 12 (75%, 13 knees) did not require further surgical intervention at the last follow-up.
CONCLUSIONS
A single intervention of BoNT-A injections to the VL muscle combined with physiotherapy is beneficial for the treatment of patients with persistent PFPS.
LEVEL III EVIDENCE
Retrospective cohort study.
目的
髌股疼痛综合征（PFPS）是一种常见病症，通常表现为髌前或髌后疼痛。它与股内侧斜肌（VMO）和股外侧肌（VL）之间的相对失衡有关。这可能导致相当大的发病率并降低生活质量（QOL）。本研究旨在评估经VL肌肉注射A型肉毒杆菌毒素（BoNT-A）治疗PFPS的长期功能结果。
材料与方法
对2008年至2015年间连续26例患者（31膝）进行回顾性研究，这些患者平均年龄为50.1岁（±19.7岁），接受了VL肌肉BoNT-A注射并随后进行了物理治疗。测量治疗前后的疼痛水平（数字评分量表，NRS）、生活质量（SF-6D）和功能评分（Kujala和Lysholm问卷）。收集人口统计学资料、物理治疗依从性、既往手术史、围手术期并发症和患者满意度。
结果
平均随访时间为58.8±36.4个月。所有检查领域均有显著改善。平均疼痛评分（NRS）从7.6降至3.2（P<0.01），Kujala、Lysholm和SF-6D评分分别从58.9提高到82.7（P<0.001）、56.2提高到83.2（P<0.001）和0.6提高到0.8（P<0.001）。无论性别、年龄、治疗后物理治疗依从性或是否并存骨关节炎，均取得了相似的改善幅度。治疗前临床状态较差的患者改善更大。在BoNT-A干预前，16例患者（18膝）计划进行手术，其中12例（75%，13膝）在最后随访时无需进一步手术干预。
结论
单次VL肌肉BoNT-A注射联合物理治疗对持续性PFPS患者的治疗有益。
三级证据
回顾性队列研究。
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