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活跃工作人群中肱骨外上髁炎的关节镜手术与开放手术对比研究

Arthroscopic surgery versus open surgery for lateral epicondylitis in an active work population: a comparative study.

作者信息

López-Alameda Socorro, Varillas-Delgado David, De Felipe-Gallego Juan, González-Granados María Gabriela, Hernández-Castillejo Luis Enrique, García-de Lucas Fernando

机构信息

Hospital FREMAP, Majadahonda, Spain.

Faculty of Health Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain.

出版信息

J Shoulder Elbow Surg. 2022 May;31(5):984-990. doi: 10.1016/j.jse.2021.11.017. Epub 2021 Dec 30.

Abstract

BACKGROUND

Lateral epicondylitis is common in workers who perform repetitive movements of the entire upper limb. Approximately 85%-90% of patients respond satisfactorily to conservative treatment, but in resistant patients, surgical treatment is considered. Classic open surgery is successful in between 70% and 97% of patients, similarly to more modern techniques such as arthroscopy. We sought to demonstrate the superiority of the Wolff technique in terms of clinical results. The goals of this study were to compare the functional and pain outcomes of arthroscopic surgery with open surgery using fasciotomy via the Wolff technique in the treatment of lateral epicondylitis.

METHODS

This was a retrospective study of 47 working-age patients with resistant lateral epicondylitis: 27 underwent arthroscopic surgery and 20 underwent open surgery. Visual analog scale scores for pain and function, as well as the QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand questionnaire) score, Mayo Elbow Performance Score, and Broberg and Morrey Rating System score, were collected preoperatively and postoperatively; return to patients' previous work and surgical time were also recorded.

RESULTS

No statistically significant differences were observed between the groups in the reduction in the visual analog scale score (5.26 in arthroscopy group vs. 5.75 in fasciotomy group, P = .5), QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand questionnaire) score (19 vs. 19.4, P = .9), Mayo Elbow Performance Score (82 vs. 81.5, P = .8), or Broberg and Morrey Rating System score (81.9 vs. 82.6, P = .9). The differences in terms of time off were also not statistically significant. The period of work leave corresponded, on average, to 83.78 days in the arthroscopy group and 89.95 days in the Wolff group. The mean surgical time was 44.2 minutes in the group undergoing arthroscopic intervention and 27.5 minutes in the fasciotomy group, showing a statistically significant difference (P < .001).

CONCLUSIONS

Arthroscopic surgery and open surgery provide similar functional results and pain reduction in the treatment of lateral epicondylitis.

摘要

背景

肱骨外上髁炎在从事整个上肢重复性运动的工人中很常见。约85%-90%的患者对保守治疗反应良好,但对于难治性患者,则考虑手术治疗。经典的开放手术在70%至97%的患者中取得成功,与关节镜检查等更现代的技术类似。我们试图证明沃尔夫技术在临床结果方面的优越性。本研究的目的是比较关节镜手术与采用沃尔夫技术进行筋膜切开术的开放手术在治疗肱骨外上髁炎时的功能和疼痛结局。

方法

这是一项对47例患有难治性肱骨外上髁炎的工作年龄患者的回顾性研究:27例行关节镜手术,20例行开放手术。收集术前和术后的视觉模拟量表疼痛和功能评分,以及QuickDASH(手臂、肩部和手部功能障碍问卷简版)评分、梅奥肘关节功能评分和布罗伯格与莫里评分系统评分;记录患者恢复原工作情况和手术时间。

结果

两组在视觉模拟量表评分降低(关节镜组为5.26,筋膜切开术组为5.75,P = 0.5)、QuickDASH(手臂、肩部和手部功能障碍问卷简版)评分(19对19.4;P = 0.9)、梅奥肘关节功能评分(82对81.5;P = 0.8)或布罗伯格与莫里评分系统评分(81.9对82.6;P = 0.9)方面未观察到统计学显著差异。休假时间差异也无统计学意义。关节镜组平均休假时间为83.78天,沃尔夫组为89.95天。关节镜干预组的平均手术时间为44.2分钟,筋膜切开术组为27.5分钟,差异有统计学意义(P < 0.001)。

结论

关节镜手术和开放手术在治疗肱骨外上髁炎时提供相似的功能结果和疼痛缓解效果。

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