Rajani Amyn M, Mittal Anmol Rs, Kulkarni Vishal, Rajani Khushi, Rajani Kashish
Department of Orthopaedics, OAKS Clinic, Mumbai, India.
Department of Clinical Research, OAKS Clinic, Mumbai, India.
Clin Shoulder Elb. 2023 Mar;26(1):49-54. doi: 10.5397/cise.2022.01375. Epub 2023 Feb 23.
Lateral epicondylitis is an increasingly debilitating condition in working population. Evidence for conservative treatment modalities has been inconclusive. Percutaneous pie crusting of the common extensor origin at the lateral epicondyle at the time of local corticosteroid injection (CSI) has been proposed sparsely. The objective of this study was to analyze if concomitant CSI and pie-crusting of the common extensor origin provides better outcome than CSI alone in lateral epicondylitis.
This case-control study on 236 patients was conducted at a single center between January 1, 2020, and May 31, 2022. Patients were divided into two groups (n=118 each) based on their preference. Group A underwent CSI alone and group B underwent pie crusting along with CSI. The clinical and functional outcomes of all patients were evaluated at 2, 4, 6, and 12-week post-procedure using the visual analog scale (VAS) and Nirschl score. The mean time for return to daily activities was also compared.
Both groups showed significant improvement in post-procedure outcome at successive follow-ups on intragroup longitudinal analysis (VAS: F=558.384 vs. F=1,529.618, Nirschl: F=791.468 vs. F=1,284.951). On intergroup analysis, VAS of group B was superior to that of group A; however, it was statistically significant (P<0.05) only from the 6-week follow-up onwards. Nirschl score of group B was significantly better throughout the period of follow-up (P<0.05). Group B returned to daily activities faster than Group A (6.2±0.44 weeks vs. 7.18±0.76 weeks).
Concomitant pie crusting with CSI is recommended for lateral epicondylitis as it provides significantly better results than CSI alone.
肱骨外上髁炎在劳动人群中日益成为一种使人衰弱的疾病。保守治疗方式的证据尚无定论。局部注射皮质类固醇（CSI）时，对肱骨外上髁处常见伸肌起点进行经皮“饼状切开术”的提议很少。本研究的目的是分析在肱骨外上髁炎中，CSI联合常见伸肌起点的饼状切开术是否比单纯CSI能带来更好的疗效。
本病例对照研究于2020年1月1日至2022年5月31日在单一中心对236例患者进行。患者根据自身偏好分为两组（每组n = 118）。A组仅接受CSI，B组接受CSI并同时进行饼状切开术。在术后2周、4周、6周和12周，使用视觉模拟量表（VAS）和Nirschl评分评估所有患者的临床和功能结局。还比较了恢复日常活动的平均时间。
在组内纵向分析中，两组在连续随访时术后结局均有显著改善（VAS：F = 558.384 对 F = 1529.618，Nirschl：F = 791.468 对 F = 1284.951）。在组间分析中，B组的VAS优于A组；然而，仅从6周随访起具有统计学意义（P < 0.05）。在整个随访期间，B组的Nirschl评分明显更好（P < 0.05）。B组比A组更快恢复日常活动（6.2±0.44周对7.18±0.76周）。
对于肱骨外上髁炎，建议CSI联合饼状切开术，因为它比单纯CSI能提供显著更好的结果。
