Thiele Kathi, Unmann Annemarie, Geyer Stephanie, Siebenlist Sebastian, Scheibel Markus, Seemann Ricarda, Lerchbaumer Markus, Schoch Christian, Mader Konrad
Center for Musculoskeletal Surgery, Charité-University of Berlin, Berlin, Germany.
Trauma Department, LKH Feldbach, Feldbach, Austria.
JSES Int. 2023 Dec 7;8(2):361-370. doi: 10.1016/j.jseint.2023.11.006. eCollection 2024 Mar.
The treatment of lateral epicondylitis remains unsatisfactory in certain cases. The aim of this study is to investigate the efficiency of an ultrasound-guided infiltration combined with fenestration of the extensor tendon postulating a 50% reduction in pain on exertion within 6 months.
In a prospective, nonrandomized, multicenter study design, 68 patients with chronic lateral epicondylitis and symptoms lasted for at least 6 weeks were included. Each hospital has been assigned for Traumeel (A), autologous whole blood (B), or dextrose (C) in advance. Preinterventional, 6 weeks, 12 weeks, 6 and 12 months after infiltration, patient-related outcome parameter, and dorsal wrist extension strength were documented. Preinterventional (obligate) and after 6 months (optional) radiological evaluation (magnetic resonance imaging) was performed.
The Visual Analog Scale showed a significant reduction after 6 months in all groups (A. 4.8-2.5, B. 6.2-2.3, C. 5.8-2.4). Similar results could be observed with Subjective elbow value, Disabilities of Arm, Shoulder, and Hand Score, Mayo Elbow Performance Score, and Patient Rated Tennis Elbow Evaluation. The loss of strength could be completely compensated after about 6 months. Magnetic resonance imaging did not fully reflect clinical convalescence. Re-infiltrations were sometimes necessary for final reduction of symptoms (A = 11, B = 8, C = 4). Switching to surgical intervention was most frequently observed in group C (A = 2, B = 1, C = 5). In 14.5% of the cases, no improvement of the symptoms could be achieved with this method.
The primary hypothesis of a significant long-term pain reduction of at least 50% could be achieved regardless of the medication chosen.
在某些情况下，外侧上髁炎的治疗效果仍不尽人意。本研究的目的是探讨超声引导下浸润联合伸肌腱开窗术的疗效，假定6个月内用力时疼痛减轻50%。
采用前瞻性、非随机、多中心研究设计，纳入68例慢性外侧上髁炎且症状持续至少6周的患者。每个医院预先分配使用创伤弧菌制剂（A组）、自体全血（B组）或葡萄糖（C组）。记录干预前、浸润后6周、12周、6个月和12个月时与患者相关的结局参数以及腕背伸力量。进行干预前（必须）和6个月后（可选）的影像学评估（磁共振成像）。
视觉模拟评分显示所有组在6个月后均有显著降低（A组：4.8 - 2.5，B组：6.2 - 2.3，C组：5.8 - 2.4）。主观肘部评分、手臂、肩部和手部功能障碍评分、梅奥肘部功能评分以及患者网球肘评估也有类似结果。力量损失在约6个月后可完全得到补偿。磁共振成像未完全反映临床康复情况。有时需要再次浸润以最终减轻症状（A组 = 11例，B组 = 8例，C组 = 4例）。C组最常转为手术干预（A组 = 2例，B组 = 1例，C组 = 5例）。在14.5%的病例中，该方法无法改善症状。
无论选择何种药物，均可实现至少50%的长期显著疼痛减轻这一主要假设。
