不同手术方式治疗外侧上髁炎的临床疗效比较：一项系统评价与Meta分析
Comparison of Clinical Outcomes After Different Surgical Approaches for Lateral Epicondylitis: A Systematic Review and Meta-analysis.
作者信息
Kholinne Erica, Singjie Leonard Christianto, Anastasia Maria, Liu Felly, Anestessia Ira Juliet, Kwak Jae-Man, Jeon In-Ho
机构信息
Department of Orthopaedic Surgery, Saint Carolus Hospital, Jakarta, Indonesia.
Faculty Of Medicine, Universitas Trisakti, Jakarta, Indonesia.
出版信息
Orthop J Sports Med. 2024 May 2;12(5):23259671241230291. doi: 10.1177/23259671241230291. eCollection 2024 May.
BACKGROUND
Lateral epicondylitis (LE) is one of the most common causes of lateral elbow pain. When nonoperative treatment fails, 1 of the 3 surgical approaches-open, percutaneous, or arthroscopic-is used. However, determining which approach has the superior clinical outcome remains controversial.
PURPOSE
To review the outcomes of different operative modalities for LE qualitatively and quantitatively.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
This review was performed and reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies published in PubMed, Medline (via EBSCO), and ScienceDirect databases that treated LE with open, percutaneous, or arthroscopic approaches with at least 12 months of follow-up were included. Study quality was assessed using the Cochrane Risk of Bias 2 tool and the Methodological Index for Non-Randomized Studies score. The primary outcome was the success rate of each operative treatment approach-open, percutaneous, and arthroscopic.
RESULTS
From an initial search result of 603 studies, 43 studies (n = 1941 elbows) were ultimately included. The arthroscopic approach had the highest success rate (91.9% [95% CI, 89.2%-94.7%]) compared with the percutaneous (91% [95% CI, 87.3%-94.6%]) and open (82.7% [95% CI, 75.6%-89.8%]) approaches for LE surgery with changes in the mean visual analog scale pain score of 5.54, 4.90, and 3.63, respectively. According to the Disabilities of the Arm, Shoulder and Hand score, the functional outcome improved in the arthroscopic group (from 54.11 to 15.47), the percutaneous group (from 44.90 to 10.47), and the open group (from 53.55 to 16.13). The overall improvement was also found in the Mayo Elbow Performance Score, the arthroscopic group (from 55.12 to 90.97), the percutaneous group (from 56.31 to 87.65), and the open group (from 64 to 93.37).
CONCLUSION
Arthroscopic surgery had the highest rate of success and the best improvement in functional outcomes among the 3 approaches of LE surgery.
背景
外侧上髁炎（LE）是肘部外侧疼痛最常见的原因之一。当非手术治疗失败时，会采用三种手术方法之一——开放手术、经皮手术或关节镜手术。然而，确定哪种方法具有更好的临床效果仍存在争议。
目的
定性和定量地回顾不同手术方式治疗LE的效果。
研究设计
系统评价；证据等级，4级。
方法
本评价按照PRISMA（系统评价和Meta分析优先报告项目）指南进行并报告。纳入在PubMed、Medline（通过EBSCO）和ScienceDirect数据库中发表的、采用开放、经皮或关节镜方法治疗LE且随访至少12个月的研究。使用Cochrane偏倚风险2工具和非随机研究方法学指数评分评估研究质量。主要结局是每种手术治疗方法——开放手术、经皮手术和关节镜手术的成功率。
结果
从603项研究的初始检索结果中，最终纳入43项研究（n = 1941例肘部）。与经皮手术（91% [95% CI，87.3%-94.6%]）和开放手术（82.7% [95% CI，75.6%-89.8%]）相比，关节镜手术治疗LE的成功率最高（91.9% [95% CI，89.2%-94.7%]），平均视觉模拟量表疼痛评分的变化分别为5.54、4.90和3.63。根据手臂、肩部和手部功能障碍评分，关节镜组（从54.11降至15.47）、经皮组（从44.90降至10.47）和开放组（从53.55降至16.13）的功能结局均有所改善。在梅奥肘关节功能评分方面也发现了总体改善，关节镜组（从55.12升至90.97）、经皮组（从56.31升至87.65）和开放组（从64升至93.37）。
结论
在LE手术的三种方法中，关节镜手术的成功率最高，功能结局改善最佳。
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