Sölveborn S A, Buch F, Mallmin H, Adalberth G
Department of Orthopaedics, Uppsala University Hospital, Sweden.
Clin Orthop Relat Res. 1995 Jul(316):99-105.
In a prospective, randomized, double-blind study of radial epicondylalgia (tennis elbow), 109 patients with an average symptom duration of 8 months were considered for treatment with a single 1-mL injection of the steroid triamcinolone combined with either lidocaine or bupivacaine. The patients received clinical examinations at regular intervals for 1 year, and followup included visual analog pain scale and questionnaires. The 2 groups were comparable and for many factors distributed completely evenly with respect to gender, age, symptom duration, side dominance, type of pain onset, earlier treatment, and occupational loading. The only difference between the groups receiving lidocaine or bupivacaine was found at 2 weeks, when the bupivacaine additive yielded a better outcome for patients who had not been treated in any way before, for those with a short history of epicondylalgia, or both. The steroid injection treatment, regardless of which local anesthetic was given, presented a typical pattern, with symptoms relieved quickly by 2 weeks and then deterioration for many patients at 3 months, indicating a tendency to recurrence. A considerable loss of patients to other treatments at the 1-year followup indicated an equivocal long-term result. Patients who had not been treated earlier in any way had a more favorable prognosis, as did those with a history of epicondylalgia to 3 months.
在一项关于桡侧肱骨髁上炎（网球肘）的前瞻性、随机、双盲研究中，109例平均症状持续时间为8个月的患者被纳入研究，接受单次1毫升的类固醇曲安奈德联合利多卡因或布比卡因注射治疗。患者定期接受临床检查，为期1年，随访包括视觉模拟疼痛量表和问卷调查。两组具有可比性，在性别、年龄、症状持续时间、优势侧、疼痛发作类型、既往治疗情况和职业负荷等诸多因素上分布完全均匀。在接受利多卡因或布比卡因治疗的两组之间，仅在2周时发现差异，即对于之前未接受过任何治疗的患者、肱骨髁上炎病史较短的患者或两者兼具的患者，布比卡因添加剂产生了更好的治疗效果。无论给予哪种局部麻醉剂，类固醇注射治疗都呈现出一种典型模式，症状在2周时迅速缓解，然后在3个月时许多患者病情恶化，表明有复发倾向。在1年随访时，相当一部分患者转而接受其他治疗，这表明长期结果不明确。之前未接受过任何治疗的患者预后较好，肱骨髁上炎病史在3个月以内的患者也是如此。
