摘要
目的比较局部封闭与体外冲击波治疗肱骨外上髁炎的疗效。方法选择复旦大学附属中山医院于2017年7月1日—2018年6月30日门诊收治并诊断为肱骨外上髁炎的患者40例,随机分为局部封闭治疗组和体外冲击波治疗组,每组各20例。局部封闭治疗组患者接受曲安奈德混悬液的局部注射治疗;体外冲击波治疗组患者接受体外冲击波治疗,共6个疗程,每个疗程间隔7 d。分别于治疗结束后第4、12周采用疼痛VAS评分和上肢功能障碍评定量表(DASH量表)评估疗效。结果局部封闭治疗组与体外冲击波治疗组患者的性别构成、年龄、病程的差异均无统计学意义(P值均>0.05)。体外冲击波治疗组患者治疗后第4周疼痛VAS评分、DASH量表评分分别为2.6(1.2,4.5)、25.0(7.5,33.3)分,较治疗前的5.0(2.9,6.2)、30.8(17.7,38.3)分均有改善,差异均有统计学意义(Z=-3.825、-2.527,P值均<0.05);治疗后第12周疼痛VAS评分、DASH量表评分分别为2.0(0.5,4.0)、10.8(5.2,29.2)分,较治疗前均有改善,差异均有统计学意义(Z=-3.875、-3.180,P值均<0.05)。局部封闭治疗组患者治疗后第4周疼痛VAS评分、DASH量表评分值分别为1.3(0,2.7)、8.3(0,18.6)分,较治疗前的5.0(4.7,6.1)、26.7(20.4,40.6)分均有改善,差异均有统计学意义(Z值均=-3.921,P值均<0.05);治疗后第12周疼痛VAS评分、DASH量表评分分别为0(0,2.3)、0(0,13.3)分,较治疗前均有改善,差异均有统计学意义(Z=-3.921、-3.920,P值均<0.05)。治疗后第4、12周局部封闭治疗组患者疼痛VAS评分(Z=-2.291、-2.644)、DASH量表评分(Z=-2.774、-2.943)均显著优于体外冲击波治疗组(P值均<0.05)。治疗后第12周,局部封闭治疗组和体外冲击波治疗组治疗有效率分别为20/20和17/19,治愈率分别为15/20和7/19,无效率分别为0和2/19,差异均有统计学意义(P值均<0.05)。结论在治疗后的12周内,局部封闭治疗肱骨外上髁炎的治愈率、有效率均显著高于体外冲击波治疗,其可在短期内有效缓解患者局部症状,改善上肢功能。
Objective To compare the clinical outcomes between local steroid injection and extracorporeal shock-wave therapy(ESWT)for the treatment of lateral epicondylitis.Methods Forty patients with lateral epicondylitis treated in Zhongshan Hospital of Fudan University from July 1,2017 to June 30,2018 were randomly divided into steroid injection group and ESWT group(n=20).Patients received local injection of triamcinolone acetonide suspension or extracorporeal shock-wave therapy for 6 courses with an interval of 7 days between each course.Visual analogue scale(VAS)and Disability of Arm,Shoulder and Hand(DASH)questionnaire were used to evaluate the curative effect at the 4th and 12th week after treatments.The curative rate and effective rate were compared between two groups.Results There was no significant difference in gender composition,age or course of disease between the two groups(all P>0.05).At the 4th week after treatment,VAS and DASH scores of the ESWT group were 2.6(1.2,4.5)and 25.0(7.5,33.3),respectively,which were significantly decreased compared to those before treatment(5.0[2.9,6.2]and 30.8[17.7,38.3],Z=-3.825 and-2.527,both P<0.05).At the 12th week after treatment,the VAS score and DASH scores of the ESWT group were 2.0(0.5,4.0)and 10.8(5.2,29.2),respectively,which were also significantly improved compared to those before treatment(Z=-3.875 and-3.180,both P<0.05).At the 4th week after treatment,the VAS and DASH scores of the steroid injection group were 1.3(0,2.7)and 8.3(0,18.6),respectively,which were significantly decreased compared to those before treatment(5.0[4.7,6.1]and 26.7[20.4,40.6],both Z=-3.921,both P<0.05).At the 12th week after treatment,the VAS score and DASH scores of the steroid injection group were 0(0,2.3)and 0(0,13.3),respectively,which were also significantly decreased as compared to those before treatment(Z=-3.921 and-3.920,P<0.05).The VAS score of the steroid injection group was significantly lower than that of the ESWT group at both the 4th and 12th weeks after treatment(Z=-2.291 and-2.644,both P<0.05);so was the DASH score(Z=-2.774 and-2.943,both P<0.05).At the 12th week after treatment,the overall effectiveness of the steroid injection group and the ESWT group were 20/20 and 17/19,the cure rates were 15/20 and 7/19,and the inefficiency rates were 0 and 2/19,respectively,and the difference was statistically significant(P=0.033).Conclusion Both cure rate and effective rate of local steroid injection are significantly higher than those of extracorporeal shock wave therapy for lateral epicondylitis at 12th weeks after the treatment,and it can effectively alleviate local symptoms and improve the upper limb function in a short period.
作者
刘光华
陈建新
王平
石明芳
杨名珍
李蕴
钟宗烨
刘欣欣
刘邦忠
LIU Guanghua;CHEN Jianxin;WANG Ping;SHI Mingfang;YANG Mingzhen;LI Yun;ZHONG Zongye;LIU Xinxin;LIU Bangzhong(Department of Rehabilitation Medicine,Zhongshan Hospital of Fudan University,Shanghai 200032,China)
出处
《上海医学》
CAS
北大核心
2020年第8期490-494,共5页
Shanghai Medical Journal
关键词
网球肘
肱骨外上髁炎
体外冲击波
局部封闭
Tennis elbow
Lateral epicondylitis
Extracorporeal shock-wave therapy
Regional block therapy
作者简介
通信作者:刘邦忠,电子邮箱为liu.bangzhong@zs-hospital.sh.cn。
