摘要
目的探讨关节镜下修复重建技术治疗顽固性网球肘的应用及其中远期临床疗效。方法回顾性选取2017年1月至2020年12月台州骨伤医院收治的58例顽固性网球肘患者的病例资料,根据治疗方法的不同,将行关节镜下肘关节清理的32例顽固性网球肘患者纳入清理组;将关节镜下修复重建桡侧腕短伸肌腱(extensor carpi radialis brevis,ECRB)的26例顽固性网球肘患者纳入重建组。通过测量ECRB横截面积、视觉模拟评分(visual analogue scale,VAS)、上肢功能评定表(upper extremity functional index,UEFI)、Mayo肘关节功能评分(Mayo elbow performance score,MEPS)及术后并发症情况对两组患者术后结局及疗效进行评价。结果两组患者一般资料比较差异无统计学意义(P>0.05)。不同时间节点的ECRB横截面积存在差异(P<0.05),重建组患者的ECRB横截面积在术后6个月、12个月及24个月呈逐步增加;清理组患者ECRB横截面积在术后6个月时出现下降,在术后12个月、24个月时间节点则表现为增加趋于平稳。干预前两组VAS、UEFI及MEPS得分比较差异无统计学意义(P>0.05);干预后,重建组VAS得分较清理组显著降低(P<0.05),重建组UEFI及MEPS得分较清理组显著升高(P<0.05)。两组间VAS、UEFI及MEPS得分时间效应、组间效应及交互效应差异均有统计学意义(P<0.05);组内两两比较,两组VAS得分的后一时间节点分值均低于前一时间节点,但清理组VAS得分仅在术后6个月低于术前,差异有统计学意义(P<0.05)。两组UEFI、MEPS得分的后一时间节点分值均高于前一时间节点,但清理组UEFI、MEPS得分仅在术后6个月高于术前,差异有统计学意义(P<0.05)。对两组患者术后第2天、出院时及术后6个月、12个月及24个月随访,均未发现神经损伤、肌腱断裂、感染和皮下血肿等手术相关并发症的发生,安全性良好。结论关节镜下修复重建手术治疗顽固性网球肘,术后疗效满意,可在中远期有效缓解患者疼痛及促进肘关节功能恢复,安全性高,值得临床推广应用。
Background Tennis elbow,also known as external humerus epicondylitis,is a common orthopedic and sports medicine disease with a prevalence rate of 1%-3%in the population,and the age of onset is 35-50 years old.Clinically,the main symptoms are evident lateral elbow tenderness and limited elbow and wrist joint activity.Patients whose pain has not been significantly relieved after more than six months of conservative treatment are defined as having intractable tennis elbow,accounting for about 10%of the patients with tennis elbow.Wada et al.reported the first case of arthroscopic treatment of tennis elbow in 1995.After continuous clinical summaries and concept updates,total arthroscopic treatment of tennis elbow has gradually become a trend.In recent years,many studies believe that tennis elbow is tendinopathy near tendon insertion,and extensor carpi radialis brevis(ECRB)is the most commonly involved,and many clinical studies have achieved good results through arthroscopic ECRB surgical treatment.However,the exact evaluation of long-term clinical efficacy is rarely reported.Objective To investigate the application of arthroscopic reconstruction in treating intractable tennis elbow and its medium-and long-term clinical effects.Methods The data of 58 patients with intractable tennis elbow treated in Taizhou Bone Injury Hospital from January 2017 to December 2020 were retrospectively selected.According to different treatment methods,32 patients with intractable tennis elbow who underwent arthroscopic debridement were included in the debridement group.Twenty-six patients with intractable tennis elbow who underwent arthroscopic reconstruction of ECRB were included in the reconstruction group.Using ECRB cross-sectional area,visual analogue scale(VAS),upper extremity functional index,UEFI,Mayo elbow performance score(MEPS),and postoperative complications were evaluated.Results There was no significant difference in the general data between the two groups(P>0.05).The cross-sectional area of ECRB at different time nodes was separate(P<0.05),and the cross-sectional area of ECRB in the reconstruction group increased gradually at 6,12,and 24 months after surgery.The cross-sectional area of ECRB decreased six months after the operation and increased steadily at 12 months and 24 months after the procedure.There was no significant difference in VAS,UEFI,and MEPS scores between the two groups before intervention(P>0.05).After the intervention,the VAS score in the reconstruction group was significantly lower than that in the debridement group(P<0.05),and UEFI and MEPS scores in the reconstruction group were considerably higher than that in the debridement group(P<0.05).The two groups had significant differences in VAS,UEFI,and MEPS scores(P<0.05).By pin-to-pair comparison within the group,the VAS score of the two groups was lower than that of the previous one.Still,the VAS score of the cleanup group was lower than that of the operation only six months after the procedure,and the difference was statistically significant(P<0.05).The UEFI and MEPS scores of the two groups were higher after the operation than before the procedure.Still,the UEFI and MEPS scores of the cleanup group were higher than before the operation,only six months after the procedure,and the difference was statistically significant(P<0.05).Postoperative complications such as nerve injury,tendon rupture,infection,and subcutaneous hematoma were not found on the second day after surgery,at discharge,6 months,12 months,and 24 months after surgery in both groups,and the safety was good.Conclusion Arthroscopic repair and reconstruction surgery for intractable tennis elbow has a satisfactory postoperative effect.It can effectively relieve patients'pain and promote the recovery of elbow joint function in the medium and long term,and it is safe and worthy of clinical application.
作者
郭科
李俊
郑杰
周韩阳
郭翱
Ke Guo;Jun Li;Jie Zheng;Hanyang Zhou;Ao Guo(The First Clinical School of Medicine,Zhejiang University of Traditional Chinese Medicine,Hangzhou 317000,China;Department of Sports Medicine,Taizhou Orthopaedic Hospital,Wenling 317500,China)
出处
《中华肩肘外科电子杂志》
2023年第2期132-138,共7页
Chinese Journal of Shoulder and Elbow(Electronic Edition)
关键词
关节镜
修复重建
顽固性网球肘
疗效
Arthroscopy
Repair and reconstruction
Intractable tennis elbow
Curative effect
作者简介
通信作者:李俊,Email:tzgsga@163.com。
