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中华临床医师杂志(电子版)

中华临床医师杂志(电子版) ›› 2019, Vol. 13 ›› Issue (12) : 888 -892. doi: 10.3877/cma.j.issn.1674-0785.2019.12.002

所属专题： 文献；

临床研究

超声引导下类固醇激素介入和体外冲击波治疗肱骨外上髁炎的临床疗效
黄晓文1, 洪顾麒1, 凡进1, 吴梦洁2, 杭菁2, 彭晓静2,†()   
  1. 1. 210029　南京医科大学第一附属医院（江苏省人民医院）骨科
    2. 210029　南京医科大学第一附属医院超声科
  • 收稿日期:2019-05-09 出版日期:2019-06-15
  • 通信作者: 彭晓静
  • 基金资助:
    江苏省六大人才高峰人才项目(2014-WSN-011)

Clinical effects of ultrasonography-guided corticosteroid injection versus extracorporeal shockwave therapy in lateral epicondylitis

Xiaowen Huang1, Guqi Hong1, Jin Fan1, Mengjie Wu2, Jing Hang2, Xiaojing Peng2,†()   

  1. 1. Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing 210029, China
    2. Department of Ultrasonography, the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing 210029, China
  • Received:2019-05-09 Published:2019-06-15
  • Corresponding author: Xiaojing Peng
  • About author:
    Corresponding author: Peng Xiaojing, Email:
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黄晓文, 洪顾麒, 凡进, 吴梦洁, 杭菁, 彭晓静. 超声引导下类固醇激素介入和体外冲击波治疗肱骨外上髁炎的临床疗效[J]. 中华临床医师杂志(电子版), 2019, 13(12): 888-892.

Xiaowen Huang, Guqi Hong, Jin Fan, Mengjie Wu, Jing Hang, Xiaojing Peng. Clinical effects of ultrasonography-guided corticosteroid injection versus extracorporeal shockwave therapy in lateral epicondylitis[J]. Chinese Journal of Clinicians(Electronic Edition), 2019, 13(12): 888-892.

目的

观察并评估对肱骨外上髁炎患者进行超声引导下类固醇激素介入治疗和体外冲击波治疗的临床疗效的差异。

方法

回顾性分析2018年7月至10月在南京医科大学第一附属医院骨科门诊治疗并获得完整随访的肱骨外上髁炎患者61例。按照治疗方法不同分为超声引导下类固醇激素介入治疗组（A组）31例和体外冲击波治疗组（B组）30例。采用t检验比较2组患者治疗前后的VAS评分、PRTEE功能评分和握力变化的差异，采用χ2检验比较组间复发率的差异。

结果

所有病例均获得随访，平均随访时间（7.2±0.9）个月。治疗后1个月时，A组VAS评分低于B组［（1.8±0.4）分vs（3.2±0.5）分］，差异具有统计学意义（t=-12.0959，P<0.001）；治疗后3个月时，2组VAS评分和PRTEE功能评分比较，差异均无统计学意义（P>0.05）。治疗后6个月时，A组VAS评分和PRTEE功能评分均低于B组［（1.7±0.3）分vs（2.8±0.4）分；（13.2±2.9）分vs（22.3±5.1）分］，A组握力变化和复发率也低于B组［（12.3±2.5）% vs（28.4±3.2）%；0/31 vs 4/30］，差异均具有统计学意义（t=-12.1772、-8.6024、-21.9381，P<0.001、<0.001、<0.001、=0.035）。

结论

在治疗肱骨外上髁炎时，超声引导下类固醇激素介入治疗较体外冲击波治疗具有注射精准，起效快，临床疗效持久，不易复发的优势。但体外冲击波治疗具有无创，安全的优势，也是一种适合临床应用的有效治疗手段。

关键词: 超声引导下, 类固醇激素, 体外冲击波, 肱骨外上髁炎, 网球肘
Objective

To compare the clinical effects of ultrasonography (USG)-guided corticosteroid injection and extracorporeal shockwave therapy (ESWT) in lateral epicondylitis.

Methods

A total of 61 patients with lateral epicondylitis were recruited from the outpatient department of orthopedics of the First Affiliated Hospital of Nanjing Medical University from July to October 2018 in this retrospective study. The patients were divided into two groups (A and B) according to the treatment method used. USG-guided corticosteroid injection was performed in group A with 31 patients. ESWT was performed in group B with 30 patients. The t-test was used to compare the difference in visual analog scale (VAS) score, grip strength, and patient-rated tennis elbow evaluation (PRTEE) between the two groups, and the Chi-square test was used to compare the recurrence rate.

Results

The patients were followed for an average duration of (7.2±0.9) months. One month after treatment, the VAS score in group A was significantly lower than that in group B [(1.8±0.4) vs (3.2±0.5), t=12.0959, P<0.001]. No significant differences were found in VAS and PRTEE scores at 3 months post-treatment between the two groups (P>0.05). The VAS [(1.7±0.3) vs (2.8±0.4), t=-12.1772, P<0.001] and PRTEE [(13.2±2.9) vs (22.3±5.1), t=-8.6024, P<0.001] scores as well as grip strength [(12.3±2.5)% vs (28.4±3.2)%, t=-21.9381, P<0.001] and recurrence rate [0/31 vs 4/30, χ2=4.4234, P=0.035] at 6 months post-treatment [(12.3±2.5)% vs (28.4±3.2)%; 0/31 vs 4/30] were significantly lower in group A than in group B.

Conclusion

For patients with lateral epicondylitis, USG-guided corticosteroid injection is an efficient treating method compared with ESWT. However, ESWT is an alternative method with the advantages of non-invasiveness and high safety.

Key words: Ultrasonography-guided, Corticosteroid, Extracorporeal shockwave therapy, Lateral epicondylitis, Tennis elbow
表1 2组肱骨外上髁炎患者基线资料比较
组别 例数 性别（男/女） 年龄（岁，±s） 病变部位（左侧/右侧） 病程（个月，±s）
A组 31 12/19 47.8±5.1 10/21 5.5±0.5
B组 30 13/17 49.1±4.7 8/22 5.3±0.7
统计值 ? χ2=0.1348 t=-1.0343 χ2=0.2291 t=1.2874
P值 ? 0.714 0.305 0.632 0.203
表2 2组肱骨外上髁炎患者治疗前后视觉模拟量表评分比较（分，±s）
组别 例数 治疗前 治疗后1个月 治疗后3个月 治疗后6个月
A组 31 6.3±1.2 1.8±0.4 1.7±0.4 1.7±0.3
B组 30 6.4±1.5 3.2±0.5 1.8±0.2 2.8±0.4
t值 ? -0.2880 -12.0959 -1.2285 -12.1772
P值 ? 0.774 <0.001 0.224 <0.001
表3 2组肱骨外上髁炎患者治疗前后临床疗效、握力变化及复发率比较
组别 例数 PRTEE评分（分，±s） 握力变化（%，±s） 复发率
治疗前 治疗后3个月 治疗后6个月
A组 31 61.2±5.3 12.3±3.2 13.2±2.9 12.3±2.5↓ 0/31
B组 30 60.8±7.7 13.6±4.1 22.3±5.1 28.4±3.2↓ 4/30
统计值 ? t=0.2370 t=-1.3831 t=-8.6024 t=-21.9381 -
P值 ? 0.814 0.172 <0.001 <0.001 0.035
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