摘要
目的探讨单纯顽固性肱骨内上髁炎与合并顽固性肱骨外上髁炎的手术疗效。方法回顾性分析2010年1月至2023年12月期间首都医科大学附属北京积水潭医院运动医学科接受小切口屈肌腱缝合修复的41例顽固性肱骨内上髁炎患者资料。男13例,女28例;年龄(52.4±7.6)岁;症状持续时间为12(6,24)个月。单纯顽固性肱骨内上髁炎26例(设为单纯组);顽固性肱骨内上髁炎合并顽固性肱骨外上髁炎的患者15例,额外进行外侧肌腱缝合修复(设为合并组)。术前、术后3个月及末次随访时对两组患者疼痛视觉模拟评分(VAS)、Mayo肘关节功能评分(MEPS)及臂、肩、手功能障碍评分(DASH)和握力肌力水平进行评估和组内比较。结果所有患者术后获12(12,16)个月随访。术后3个月及末次随访时单纯组患者的疼痛VAS评分[3.0(1.8,5.0)、0.0(0.0,2.0)分]、MPES[85.0(81.3,85.0)、100.0(85.0,100.0)分]、DASH[18.9(12.7,26.7)、0.0(0.0,7.3)分]均较术前[5.0(4.0,7.0)、70.0(65.0,85.0)、34.9(23.2,46.2)分]显著改善,差异均有统计学意义(P<0.05)。末次随访时单纯组患者握力(88.4%±7.0%)较术前(50.2%±14.7%)显著改善,差异有统计学意义(P<0.05),但术后3个月单纯组患者握力(56.2%±12.3%)与术前比较差异无统计学意义(P=0.137)。术后3个月及末次随访时合并组患者的疼痛VAS评分[3.0(3.0,4.0)、0.0(0.0,1.0)分]、MPES[85.0(85.0,85.0)、100.0(85.0,100.0)分]、DASH[16.7(13.3,23.3)、3.3(0.0,7.0)分]、握力(58.9%±11.2%、86.9%±5.5%)均较术前[5.0(5.0,7.0)分、70.0(60.0,70.0)分、45.6(33.3,46.6)分、43.7%±16.1%]显著改善,差异均有统计学意义(P<0.05)。所有患者在随访期间未观察到需要进一步治疗的并发症。结论小切口屈肌腱缝合修复可有效治疗单纯性顽固性肱骨内上髁炎,对于合并顽固性肱骨外上髁炎者,额外进行外侧肌腱缝合修复也可以获得良好疗效。
Objective:To evaluate the surgical outcomes of recalcitrant medial epicondylitis combined with recalcitrant lateral epicondylitis or without.Methods:A retrospective study was conducted to analyze the clinical data of the 41 patients who had undergone suture repair of the flexor tendon via a small incision for recalcitrant medial epicondylitis between January 2010 and December 2023 at Department of Sports Medicine,Beijing Jishuitan Hospital,Capital Medical University.There were 13 males and 28 females,with an age of(52.4±7.6)years and duration of symptoms of 12(6,24)months.Of the patients,26 suffered from simple recalcitrant medial epicondylitis(the simple group)and 15 recalcitrant medial epicondylitis combined with recalcitrant lateral epicondylitis(the combined group subjected to additional suture repair of the lateral tendon).The visual analogue scale(VAS)for pain,Mayo elbow performance score(MEPS),disabilities of the arm,shoulder,and hand(DASH)score,and grip strength level were evaluated at preoperation,postoperative 3 months,and the final follow-up to evaluate the surgical efficacy.Comparisons were made within the 2 groups.Results:The follow-up time for all patients was 12(12,16)months.At postoperative 3 months and the final follow-up,the VAS pain score[3.0(1.8,5.0)points,and 0.0(0.0,2.0)point],MPES[85.0(81.3,85.0)points,and 100.0(85.0,100.0)points],and DASH score[18.9(12.7,26.7)points,and 0.0(0.0,7.3)point]in the simple group were significantly improved compared with those at preoperation[5.0(4.0,7.0)points,70.0(65.0,85.0)points,and 34.9(23.2,46.2)points](P<0.05).In the simple group,the grip strength at the final follow-up(88.4%±7.0%)was significantly improved compared with that at preoperation(50.2%±14.7%)(P<0.05),but the difference in the grip strength was not statistically significant between that at postoperative 3 months(56.2%±12.3%)and that at preoperation(P=0.137).In the combined group,at postoperative 3 months and the final follow-up,the VAS pain score[3.0(3.0,4.0)points,and 0.0(0.0,1.0)point],MPES[85.0(85.0,85.0)points,and 100.0(85.0,100.0)points],DASH score[16.7(13.3,23.3)points,and 3.3(0.0,7.0)points],and grip strength(58.9%±11.2%,and 86.9%±5.5%)were significantly improved compared with those at preoperation[5.0(5.0,7.0)points,70.0(60.0,70.0)points,45.6(33.3,46.6)points,and 43.7%±16.1%](P<0.05).Follow-ups revealed no complications requiring further treatment in all the patients.Conclusions:Early clinical follow-ups show that suture repair of the affected tendon through a small incision is an effective treatment of recalcitrant medial epicondylitis.Additional suture repair of the lateral tendon can also achieve good outcomes for those combined with recalcitrant lateral epicondylitis.
作者
李尚哲
陈仁杰
杨珖
鲁谊
Li Shangzhe;Chen Renjie;Yang Guang;Lu Yi(Department of Sports Medicine,Beijing Jishuitan Hospital,Capital Medical University,,Beijing100035,China)
出处
《中华创伤骨科杂志》
北大核心
2025年第5期403-409,共7页
Chinese Journal of Orthopaedic Trauma
基金
北京市自然科学基金-海淀原始创新联合基金(L222013)。
关键词
肌腱病
缝合锚
修复外科手术
肱骨内上髁炎
小切口
Elbowtendinopathy
Suture anchors
Reconstructivesurgical procedures
Medial epicondylitis
Small incisions
