囊外法关节镜手术治疗顽固性网球肘的临床效果及预后因素分析

Analysis of factors influencing the efficacy of extracapsular arthroscopic surgery for refractory tennis elbow

目的探讨囊外法关节镜手术治疗顽固性网球肘的中期临床效果,分析影响手术效果的预后因素。方法回顾性分析2012年3月至2016年1月北京大学第三医院运动医学研究所同一组医师行囊外法关节镜手术治疗的38例顽固性网球肘患者的临床资料。其中男性15例,女性23例,年龄44.2岁(范围:32~59岁)。左肘15例,右肘23例。保守治疗19个月(范围:4~60个月)效果不佳,行囊外法关节镜手术治疗。收集患者手术前、后疼痛视觉模拟评分(VAS)、Mayo肘功能评分和臂肩功能障碍(DASH)评分,采用配对样本t检验对进行比较;采用独立样本t检验、χ^2检验、秩和检验对临床资料进行单因素分析,并用Logistic回归进行多因素分析,筛选影响患者手术效果的预后因素。结果38例患者均随访24个月,未出现感染、神经损伤等并发症。末次随访时,患者的VAS评分[M(QR)]由术前的7.0(1.2)分降低至0(1)分(Z=-5.40,P=0.00),Mayo评分由术前的55(26)分升至100(0)分(Z=-5.38,P=0.00),DASH评分由术前的56.7(27.3)分降低至0.8(5.8)分(Z=-5.37,P=0.00),差异均有统计学意义。Mayo功能评分优36例(94.7%),良2例(5.3%)。单因素及多因素分析结果显示,患者性别为女性与术后6个月Mayo评分未完全正常相关(OR=4.96,95%CI:1.06~23.16,P=0.04)。结论囊外法关节镜处理顽固性网球肘的中期疗效满意,术后并发症少。性别为女性与预后不良相关。

Objective To investigate the mid-term efficacy of extracapsular arthroscopic surgery for refractory tennis elbow and explore prognostic factors.Methods A retrospective study of 38 patients suffered from refractory tennis elbow and underwent extracapsular arthroscopic surgery performed by the same group of doctors during March 2012 to January 2016 at Institute of Sports Medicine,Peking University Third Hospital.There were 15 males and 23 females with age of 44.2 years(range:32-59 years).Fifteen cases on the left and 23 cases on the right.Visual analogue scale(VAS),Mayo elbow performance score and Disability of Army,Shoulder and Hand(DASH)score were collected preoperatively and postoperatively,and compared by paired-t test.Independent sample t test,χ^2 test,multivariate logistic regression were used to analyze the relationship between scores and various potential influencing factors.Results All 38 patients were followed up for 24 months.There was no complication such as infection or nerve injury recorded.VAS decreased from 7.0(1.2)(M(QR))preoperative to 0(1)(Z=-5.40,P=0.00),Mayo increased from 55(26)to 100(0)(Z=-5.38,P=0.00),DASH decreased from 56.7(27.3)to 0.8(5.8)(Z=-5.37,P=0.00).The Mayo elbow performance score was excellent in 36 cases(94.7%)and good in 2 cases(5.3%).Women was significantly associated with poor prognosis.Conclusions The mid-term effect of extracapsular arthroscopic treatment of refractory tennis elbow is satisfactory with few postoperative complications.Women was associated with poor prognosis.