顽固性网球肘的MRI分型与治疗

Classification and treatment analysis of refractory tennis elbow based on magnetic resonance imaging

目的探讨顽固性网球肘基于磁共振成像(MRI)的分型及治疗方法。方法回顾性分析遂宁市中心医院关节外科2014年6月至2018年2月连续收治的顽固性网球肘患者28例31个肘关节,均行MRI检查。根据MRI表现分型,采取分型治疗:Ⅰa型、Ⅳ型采用改良的Nirschl手术治疗;Ⅰb型、Ⅲ型采用关节镜治疗;Ⅱ型采用保守治疗。随访观察治疗前后患者VAS疼痛评分、Mayo肘关节功能评分、患肘握力;采用Verhaar肘关节疗效评估标准评价优良率。结果28例患者,3例为双侧顽固性网球肘;左肘7例,右肘24例;根据MRI分型:Ⅰa型17肘,Ⅰb型9肘,Ⅱ型1肘,Ⅲ型2肘,Ⅳ型2肘;所有患者均获随访,随访时间13~36个月,平均19.2个月;未见围手术期并发症;VAS评分由治疗前的(5.65±0.95)分降至治疗后的(0.65±0.61)分,差异有统计学意义(P<0.05);Mayo肘关节功能评分由(60.84±9.06)分增高至(96.13±6.67)分,差异有统计学意义(P<0.05);握力由(13.65±2.85)kg增加至(26.23±2.99)kg,差异具有统计学意义(P<0.05);根据Verhaar肘关节疗效评估标准,优良率达96.77%(30/31)。结论MRI可较好的明确顽固性网球肘的病因病理,根据MRI分型治疗,顽固性网球肘患者可取得更好的临床疗效,但这种分型标准尚需多中心、大样本的临床考证。

Objective To explore the classification of refractory tennis elbow based on magnetic resonance imaging(MRI) and its treatment. Methods A retrospective analysis of 28 consecutive cases(31 elbow), who admitted to Department of Joint Surgery, Suining Central Hospital Affiliated to Chongqing Medical University from June 2014 to February 2018 was performed. These patients underwent MRI and were classified and treated according to MRI findings;Type Ⅰa and type Ⅳ was treated with improved Nirschl surgery;Type Ⅰb and type Ⅲ was performed with arthroscopy;Type Ⅱ was treated with conservative treatment. The patients were followed up with visual analog scale(VAS) pain score, Mayo Elbow Performance Score(MEPS) and grip strength before and after treatment, and the excellent and good rate was evaluated by Verhaar elbow joint efficacy evaluation criteria. Results Among the 28 patients(31 elbows), there were 7 left and 24 right elbow, and 3 were bilateral refractory tennis elbow. According to MRI performance classification: there were 17 cases of Type Ⅰa elbows, 9 cases of type Ⅰb elbows, 1 cases of type Ⅱ elbow, 2 cases for each of type Ⅲ elbows and type Ⅳ elbows. All patients were followed up 13-36 months, with an average of19.2 months. No perioperative complications were observed. VAS score decreased from(5.65 ± 0.95) points to(0.65 ±0.61) points(P<0.05);Mayo Elbow Function Score increased from(60.84±9.06) points to(96.13±6.67) points(P<0.05);Grip strength increased from(13.65±2.85) kg to(26.23±2.99) kg(P<0.05);according to Verhaar elbow joint efficacy evaluation criteria, the excellent and good rate was 96.77%(30/31). Conclusion MRI examination can better determine the etiology and pathology of refractory tennis elbow. Treatment according to MRI classification can help patients with refractory tennis elbow can achieve better clinical efficacy. But this classification standard still needs confirmation from multi-center and large sample clinical research.