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中华老年骨科与康复电子杂志

中华老年骨科与康复电子杂志 ›› 2021, Vol. 07 ›› Issue (03) : 158 -163. doi: 10.3877/cma.j.issn.2096-0263.2021.03.006

康复医学

局部注射富血小板血浆或糖皮质激素联合体外冲击波治疗肱骨外上髁炎的临床疗效对比
张熙斌1, 尹正录1, 李贵玲2, 黄吉军3, 全逸锋1, 林舜艳4,†()   
  1. 1. 225002　扬州大学临床医学院苏北人民医院康复科
    2. 225002　扬州大学临床医学院苏北人民医院检验科
    3. 225002　扬州大学临床医学院苏北人民医院骨科
    4. 225002　扬州大学临床医学院苏北人民医院麻醉科
  • 收稿日期:2020-03-15 出版日期:2021-06-05
  • 通信作者: 林舜艳
  • 基金资助:
    江苏省扬州市社会发展面上项目(YZ2017073)

Clinical efficacy of local injection of platelet-rich plasma or glucocorticoid combined with extracorporeal shock wave therapy in the treatment of lateral epicondylitis

Xibin Zhang1, Zhenglu Yin1, Guiling Li2, Jijun Huang3, Yifeng Quan1, Shunyan Lin4,†()   

  1. 1. Department of Rehabilitation, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou 225002, China
    2. Department of Laboratory, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou 225002, China
    3. Department of Orthopaedic, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou 225002, China
    4. Department of Anesthesiology, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou 225002, China
  • Received:2020-03-15 Published:2021-06-05
  • Corresponding author: Shunyan Lin
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张熙斌, 尹正录, 李贵玲, 黄吉军, 全逸锋, 林舜艳. 局部注射富血小板血浆或糖皮质激素联合体外冲击波治疗肱骨外上髁炎的临床疗效对比[J]. 中华老年骨科与康复电子杂志, 2021, 07(03): 158-163.

Xibin Zhang, Zhenglu Yin, Guiling Li, Jijun Huang, Yifeng Quan, Shunyan Lin. Clinical efficacy of local injection of platelet-rich plasma or glucocorticoid combined with extracorporeal shock wave therapy in the treatment of lateral epicondylitis[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2021, 07(03): 158-163.

目的

比较局部注射自体富血小板血浆（PRP）或糖皮质激素联合体外冲击波（ESWT）治疗肱骨外上髁炎（LE）的临床疗效。

方法

前瞻性收集2017年1月至2018年12月在江苏省苏北人民医院骨科或康复科门诊收治的LE患者47例，采用随机数字表法分为3组，均给予常规康复训练：糖皮质激素组（n=16）患者给予局部注射倍他米松和利多卡因，每周1次，连续4次；糖皮质激素+ESWT组（n=16）给予局部注射倍他米松和利多卡因，48 h后给予ESWT治疗，每周1次，连续4次；PRP+ESWT组（n=15）给予局部注射自体PRP，48 h后给予ESWT治疗，每周1次，连续4次。治疗前、治疗结束时，治疗后4 w、12 w和24 w分别采用视觉模拟评分法（VAS）、Mayo肘关节功能评分系统（MEPS）和上肢功能评分系统（DASH）对三组患者临床疗效进行评估，并记录不良事件。

结果

47例患者获得满意随访，随访率100%，随访时间4~8个月，无明显不良事件发生。三组治疗后不同时间点VAS评分均低于治疗前，差异均有统计学意义（F=14.208，F=15.752，F=16.517，P<0.05）；组间比较，PRP+ESWT组治疗后4 w、12 w、24 w评分显著低于糖皮质激素组和糖皮质激素+ESWT组，差异均有统计学意义（F=2.523，F=3.124，F=4.036，P<0.05）。三组治疗后不同时间点MEPS评分均高于治疗前，差异有统计学意义（F=19.275，F=20.789，F=23.443，P<0.01）；组间比较，PRP+ESWT组治疗后4 w、12 w、24 w评分显著高于糖皮质激素组和糖皮质激素+ESWT组，差异均有统计学意义（F=2.989，F=3.412，F=4.104，P<0.05）。三组治疗后不同时间点DASH评分均低于治疗前，差异均有统计学意义（F=22.341，F=23.548，F=25.338，P<0.01）；组间比较，PRP+ESWT组治疗后4 w、12 w、24 w评分显著低于糖皮质激素组和糖皮质激素+ESWT组，差异均有统计学意义（F=2.587，F=3.264，F=3.894，P<0.05）。

结论

局部注射自体PRP或糖皮质激素联合ESWT均可以有效缓解LE患者疼痛，改善肘关节功能，但PRP综合疗效更显著，值得临床推广。

关键词: 肱骨外上髁炎, 体外冲击波, 富血小板血浆, 糖皮质激素类
Objective

To compare the clinical efficacy of local injection of autologous plateletrich plasma (PRP) or glucocorticoid combined with extracorporeal shock wave therapy (ESWT) in the treatment of lateral epicondylitis (LE).

Methods

Forty-seven patients with LE from January 2017 to December 2018 were randomly divided into three groups: control group (n=16), combined 1 group (n=16) and combined 2 groups (n=15). Three groups of patients were given routine rehabilitation training, and the control group was given local injections of betamethasone and lidocaine once a week for 4 times; combined group 1 was given local injections of betamethasone and lidocaine, and ESWT was given 48 hours later. Treatment, once a week, 4 times in a row. The two groups were given local injection of autologous PRP, and were treated with ESWT 48 hours later, once a week for 4 times. Before treatment, at the end of treatment, 4 weeks, 12 weeks, and 24 weeks after treatment, the clinical effects of the three groups were analyzed by visual analog scale (VAS), Mayo elbow function score system (MEPS), and upper limb function score system (DASH). Adverse events were recorded.

Results

47 patients were followed up satisfactorily. The follow-up rate was 100%. The follow-up time was 4-8 months. No significant adverse events occurred. The VAS scores of the three groups at different time points after treatment were lower than before treatment, and the differences were statistically significant (F=14.208, F=15.752, F=16.517, P<0.05); comparison between groups, 4 weeks after treatment of the combined 2 The scores at 12 weeks and 12 weeks were significantly lower than those in the control group and the combined group 1, and the differences were statistically significant (F=2.523, F=3.124, F=4.036, P<0.05). The MEPS scores at different time points after treatment were higher than before treatment, and the differences were statistically significant (F=19.275, F=20.789, F=23.443, P<0.01); comparison between groups, 4 w, The scores at 12 w and 24 w were significantly higher than those in the control group and the combined 1 group, and the differences were statistically significant (F=2.989, F=3.412, F=4.104, P<0.05). The DASH scores at different time points after treatment were lower than before treatment, and the differences were statistically significant (F=22.341, F=23.548, F=25.338, P<0.01). Between groups, the 4 w, 12 w, and 24 w scores of the combined 2 groups were significantly lower than those of the control group and the combined 1 group, and the differences were statistically significant (F=2.587, F=3.264, F=3.894, P<0.05).

Conclusion

Local injection of autologous PRP or glucocorticoid combined with ESWT can effectively alleviate pain in LE patients and improve elbow joint function, but the comprehensive effect of PRP is more significant and worthy of clinical promotion.

Key words: Lateral epicondylitis, Extracorporeal shock wave therapy, Platelet-rich plasma, Glucocorticoids
表1 三组肱骨外上髁炎患者性别、年龄、病程及病情等一般资料比较
组别 性别（例，男/女） 年龄（年，±s） 病程（月，±s） 病侧（例，左/右） 优势手（例，左/右）
糖皮质激素组 11/5 67±14 10.3±1.8 4/12 4/12
糖皮质激素+ESWT组 10/6 65±14 9.6±1.7 3/13 3/13
PRP+ESWT组 10/5 66±13 10.1±1.9 4/11 3/12
统计值 χ2=1.078 F=1.551 F=1.723 χ2=1.122 χ2=1.256
P值 0.441 0.201 0.149 0.463 0.467
表2 三组肱骨外上髁炎患者治疗前后VAS评分结果比较（分，±s）
组别 治疗前 治疗结束时 治疗后4 w 治疗后12 w 治疗后24 w F值 P值
糖皮质激素组 8.2±1.2 1.1±0.5 3.5±1.2 3.5±1.5 4.0±1.5 14.208 0.003
糖皮质激素+ESWT组 8.2±1.1 1.0±0.8 2.2±1.0 2.8±1.2 4.0±1.5 15.752 0.002
PRP+ESWT组 8.4±1.0 1.1±0.5 1.1±1.0 1.1±0.6 1.0±0.6 16.517 0.001
F值 1.868 1.774 2.623 3.124 4.036    
P值 0.117 0.137 0.034 0.016 0.005    
表3 三组肱骨外上髁炎患者治疗前后MEPS评分结果比较（分，±s）
组别 治疗前 治疗结束时 治疗后4 w 治疗后12 w 治疗后24 w F值 P值
糖皮质激素组 24±6 67±8 68±8 66±8 63±8 19.275 0.001
糖皮质激素+ESWT组 23±5 68±9 72±8 73±8 65±8 20.789 0.001
PRP+ESWT组 23±6 70±8 79±8 80±6 82±7 23.443 0.001
F值 1.789 1.846 2.989 3.412 4.104    
P值 0.134 0.121 0.020 0.011 0.004    
表4 三组肱骨外上髁炎患者治疗前后DASH评分结果比较（分，±s）
组别 治疗前 治疗结束时 治疗后4 w 治疗后12 w 治疗后24 w F值 P值
糖皮质激素组 133±17 76±14 75±12 79±14 79±11 22.341 0.001
糖皮质激素+ESWT组 134±18 76±16 70±13 72±14 78±12 23.548 0.001
PRP+ESWT组 135±17 74±15 66±10 58±12 56±12 25.338 0.001
F值 1.684 1.589 2.587 3.264 3.894    
P值 0.160 0.188 0.036 0.002 0.006    
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