肱骨外上髁炎命名合理性的系统评价  

The lateral epicondylitisnamed rationality：a systematic review

作　　者：熊科[1] 范伟[1] 安洪[1] 蔡枭[1] 胡廷毅[1] 

机构地区：[1]重庆医科大学附属第一医院骨科,400016

出　　处：《中华医学教育探索杂志》2015年第1期78-83,共6页Chinese Journal of Medical Education Research

摘　　要：目的：分析肱骨外上髁炎患者MRI表现，探讨肱骨外上髁炎命名的合理性，为第九版外科学教材审定时提出更名意见。方法采用Cochrane系统评价方法，检索Cochrane图书馆、Medline、OVID、EMbase、中国生物医学文献数据库（CBM）、中文科技期刊数据库（VIP）、中国期刊全文数据库（CNKI）、万方数字化期刊全文数据库，共检索到31篇文献。其中符合纳入标准为肱骨外上髁炎患者肘部磁共振表现的文献13篇。对符合病例对照研究的资料采用RevMan 5.0进行Meta分析，比值比（OR）作为计数资料效应量，区间估计均采用95%的可信区间（CI）。当纳入的研究数据不能进行Meta分析时，则仅作描述性定性分析。结果共纳入13篇文献，包括患侧肘关节组315例（5例为双侧发病，305例为单侧发病），无症状侧肘关节组169例（98例为患者健侧肘关节，71例为健康志愿者肘关节）。 Meta分析结果提示：患者组与健康志愿者对照组肘部MRI表现差异有统计学意义[OR 合并=88.55，95%CI=（29.20，268.57）]。患侧与健侧肘关节组之间的肘部MRI表现差异有统计学意义[OR 合并=80.17，95%CI=（21.53，298.59）]。MRI分析显示，除了伸肌总腱的损伤征象外，肘部还广泛合并有其他改变，如桡侧副韧带损伤、骨髓水肿、关节积液、肌腱撕裂、肘肌水肿等。结论通过MRI常规扫描成像发现，所谓肱骨外上髁炎其病理变化主要为伸肌总腱及邻近组织的慢性损伤，当前肱骨外上髁炎的命名存在不合理性，故建议在第九版外科学教材审定时，宜用肱骨外上髁周围炎命名更为确切。Objective By analysis oflateralepicondylitis patients MRI features to explore the lateralepicondylitis namedrationality and authorized its opinions for the ninth edition surgery textbook. Methods Cochrane＇s systematic review methods were used to retrieve the literature about lateralepi-condylitis patients MRI features fromCochrane Library, Medline, OVID, EMBASE, Chinese biomedical literature database （CBM）, VIP, CNKI, Wan fang digital journals, and totally 31 articles were reviewed. 13 articles met the inclusion criteria for the lateral epicondyle of humerus elbow in patients with MRI findings. In accordance with the case-control data RevMan 5.0 software was used for Meta analysis withodds ratio （OR） as count data statistics. Interval estimation wasmade of 95% confidence interval （CI）. When the datacannot be performed Meta analysis, only qualitative analysis was made. Results 13 studies met the inclusion criteria, including 315 ipsilateralelbows （5 patients with bilateral disease, 305 patients with unilateral disease） and 169 asymptomatic side of the elbow （98 cases of patients with the contralateral elbow, 71 cases of healthy volunteers）. The results of Meta analysis suggested that pa-tients and healthy volunteers of elbow MRI showed statistically significance [OR=88.55, 95%CI=（29.20, 268.57）]. Between ipsilateral elbow and contra lateral of elbow MRI showed statistically significance [OR=80.17, 95%CI=（21.53, 298.59）]. MRI analysis showed that in addition to signs of extensor tendon injury, the elbow was also widely associated with other changes, such as radial collateral ligament in-jury, bone marrow edema, joint effusion, tendon tear, and elbows muscle edema. Conclusion Through MRI findings,the maln pathological changes of the so-called lateralepicondyliti-saremalnly for total ex-tensor tendon and adjacent tissue of chronic injury, Naming the current external humeral epicondylitis is unreasonable. Therefore, periarthritis of lateral epicondyle of humerus seems to be the best appro

关 键 词：磁共振成像 肱骨外上髁炎 肘关节 

分 类 号：R68[医药卫生—骨科学]