超声引导下经皮伸肌总腱微血管神经束射频热凝术治疗顽固性肱骨外上髁炎的临床效果  

Clinical effect of ultrasound-guided percutaneous radiofrequency thermocoagulation for common extensor tendon microvascular nerve bundle in the treatment of refractory external humeral epicondylitis

作　　者：谢永强 陈堂斌 丁源 归发睦 江兴华[3] Xie Yongqiang;Chen Tangbin;Ding Yuan;Gui Famu;Jiang Xinghua(Department of Anesthesiology,Guidong People's Hospital of Guangxi Zhuang Autonomous Region,Wuzhou City,Guangxi Zhuang Autonomous Region 543001,China;Department of Orthopedics,Guidong People's Hospital of Guangxi Zhuang Autonomous Region,Wuzhou City,Guangxi Zhuang Autonomous Region 543001,China;Department of Pain Medicine,Second Xiangya Hospital of Central South University,Changsha City,Hunan Province 410011,China)

机构地区：[1]广西壮族自治区桂东人民医院麻醉科,广西壮族自治区梧州市543001 [2]广西壮族自治区桂东人民医院骨科,广西壮族自治区梧州市543001 [3]中南大学湘雅二医院疼痛科,长沙市410011

出　　处：《中华疼痛学杂志》2022年第4期497-501,共5页Chinese Journal Of Painology

基　　金：湖南省临床医疗技术创新引导项目(2020SK53412)。

摘　　要：目的探讨超声引导下经皮伸肌总腱微血管神经束射频热凝去神经术治疗顽固性肱骨外上髁炎的疗效。方法对2019年3月至2020年7月期间广西壮族自治区桂东人民医院疼痛科收治的18例顽固性肱骨外上髁炎患者,在超声引导下对穿经伸肌总腱的微血管神经束采用射频热凝去神经术。分别采用视觉模拟评分(VAS)、梅奥肘关节功能评分(MEPS)、日常生活质量评分(SF-36)评估治疗前,治疗后1、6、12个月时疼痛程度,以及肘关节功能和生活质量变化。同时观察治疗后可能的神经损伤、肌腱断裂、感染和皮下血肿等手术相关并发症的发生情况。结果所有患者手术均顺利完成,术中及术后未见血管神经损伤,自述疼痛症状及活动受限程度较术前减轻。与术前相比,患者术后12个月时静息、触碰和紧握时VAS评分都得到了显著改善,差异均具有统计学意义(P均<0.05)。与术后1个月时比较,术后12个月时各状态下的VAS评分均有显著改善,差异有统计学意义(P均<0.05);与术前比较,术后各观察时点的MEPS和SF-36评分均有显著改善,差异均有统计学意义(P均<0.05)。结论超声引导下经皮伸肌总腱微血管神经束射频热凝术是治疗顽固性肱骨外上髁炎的一种安全、有效的方法。Objective To explore the efficacy of ultrasound-guided radiofrequency thermocoagulation for common extensor tendon microvascular nerve bundle in the treatment of refractory external humeral epicondylitis.Methods From March 2019 to July 2020,18 patients with refractory external humeral epicondylitis were treated in the Department of Pain Medicine,Guidong People's Hospital of Guangxi Zhuang Autonomous Region.Visual analogue scale(VAS),Mayo elbow function score(MEPS)and SF-36 were used to evaluate the pain level,and elbow joint function and quality of life were also evaluated before treatment and at 1,6 and 12 months after the treatment.Postoperative complications such as nerve injury,tendon rupture,infection and subcutaneous hematoma were observed at the same time.Results All the operations were successfully completed,and there was no injury of blood vessels and nerves during and after the operation.Compared with that before the treatment,VAS were obviously improved at rest,touch and grip in 12 months after the treatment(all P<0.05).Compared with 1 month after the treatment,VAS was significantly improved in each state at 12 months after the treatment,and the difference was statistically significant(all P<0.05).SF-36 scores were significantly improved,and the differences were statistically significant(all P<0.05).Conclusion Ultrasound guided radiofrequency thermocoagulation denervation of common extensor tendon microvascular nerve bundle is a safe and effective method for the treatment of intractable external humeral epicondylitis.

关 键 词：网球肘(肱骨外上髁炎) 慢性疼痛 射频热凝术 超声引导 

分 类 号：R681.7[医药卫生—骨科学]