网球肘的治疗进展------Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicond
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Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial
N.Smidt, D.van der Windt, W.Assendelft, W.Devillé, I.Korthals-de Bos, L.Bouter
Background
Lateral epicondylitis is generally treated with corticosteroid injections or physiotherapy. Dutch clinical guidelines recommend a wait-and-see policy. We compared the efficacy of these approaches.
Methods
Patients with lateral epicondylitis of at least 6 weeks' duration were recruited by family doctors. We randomly allocated eligible patients to 6 weeks of treatment with corticosteroid injections, physiotherapy, or a wait-and-see policy. Outcome measures included general improvement, severity of the main complaint, pain, elbow disability, and patient satisfaction. Severity of elbow complaints, grip strength, and pressure pain threshold were assessed by a research physiotherapist who was unaware of treatment allocation. We assessed all outcomes at 3, 6, 12, 26, and 52 weeks. The principal analysis was done on an intention-to-treat basis.
Findings
We randomly assigned 185 patients. At 6 weeks, corticosteroid injections were significantly better than all other therapy options for all outcome measures. Success rates were 92% (57) compared with 47% (30) for physiotherapy and 32% (19) for wait-and-see policy. However, recurrence rate in the injection group was high. Long-term differences between injections and physiotherapy were significantly in favour of physiotherapy. Success rates at 52 weeks were 69% (43) for injections, 91% (58) for physiotherapy, and 83% (49) for a wait-and-see policy. Physiotherapy had better results than a wait-and-see policy, but differences were not significant.
Interpretation
Patients should be properly informed about the advantages and disadvantages of the treatment options for lateral epicondylitis. The decision to treat with physiotherapy or to adopt a wait-and-see policy might depend on available resources, since the relative gain of physiotherapy is small.
References
The Lancet, Volume 359, Issue 9307, Pages 657-662
肱骨外上髁炎的局部封闭、理疗康复或等待观察的治疗效果随机对照研究
N.Smidt, D.van der Windt, W.Assendelft, W.Devillé, I.Korthals-de Bos, L.Bouter
背景
肱骨外上髁炎常见的治疗方法有封闭和理疗，德国临床指导说明建议使用等待观察方法，我们比较了不同治疗方式的效果。
方法
在家庭医生的协助下选择有6月以上的肱骨外上髁炎病史的患者作为研究对象，我们随机的选择合适的患者进行6个月的皮质激素的封闭治疗、理疗或等待观察治疗。研究的结果包括一般情况的提高，主诉的严重程度、疼痛、肘关节的残疾程度以及患者的满意度。肘关节不适的严重程度、抓持的力量和疼痛程度由独立的不参与治疗的理疗师进行评估。我们评估了3，6， 12， 26和52周所有的结果。分析时按照intention-to-treat basis原则 。
结论
随机选定185位患者，皮质激素封闭的患者的治疗效果6周内明显优于其它方法， 有效率为92% (57)，而理疗的有效率为47% (30)，等待观察方法为32% (19)。然而封闭组的复发率很高，长期观察后理疗组的效果明显优于封闭组。52周时封闭组的有效率为69% (43)，理疗组为91% (58)，而等待观察组是83% (49) 。理疗组的效果优于等待观察组，但无统计学差异。
讨论
首先需要向肱骨外髁炎的患者说明不同治疗方法的优缺点，选择进行理疗亦或采取等待观察的方法，需要根据自身的医疗资源，因为这样会影响到理疗的效果 。
参考文献
The Lancet, Volume 359, Issue 9307, Pages 657-6
N.Smidt, D.van der Windt, W.Assendelft, W.Devillé, I.Korthals-de Bos, L.Bouter
Background
Lateral epicondylitis is generally treated with corticosteroid injections or physiotherapy. Dutch clinical guidelines recommend a wait-and-see policy. We compared the efficacy of these approaches.
Methods
Patients with lateral epicondylitis of at least 6 weeks' duration were recruited by family doctors. We randomly allocated eligible patients to 6 weeks of treatment with corticosteroid injections, physiotherapy, or a wait-and-see policy. Outcome measures included general improvement, severity of the main complaint, pain, elbow disability, and patient satisfaction. Severity of elbow complaints, grip strength, and pressure pain threshold were assessed by a research physiotherapist who was unaware of treatment allocation. We assessed all outcomes at 3, 6, 12, 26, and 52 weeks. The principal analysis was done on an intention-to-treat basis.
Findings
We randomly assigned 185 patients. At 6 weeks, corticosteroid injections were significantly better than all other therapy options for all outcome measures. Success rates were 92% (57) compared with 47% (30) for physiotherapy and 32% (19) for wait-and-see policy. However, recurrence rate in the injection group was high. Long-term differences between injections and physiotherapy were significantly in favour of physiotherapy. Success rates at 52 weeks were 69% (43) for injections, 91% (58) for physiotherapy, and 83% (49) for a wait-and-see policy. Physiotherapy had better results than a wait-and-see policy, but differences were not significant.
Interpretation
Patients should be properly informed about the advantages and disadvantages of the treatment options for lateral epicondylitis. The decision to treat with physiotherapy or to adopt a wait-and-see policy might depend on available resources, since the relative gain of physiotherapy is small.
References
The Lancet, Volume 359, Issue 9307, Pages 657-662
肱骨外上髁炎的局部封闭、理疗康复或等待观察的治疗效果随机对照研究
N.Smidt, D.van der Windt, W.Assendelft, W.Devillé, I.Korthals-de Bos, L.Bouter
背景
肱骨外上髁炎常见的治疗方法有封闭和理疗，德国临床指导说明建议使用等待观察方法，我们比较了不同治疗方式的效果。
方法
在家庭医生的协助下选择有6月以上的肱骨外上髁炎病史的患者作为研究对象，我们随机的选择合适的患者进行6个月的皮质激素的封闭治疗、理疗或等待观察治疗。研究的结果包括一般情况的提高，主诉的严重程度、疼痛、肘关节的残疾程度以及患者的满意度。肘关节不适的严重程度、抓持的力量和疼痛程度由独立的不参与治疗的理疗师进行评估。我们评估了3，6， 12， 26和52周所有的结果。分析时按照intention-to-treat basis原则 。
结论
随机选定185位患者，皮质激素封闭的患者的治疗效果6周内明显优于其它方法， 有效率为92% (57)，而理疗的有效率为47% (30)，等待观察方法为32% (19)。然而封闭组的复发率很高，长期观察后理疗组的效果明显优于封闭组。52周时封闭组的有效率为69% (43)，理疗组为91% (58)，而等待观察组是83% (49) 。理疗组的效果优于等待观察组，但无统计学差异。
讨论
首先需要向肱骨外髁炎的患者说明不同治疗方法的优缺点，选择进行理疗亦或采取等待观察的方法，需要根据自身的医疗资源，因为这样会影响到理疗的效果 。
参考文献
The Lancet, Volume 359, Issue 9307, Pages 657-6
