兩種網球肘手術均被視為成功


  July 16, 2007 (卡加立) — 肱骨外上髁炎 (網球肘) 手術的一些首次長期結果中,開刀型和關節鏡檢查兩者均宣稱有好的結果;美國運動醫學整型外科協會(American Orthopedic Society for Sports Medicine(AOSSM)) 第31屆年會中,一個小組的共同主持人Patrick J. DeMeo醫師表示,研究顯示,醫師可以依照他們個人的背景和訓練選擇這兩種手術之一。
  
  匹茲堡海盜隊的醫療主任DeMeo醫師向Medscape表示,兩種手術在長期來說都可以有絕佳的結果;他指出,該研究會吸引廣泛的興趣,這是大多數整形外科醫生每天幾乎都會看見的一個非常普通的問題,但有關它的長期研究非常少。
  
  關節鏡檢查是由Champ L. Baker III 醫師、匹茲堡大學的整形外科住院醫師所提出,他是和他的父親,Hughston診所的 Champ L. Baker Jr. 醫師一起進行研究。
  
  該研究共追蹤30位病患(年紀平均43 歲),手術後平均年數為10.8,追蹤時,平均視覺類比量表(visual analogue scale (VAS))在休息時的疼痛分數是 0 ,日常活動時的分數是 1.0 ,工作或運動時的分數是1.9 。
  
  梅約診所手肘表現指數(Mayo Clinic Elbow Performance Index)的平均功能分數是11.66 、接近滿分的12;26位病患 (87%)表示他們滿意手術結果。
  
  開刀型手術是由Georgetown大學整形外科副教授Robert P. Nirschl醫師所提出,使用稍微不同的測量。
  
  獨立評估者評估Nirschl醫師手術的83位病患(平均年紀46歲)的紀錄,平均追蹤 12.6 年,平均整體VAS 疼痛分數從手術前的8.4改善到追蹤時的2.1(P < .001)。
  
  Nirschl醫師的病患,其美國肩膀手肘外科醫師 (American Shoulder and Elbow Surgeons)平均分數從34.3改善到87.7 (P < .001),病患滿意度在滿分10分中平均達到8.9 。
  
  Nirschl醫師向Medscape表示,雖然兩個研究的結果相似,但開刀型提供比較清楚的優勢,關節鏡手術牽涉到技術上的困難,且醫師需要較多的昂貴設備,非關節鏡專家的外科醫師可能會切掉太多肌腱或者留下太多病理組織。
  
  DeMeo醫師同意關節鏡手術需要更多的專業技術,但他表示,可以提供較快恢復時間的優勢。
  
  DeMeo醫師的報告沒有相關的財經關係,Nirschl醫師是Medical Sports的諮詢委員,Medical Sports生產用在治療側邊上髁炎的反作用力支撐臂。
  
  美國運動醫學整型外科協會第31屆年會,發表於 2007年7月14日。

Competing Tennis Elbow Surgeri

By Laird Harrison
Medscape Medical News

July 16, 2007 (Calgary) — In some of the first long-term outcome reports on operations for lateral epicondylitis (tennis elbow), pioneers of open surgery and arthroscopy both announced good results.

The studies showed that physicians could choose between the 2 procedures based on their individual backgrounds and training, said Patrick J. DeMeo, MD, the comoderator of a panel in which the studies were presented at the American Orthopaedic Society for Sports Medicine 31st Annual Meeting here.

"Both procedures can produce excellent results in the long run," Dr. DeMeo, medical director of the Pittsburgh Pirates, told Medscape.

The studies should attract widespread interest, he said. "This is a very common problem that most orthopaedic surgeons see almost every day, and there are very few long-term studies of it."

The arthroscopic study was described by Champ L. Baker III, MD, an orthopaedic resident at the University of Pittsburgh, who worked on the study under his father, Champ L. Baker Jr, MD, of the Hughston Clinic in Columbus, Georgia.

The researchers followed 30 patients (average age, 43 years) for a mean of 10.8 years after surgery. At follow-up, the average visual analog scale (VAS) pain score was 0 at rest, 1.0 with activities of daily living, and 1.9 with work or sports.

The average functional score on the Mayo Clinic Elbow Performance Index was 11.66 of a possible 12. Twenty-six patients (87%) said they were satisfied with the procedure.

The open surgery study was described by Robert P. Nirschl, MD, MS, an associate professor of orthopaedics at Georgetown University in Washington, DC, and used slightly different outcome measures.

Independent evaluators assessed the records of 83 patients (average age, 46 years) on whom Dr. Nirschl operated, with a mean follow-up of 12.6 years. The average overall VAS pain score improved from 8.4 before surgery to 2.1 at follow-up (P < .001).

The average American Shoulder and Elbow Surgeons score for Dr. Nirschl's patients improved from 34.3 to 87.7 (P < .001), and patient satisfaction scores averaged 8.9 of 10.

Although the results of the 2 studies were similar, open surgery offers clear advantages, Dr. Nirschl told Medscape. "The arthroscopic approach involves technical difficulties," he said. "And you need a lot of expensive equipment." A surgeon who isn't an expert with an arthroscope may cut too much tendon or leave pathological tissue in place, he added.

Dr. DeMeo agreed that arthroscopy demands more specialized skill, but he said that it also offers the advantage of a quicker recovery time.

Dr. DeMeo reported no relevant financial relationships. Dr. Nirschl is a consultant to Medical Sports, which manufactures counterforce braces used in lateral epicondylitis treatment.

American Orthopaedic Society for Sports Medicine 31st Annual Meeting. Presented July 14, 2007.

    
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