OBJECTIVE:To assess if ultrasound guided autologous blood injection is an effective treatment for medial epicondylitis. METHODS:Twenty patients (13 men, 7 women) with refractory medial epicondylitis with symptom duration of 12 months underwent sonographic evaluation. Tendinosis was confirmed according to three sonographic criteria: echo texture, interstitial tears and neovascularity. The tendon was then dry needled and autologous blood was injected. Patients were reviewed at 4 weeks and at 10 months. VAS scores and modified Nirschl scores were assessed pre-procedure and post-procedure. RESULTS:There was significant reduction in VAS pain score between pre-procedure and 10 months post-procedure when it had a median (IQR) of 1.00 (1-1.75), range 0-7. The median (IQR) Nirschl score, which at pre-procedure was 6.00 (5-7), range 4-7, had decreased at 4 weeks to 4.00 (2.25-5), range 2-7, and at 10 months to 1.00 (1-1.75), range 0-7, revealing a significant decrease (z = 3.763, p<0.001). The hypo-echoic change in the flexor tendon significantly decreased between pre-procedure, when there was a mean (SD) of 6.45 (1.47), and at 10 months, when it was 3.85 (2.37) (p<0.001). Doppler ultrasound showed that neovascularity decreased between pre-procedure, when there was a mean (SD) of 6.10 (1.62), range 4-9, and at 10 months, when it was 3.60 (2.56), range 0-9 (p<0.001). DISCUSSION:The combined action of dry needling and autologous blood injection under ultrasound guidance appears to be an effective treatment for refractory medial epicondylitis as demonstrated by a significant decrease in VAS pain and a fall in the modified Nirschl scores.

译文

目的:评估超声引导下自体血注射是否是治疗内侧上con炎的有效方法。
方法:对20例症状持续时间为12个月的难治性内侧上con炎患者(13例男性,7例女性)进行超声检查。根据三个超声检查标准确认了腱鞘病:回声纹理,间质性眼泪和新生血管。然后将肌腱干针并注射自体血。在第4周和第10个月对患者进行检查。在手术前和手术后评估VAS评分和修正的Nirschl评分。
结果:术前至术后10个月,VAS疼痛评分的中位数(IQR)为1.00(1-1.75),范围为0-7,显着降低。术前Nirschl评分中位数(IQR)为6.00(5-7),范围为4-7,在第4周时降至4.00(2.25-5),范围为2-7,在10个月时降至1.00 (1-1.75),范围为0-7,显示出显着下降(z = 3.763,p <0.001)。在术前平均屈伸(SD)为6.45(1.47)时和10个月屈伸肌腱的低回声变化为3.85(2.37)(p <0.001)时,显着降低。多普勒超声显示,术前两次平均血管密度(SD)为6.10(1.62),范围为4-9,而在10个月时为3.60(2.56),范围为0-9(p < 0.001)。
讨论:超声引导下干针刺和自体血液注射的联合作用似乎是治疗难治性内侧上con炎的有效方法,其表现为VAS疼痛明显减轻,Nirschl评分降低。

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