PDF(Pubmed)
Abstract：
OBJECTIVE: To investigate the structural alterations, neovascularity, and elasticity of tendons and the relationship between elasticity and the Patient Rated Tennis Elbow Evaluation score after undergoing US-guided fenestration or surgery in patients with chronic lateral elbow tendinopathy.
METHODS: Participants from the per-protocol population of a randomized trial conducted between October 2016 and June 2020 were included. The surgery and fenestration groups included 24 (mean age, 50 ± 7 years [standard deviation], 10 men) and 29 (47 ± 8 years, 18 men) participants, respectively. Ultrasound exams were performed at baseline, 6 months, and 12 months. Statistical analyses included linear mixed effects and generalized equation estimation models.
RESULTS: Fenestration had no significant impact on tendon thickness (p = 0.46). Conversely, surgery significantly increased tendon thickness at 6 months (p < 0.0001) and remained elevated at 12 months (p = 0.04). Tendon echostructure exhibited a group effect (p = 0.03), indicating a higher proportion of pathological scores in the surgery group post-intervention compared to the fenestration group. Both groups showed a similar reduction in neovascularity from 6 to 12 months postintervention (p = 0.006). Shear-wave velocity increased in the fenestration group at 6 months (p = 0.04), while the surgery group experienced a nonsignificant decrease at 6 months, with some improvement at 12 months (p = 0.08). Changes in shear-wave velocity did not correlate with clinical outcome.
CONCLUSIONS: Fenestration and surgery reduced tendon neovascularity over time. Unlike surgery, fenestration did not impact tendon size while improving tendon echostructure and elasticity.
UNASSIGNED: Fenestration and surgery equally alleviated symptoms and decreased tendon neovascularity in lateral elbow tendinopathy; however, fenestration did not alter tendon thickness and improved echostructure and shear-wave velocity, suggesting shear-wave velocity\'s potential for quantitatively monitoring tendon elasticity during healing.
CONCLUSIONS: Reliable markers for monitoring healing response and informing treatment protocols in elbow tendinopathy are lacking. Fenestration and surgery reduced tendon neovascularity, while fenestration improved tendon echostructure and shear-wave velocity. Shear-wave velocity may provide quantitative measures to monitor tendon elasticity in response to treatment.
METHODS: Participants from the per-protocol population of a randomized trial conducted between October 2016 and June 2020 were included. The surgery and fenestration groups included 24 (mean age, 50 ± 7 years [standard deviation], 10 men) and 29 (47 ± 8 years, 18 men) participants, respectively. Ultrasound exams were performed at baseline, 6 months, and 12 months. Statistical analyses included linear mixed effects and generalized equation estimation models.
RESULTS: Fenestration had no significant impact on tendon thickness (p = 0.46). Conversely, surgery significantly increased tendon thickness at 6 months (p < 0.0001) and remained elevated at 12 months (p = 0.04). Tendon echostructure exhibited a group effect (p = 0.03), indicating a higher proportion of pathological scores in the surgery group post-intervention compared to the fenestration group. Both groups showed a similar reduction in neovascularity from 6 to 12 months postintervention (p = 0.006). Shear-wave velocity increased in the fenestration group at 6 months (p = 0.04), while the surgery group experienced a nonsignificant decrease at 6 months, with some improvement at 12 months (p = 0.08). Changes in shear-wave velocity did not correlate with clinical outcome.
CONCLUSIONS: Fenestration and surgery reduced tendon neovascularity over time. Unlike surgery, fenestration did not impact tendon size while improving tendon echostructure and elasticity.
UNASSIGNED: Fenestration and surgery equally alleviated symptoms and decreased tendon neovascularity in lateral elbow tendinopathy; however, fenestration did not alter tendon thickness and improved echostructure and shear-wave velocity, suggesting shear-wave velocity\'s potential for quantitatively monitoring tendon elasticity during healing.
CONCLUSIONS: Reliable markers for monitoring healing response and informing treatment protocols in elbow tendinopathy are lacking. Fenestration and surgery reduced tendon neovascularity, while fenestration improved tendon echostructure and shear-wave velocity. Shear-wave velocity may provide quantitative measures to monitor tendon elasticity in response to treatment.
摘要：
目的：为了研究结构改变，新生血管,慢性肘部外侧肌腱病患者接受美国指导的开窗术或手术后，肌腱的弹性以及弹性与患者评定的网球肘评估评分之间的关系。
方法：纳入2016年10月至2020年6月进行的一项随机试验的符合方案人群的参与者。手术和开窗组包括24(平均年龄，50±7年[标准偏差]，10名男子）和29名（47±8岁，18名男子）参与者，分别。在基线时进行超声检查，6个月,和12个月。统计分析包括线性混合效应和广义方程估计模型。
结果：开窗术对肌腱厚度没有显着影响（p=0.46）。相反，手术在6个月时肌腱厚度显著增加(p<0.0001),在12个月时肌腱厚度仍然升高(p=0.04).肌腱回声结构表现出群体效应(p=0.03)，表明手术组干预后病理评分的比例高于开窗组。从干预后6到12个月，两组都显示出相似的新生血管减少（p=0.006）。开窗组在6个月时剪切波速度增加（p=0.04），而手术组在6个月时没有显着下降，在12个月时有所改善（p=0.08）。剪切波速度的变化与临床结果无关。
结论：随着时间的推移，开窗术和手术减少了肌腱新生血管。不像手术,开窗术不会影响肌腱大小，同时改善肌腱回声结构和弹性。
■开窗术和手术同样减轻了肘部外侧肌腱病的症状并减少了肌腱新生血管；然而，开窗术没有改变肌腱厚度，改善回声结构和剪切波速度，提示剪切波速度在愈合过程中定量监测肌腱弹性的潜力。
结论：缺乏监测肘部肌腱病愈合反应和指导治疗方案的可靠指标。开窗术和手术减少了肌腱新生血管，而开窗术改善了肌腱的回声结构和剪切波速度。剪切波速度可以提供定量测量以监测响应于治疗的肌腱弹性。
方法：纳入2016年10月至2020年6月进行的一项随机试验的符合方案人群的参与者。手术和开窗组包括24(平均年龄，50±7年[标准偏差]，10名男子）和29名（47±8岁，18名男子）参与者，分别。在基线时进行超声检查，6个月,和12个月。统计分析包括线性混合效应和广义方程估计模型。
结果：开窗术对肌腱厚度没有显着影响（p=0.46）。相反，手术在6个月时肌腱厚度显著增加(p<0.0001),在12个月时肌腱厚度仍然升高(p=0.04).肌腱回声结构表现出群体效应(p=0.03)，表明手术组干预后病理评分的比例高于开窗组。从干预后6到12个月，两组都显示出相似的新生血管减少（p=0.006）。开窗组在6个月时剪切波速度增加（p=0.04），而手术组在6个月时没有显着下降，在12个月时有所改善（p=0.08）。剪切波速度的变化与临床结果无关。
结论：随着时间的推移，开窗术和手术减少了肌腱新生血管。不像手术,开窗术不会影响肌腱大小，同时改善肌腱回声结构和弹性。
■开窗术和手术同样减轻了肘部外侧肌腱病的症状并减少了肌腱新生血管；然而，开窗术没有改变肌腱厚度，改善回声结构和剪切波速度，提示剪切波速度在愈合过程中定量监测肌腱弹性的潜力。
结论：缺乏监测肘部肌腱病愈合反应和指导治疗方案的可靠指标。开窗术和手术减少了肌腱新生血管，而开窗术改善了肌腱的回声结构和剪切波速度。剪切波速度可以提供定量测量以监测响应于治疗的肌腱弹性。
