Pragmatic randomised controlled trial of local corticosteroid injection and naproxen for treatment of lateral epicondylitis of elbow in primary care
Pragmatic randomised controlled trial of local corticosteroid injection and naproxen for treatment of lateral epicondylitis of elbow in primary care
复制标题
DOI：
10.1136/bmj.319.7215.964
复制
发表时间：
1999-10-09
影响因子：
--
通讯作者：
Croft, P
中科院分区：
文献类型：
--
作者：
Hay, EM;Paterson, SM;Croft, P
目的比较皮质类固醇局部注射、标准非类固醇消炎药和单纯止痛药在初级保健中早期治疗外上髁炎的临床疗效，设计多中心实用随机对照试验，在北斯塔福德郡和南切什郡设立23个全科医疗机构。受试者164例，年龄18~70岁，表现为新发的外上髁炎。干预措施局部注射甲基强的松龙20 mg加利尼卡因，萘普生500 mg，每日2次，IBR，或服用安慰剂。所有参与者按要求接受标准建议和辅佐可达莫。主要结果衡量参与者在四周内对改善情况的总体评估(5分制)。在4周、6个月和12个月时用10分Likert量表测量疼痛、功能和“主诉”。结果在两年多的时间里，53名受试者随机接受注射，53名接受萘普生治疗，58名接受安慰剂治疗。基线时，两组间的预后变量相似。在4周时，注射组有48名患者(92%)完全好转或改善，而萘普生组(P<；0.001)和安慰剂组(P<；0.001)分别为30名(57%)和28名(50%)。在12个月时，注射组有43名患者(84%)的疼痛评分小于或等于3分，而注射组有45名患者(85%)和安慰剂组的44名患者(82%)疼痛评分低于或等于3分(P>；0.05)。注射是治疗外上髁炎的有效方法。一年的结果在所有组中都很好，有效的早期治疗似乎并不影响这一点。
Objective To compare the clinical effectiveness of local corticosteroid injection, standard non-steroidal anti-inflammatory drugs, and simple analgesics for the early treatment of lateral epicondylitis in primary care,Design Multicentre pragmatic randomised controlled trial.Setting 23 general practices in North Staffordshire and South Cheshire.Participants 164 patients aged 18-70 years presenting with a new episode of lateral epicondylitis.Interventions Local injection of 20 mg methylprednisolone plus lignocaine, naproxen 500 mg twice daily Ibr two weeks, or placebo tablets. All participants received a standard advice sheer and co-codamol as required.Main outcome measures Participants' global assessment of improvement (five point scale) at four weeks. Pain,function, and "main complaint" measured on 10 point Likert scales at 4 weeks, 6 months, and 12 monthsResults Over 2 years,53 subjects cz ere randomised to injection, 53 to naproxen, and 58 to placebo. Prognostic variables were similar between groups at baseline. At 4 weeks, 48 patients (92%) in the injection group were completely better or improved compared with 30 (57%) in the naproxen group (P < 0.001) and 28 (50%) in the placebo group (P < 0.001). At 12 months, 43 patients (84%) in the injection group had pain scores less than or equal to 3 compared with 45 (85%) in the naproxen group and 44 (82%) in the placebo group (P > 0.05),Conclusions Early local corticosteroid. injection is effective for lateral epicondylitis. Outcome at one year was good in all groups, and effective early treatment does not seem to influence this.