肘关节滑囊炎复发的滑囊内强力霉素硬化疗法：病例对照研究

Q3 Medicine Journal of Hand Surgery Global Online Pub Date : 2024-07-01 DOI:10.1016/j.jhsg.2024.03.006

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摘要

目的本研究旨在确定滑囊内注射强力霉素硬化疗法治疗保守治疗难治性肩峰滑囊炎（OB）的疗效和安全性。方法我们回顾性研究了 27 例复发性肩峰滑囊炎患者，他们接受滑囊内注射强力霉素治疗长达 11 年之久。我们将这些患者与接受外科手术切除的 18 名复发性 OB 患者组成的对照组进行了比较。患者由主治医生重新评估滑囊炎的复发情况和治疗并发症，并填写一份调查问卷以评估满意度、疼痛和其他患者报告的结果。3名接受手术治疗的患者（16.7%）在术后复发，需要再次抽吸。在最后的随访中（中位数分别为195天和1,055天），强力霉素组和手术组都没有患者出现滑囊炎复发。多西环素组中没有患者最终需要进行手术切除滑囊，也没有接受手术的患者需要重复手术。在控制协变量的回归模型中，并未发现多西环素灌洗或手术穿刺后发生医生认定的并发症或重复抽吸的可能性在组间存在显著差异。在接受强力霉素硬化剂治疗的患者中，85.7%的患者表示非常满意（Likert评分：8-10分），95.2%的患者表示会再次接受这种治疗。结论滑囊内使用强力霉素作为硬化剂治疗复发性骨转移是安全有效的，患者满意度高，在最终随访中滑囊炎没有复发。对于保守治疗无效的复发性滑囊炎患者，这可能是手术切除滑囊的有效替代方法。

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Intrabursal Doxycycline Sclerotherapy for Recurrent Olecranon Bursitis of the Elbow: A Case Control Study

Purpose

This study aimed to determine the efficacy and safety of intrabursal injection of doxycycline sclerotherapy to treat olecranon bursitis (OB) refractory to conservative management.

Methods

We retrospectively reviewed 27 patients with recurrent OB who were treated over 11 years with intrabursal injections of doxycycline. They were compared with a control group of 18 patients with recurrent OB who underwent surgical bursectomy. Patients were re-evaluated by the treating physician for recurrence of bursitis and treatment complications and completed a questionnaire to assess satisfaction, pain, and other patient-reported outcomes.

Results

Eight patients (29.6%) undergoing doxycycline sclerotherapy had recurrence, requiring one more doxycycline lavage within the first 4 weeks of initial doxycycline treatment. Three patients (16.7%) undergoing surgery had recurrence after surgery, requiring repeat aspiration. There were no patients in either doxycycline or surgical groups with recurrence of bursitis at the final follow-up (median = 195 and 1,055 days, respectively). No patients in the doxycycline group ultimately required surgical bursectomy, and no patients undergoing surgery required repeat surgeries. A regression model controlling for covariates did not find a significant difference between groups in the likelihood of physician-identified complication or repeat aspiration after doxycycline lavage or surgical bursectomy. Of patients undergoing doxycycline sclerotherapy, 85.7% of patients reported high satisfaction (Likert score: 8–10), and 95.2% reported that they would pursue this treatment again.

Conclusions

Use of intrabursal doxycycline as a sclerosing agent for recurrent OB was safe and effective, with high patient satisfaction and no ultimate recurrence of bursitis at the final follow-up. This may be an effective alternative to surgical bursectomy for patients with recurrent OB refractory to conservative management.