荷兰伊拉斯谟医学中心Robert-Jan de Vos团队研究了高容量注射治疗慢性跟腱病变的疗效。2020年9月9日，该研究发表在《英国医学杂志》上。

为了探讨在不进行皮质类固醇激素治疗的情况下进行高容量注射是否能改善除常规治疗外的慢性中段跟腱炎患者的疗效，研究组进行了一项双盲、安慰剂对照、随机临床试验，在荷兰一家大型地区综合医院的运动医学系招募18-70岁、慢性跟腱中段病变、超声造影显示新血管形成的患者，均接受为期24周的运动计划。

将患者随机分组，其中39例接受不含皮质类固醇的高容量注射，基线时注射50毫升高容量的生理盐水和利多卡因，41例接受2毫升生理盐水和利多卡因进行安慰剂治疗。主要结局指标为24周时使用经验证的维多利亚运动评估协会-阿喀琉斯(VISA-A)问卷对疼痛和功能进行评估。

只有1名参与者（1%）失访。高容量注射组的估计平均VISA-A得分显著提高，从基线时的40.4分提高到24周时的59.1分，安慰剂组则从36.9分提高到58.5分。两组间随时间变化的VISA-A评分无显著差异。两组间的患者满意率分别为57%和49%，运动恢复率分别为52%和61%，均无显著差异，其他次要结局亦是如此。

总之，除常规治疗外，无皮质类固醇激素的高容量注射无益于缓解慢性中段跟腱炎患者的症状。

附：英文原文

Title: Effectiveness of a high volume injection as treatment for chronic Achilles tendinopathy: randomised controlled trial

Author: Arco C van der Vlist, Robert F van Oosterom, Peter L J van Veldhoven, Sita M A Bierma-Zeinstra, Jan H Waarsing, Jan A N Verhaar, Robert-Jan de Vos

Issue&Volume: 2020/09/09

Abstract:

Objective To study whether a high volume injection without corticosteroids improves clinical outcome in addition to usual care for adults with chronic midportion Achilles tendinopathy.

Design Patient and assessor blinded, placebo controlled randomised clinical trial.

Setting Sports medicine department of a large district general hospital, the Netherlands.

Participants 80 adults (aged 18-70 years) with clinically diagnosed chronic midportion Achilles tendinopathy and neovascularisation on ultrasonography. 39 were randomised to a high volume injection without corticosteroids and 41 to placebo.

Interventions Participants were instructed to perform an exercise programme for 24 weeks (usual care) combined with one 50 mL high volume injection of saline and lidocaine (intervention group) or one 2 mL placebo injection of saline and lidocaine (placebo group) at baseline.

Main outcome measures Primary outcome was pain and function assessed using the validated Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire at 24 weeks (analysed using a generalised estimation equations model). Secondary outcomes were patient satisfaction, return to sport, degree of ultrasonographic Doppler flow, visual analogue scale on 10 hop test, power and flexibility of the gastrocnemius and soleus muscles, pain detect questionnaire for neuropathic pain, and pain coping inventory. Participants were evaluated at baseline and at 2, 6, 12, and 24 weeks.

Results Only one participant (1%) was lost to follow-up. The estimated mean VISA-A score improved significantly, from 40.4 (95% confidence interval 32.0 to 48.7) at baseline to 59.1 (50.4 to 67.8) at 24 weeks in the high volume injection group and from 36.9 (27.1 to 46.8) to 58.5 (47.9 to 69.1) in the placebo group. The VISA-A score over time did not differ between the groups (adjusted between group difference at 24 weeks 0.5 points, 95% confidence interval 17.8 to 18.8). No significant between group differences were found for patient satisfaction (21/37 (57%) v 19/39 (49%) patients, P=0.50) and return to desired sport (15/29 (52%) v 19/31 (61%) patients active in sports, P=0.65) at 24 weeks. None of the other secondary outcomes differed between the two groups.

Conclusions A high volume injection without corticosteroids in addition to usual care is not effective for symptom reduction in patients with chronic midportion Achilles tendinopathy. On the basis of our findings, we cannot recommend the use of a high volume injection in this patient group.

DOI: 10.1136/bmj.m3027

Source: https://www.bmj.com/content/370/bmj.m3027