Cumpston Miranda, Johnston Renea V, Wengier Lainie, Buchbinder Rachelle
Monash Institute of Health Services Research, Monash University, Monash Medical Centre, Locked Bag 29, Clayton, Victoria, Australia, 3168.
Cochrane Database Syst Rev. 2009 Jul 8(3):CD006355. doi: 10.1002/14651858.CD006355.pub2.
Rotator cuff disease is a common cause of shoulder pain. Topical glyceryl trinitrate is a possible new treatment.
To determine the effectiveness and safety of topical glyceryl trinitrate for rotator cuff disease.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, SPORTDiscus, PEDro, the Australian Clinical Trials Registry, Current Controlled Trials (to October 2007) and the references and citations of included studies.
We included randomised controlled trials and controlled clinical trials of people with rotator cuff disease who received topical glyceryl trinitrate, alone or in combination, compared to placebo or active therapy.
Two authors independently assessed risk of bias and extracted data.
Three small studies, one at moderate risk of bias and two at high risk of bias, were included. Meta-analysis was precluded due to different interventions and outcome measures. Study participants also had differing durations of symptoms and data for pain and function could only be extracted from one study. One placebo-controlled trial (20 participants) tested 5 mg glyceryl trinitrate patches, used daily for three days, among participants with 'acute supraspinatus tendinitis' of less than seven days duration. Treatment resulted in reduced pain intensity (adjusted MD -3.50, 95% CI -3.96 to -3.04). Function was not measured. One trial (53 participants) compared one quarter of a 5 mg glyceryl trinitrate patch used daily for up to 24 weeks combined with rehabilitation to placebo patches and rehabilitation among participants with 'supraspinatus tendinopathy' for longer than six months. A third trial (48 participants) tested 5 mg glyceryl trinitrate patches, used daily for three days, compared to corticosteroid injection among participants with 'rotator cuff tendinitis' of less than six-weeks duration. Fifteen out of 24 participants in the glyceryl trinitrate treatment reported headache (RR 0.11, 95% CI 0.01 to 1.96).
AUTHORS' CONCLUSIONS: There is some evidence from one study at high risk of bias that topical glyceryl trinitrate is more effective than placebo for rotator cuff disease among patients with acute symptoms (< seven-days duration), but there is insufficient evidence to be certain about their longer-term effects. Headache was a common side effect in one trial and any benefits of treatment need to be balanced against the risk of headache. Further high quality research is needed to determine the effectiveness and safety of this new therapy.
肩袖疾病是肩部疼痛的常见原因。局部用硝酸甘油是一种可能的新治疗方法。
确定局部用硝酸甘油治疗肩袖疾病的有效性和安全性。
我们检索了Cochrane对照试验中央注册库（CENTRAL）、MEDLINE、EMBASE、CINAHL、SPORTDiscus、PEDro、澳大利亚临床试验注册库、当前对照试验（截至2007年10月）以及纳入研究的参考文献和引用文献。
我们纳入了肩袖疾病患者的随机对照试验和对照临床试验，这些患者接受了单独或联合使用的局部硝酸甘油治疗，并与安慰剂或积极治疗进行比较。
两位作者独立评估偏倚风险并提取数据。
纳入了三项小型研究，一项研究存在中度偏倚风险，两项研究存在高度偏倚风险。由于干预措施和结局指标不同，无法进行荟萃分析。研究参与者的症状持续时间也各不相同，疼痛和功能数据仅能从一项研究中提取。一项安慰剂对照试验（20名参与者）在病程少于7天的“急性冈上肌腱炎”患者中测试了5毫克硝酸甘油贴片，每天使用，共使用三天。治疗导致疼痛强度降低（调整后均差-3.50，95%置信区间-3.96至-3.04）。未测量功能。一项试验（53名参与者）比较了在病程超过6个月的“冈上肌腱病”患者中，每天使用四分之一片5毫克硝酸甘油贴片，共使用24周并联合康复治疗与安慰剂贴片及康复治疗的效果。第三项试验（48名参与者）在病程少于6周的“肩袖肌腱炎”患者中，比较了每天使用5毫克硝酸甘油贴片，共使用三天与皮质类固醇注射的效果。硝酸甘油治疗组的24名参与者中有15名报告头痛（相对危险度0.11，95%置信区间0.01至1.96）。
一项存在高度偏倚风险的研究提供了一些证据，表明在急性症状（病程<7天）的肩袖疾病患者中，局部用硝酸甘油比安慰剂更有效，但没有足够的证据确定其长期效果。在一项试验中，头痛是常见的副作用，治疗的任何益处都需要与头痛风险相权衡。需要进一步的高质量研究来确定这种新疗法的有效性和安全性。
