Department of General Practice Erasmus Medical Center PO Box 2040, 3000 CA, The Netherlands.
BMC Musculoskelet Disord. 2010 Sep 13;11:206. doi: 10.1186/1471-2474-11-206.
To estimate the occurrence and type of adverse effects after application of an extra-articular (soft tissue) corticosteroid injection.
A systematic review of the literature was made based on a PubMed and Embase search covering the period 1956 to January 2010. Case reports were included, as were prospective and retrospective studies that reported adverse events of corticosteroid injection. All clinical trials which used extra-articular corticosteroid injections were examined. We divided the reported adverse events into major (defined as those needing intervention or not disappearing) and minor ones (transient, not requiring intervention).
The search yielded 87 relevant studies:44 case reports, 37 prospective studies and 6 retrospective studies. The major adverse events included osteomyelitis and protothecosis; one fatal necrotizing fasciitis; cellulitis and ecchymosis; tendon ruptures; atrophy of the plantar fat was described after injecting a neuroma; and local skin effects appeared as atrophy, hypopigmentation or as skin defect. The minor adverse events effects ranged from skin rash to flushing and disturbed menstrual pattern. Increased pain or steroid flare after injection was reported in 19 studies. After extra-articular injection, the incidence of major adverse events ranged from 0-5.8% and that of minor adverse events from 0-81%. It was not feasible to pool the risk for adverse effects due to heterogeneity of study populations and difference in interventions and variance in reporting.
In this literature review it was difficult to accurately quantify the incidence of adverse effects after extra-articular corticosteroid injection. The reported adverse events were relatively mild, although one fatal reaction was reported.
评估关节外（软组织）皮质类固醇注射后的不良反应发生情况和类型。
基于 1956 年至 2010 年 1 月期间在 PubMed 和 Embase 上进行的文献检索，进行了系统评价。纳入了病例报告以及报告皮质类固醇注射不良事件的前瞻性和回顾性研究。所有使用关节外皮质类固醇注射的临床试验均进行了检查。我们将报告的不良事件分为主要（定义为需要干预或未消失的事件）和次要（短暂的，无需干预的事件）。
检索结果共 87 项相关研究：44 例病例报告、37 项前瞻性研究和 6 项回顾性研究。主要不良事件包括骨髓炎和原绿菌病；1 例致命性坏死性筋膜炎；蜂窝织炎和瘀斑；注射神经瘤后出现跟腱断裂；足底脂肪萎缩；局部皮肤效应表现为萎缩、色素减退或皮肤缺损。轻微不良事件的影响范围从皮疹到潮红和月经紊乱。19 项研究报告注射后疼痛增加或类固醇爆发。关节外注射后，主要不良事件的发生率为 0-5.8%，次要不良事件的发生率为 0-81%。由于研究人群、干预措施和报告的差异，不良事件的风险难以进行汇总。
在这项文献综述中，很难准确量化关节外皮质类固醇注射后不良反应的发生率。报告的不良事件相对较轻，尽管有 1 例致命反应的报道。
