Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Queensland, Australia.
Lancet. 2010 Nov 20;376(9754):1751-67. doi: 10.1016/S0140-6736(10)61160-9. Epub 2010 Oct 21.
Few evidence-based treatment guidelines for tendinopathy exist. We undertook a systematic review of randomised trials to establish clinical efficacy and risk of adverse events for treatment by injection.
We searched eight databases without language, publication, or date restrictions. We included randomised trials assessing efficacy of one or more peritendinous injections with placebo or non-surgical interventions for tendinopathy, scoring more than 50% on the modified physiotherapy evidence database scale. We undertook meta-analyses with a random-effects model, and estimated relative risk and standardised mean differences (SMDs). The primary outcome of clinical efficacy was protocol-defined pain score in the short term (4 weeks, range 0-12), intermediate term (26 weeks, 13-26), or long term (52 weeks, ≥52). Adverse events were also reported.
3824 trials were identified and 41 met inclusion criteria, providing data for 2672 participants. We showed consistent findings between many high-quality randomised controlled trials that corticosteroid injections reduced pain in the short term compared with other interventions, but this effect was reversed at intermediate and long terms. For example, in pooled analysis of treatment for lateral epicondylalgia, corticosteroid injection had a large effect (defined as SMD>0·8) on reduction of pain compared with no intervention in the short term (SMD 1·44, 95% CI 1·17-1·71, p<0·0001), but no intervention was favoured at intermediate term (-0·40, -0·67 to -0·14, p<0·003) and long term (-0·31, -0·61 to -0·01, p=0·05). Short-term efficacy of corticosteroid injections for rotator-cuff tendinopathy is not clear. Of 991 participants who received corticosteroid injections in studies that reported adverse events, only one (0·1%) had a serious adverse event (tendon rupture). By comparison with placebo, reductions in pain were reported after injections of sodium hyaluronate (short [3·91, 3·54-4·28, p<0·0001], intermediate [2·89, 2·58-3·20, p<0·0001], and long [3·91, 3·55-4·28, p<0·0001] terms), botulinum toxin (short term [1·23, 0·67-1·78, p<0·0001]), and prolotherapy (intermediate term [2·62, 1·36-3·88, p<0·0001]) for treatment of lateral epicondylalgia. Lauromacrogol (polidocanol), aprotinin, and platelet-rich plasma were not more efficacious than was placebo for Achilles tendinopathy, while prolotherapy was not more effective than was eccentric exercise.
Despite the effectiveness of corticosteroid injections in the short term, non-corticosteroid injections might be of benefit for long-term treatment of lateral epicondylalgia. However, response to injection should not be generalised because of variation in effect between sites of tendinopathy.
None.
针对腱病，目前仅有少量基于循证的治疗指南。我们对随机试验进行了系统性回顾，以确定注射治疗的临床疗效和不良事件风险。
我们在没有语言、出版或日期限制的情况下，检索了 8 个数据库。我们纳入了评估一种或多种腱周注射与安慰剂或非手术干预治疗腱病的疗效的随机试验，这些试验的改良物理治疗证据数据库评分超过 50%。我们采用随机效应模型进行荟萃分析，并估计相对风险和标准化均数差值（SMD）。主要的临床疗效终点是短期（4 周，0-12 分）、中期（26 周，13-26 分）或长期（52 周，≥52 分）的方案定义疼痛评分。同时也报告了不良事件。
共确定了 3824 项试验，其中 41 项符合纳入标准，为 2672 名参与者提供了数据。我们从许多高质量的随机对照试验中得出了一致的发现，即与其他干预措施相比，皮质类固醇注射可在短期内减轻疼痛，但这种效果在中期和长期内会逆转。例如，在外侧肱骨上髁炎治疗的汇总分析中，皮质类固醇注射在短期（SMD 1.44，95%CI 1.17-1.71，p<0.0001）和中期（-0.40，-0.67 至-0.14，p<0.003）和长期（-0.31，-0.61 至-0.01，p=0.05）时对疼痛的缓解效果明显大于无干预。皮质类固醇注射治疗肩袖腱病的短期疗效尚不明确。在报告不良事件的研究中，991 名接受皮质类固醇注射的参与者中，只有 1 名（0.1%）发生严重不良事件（肌腱断裂）。与安慰剂相比，透明质酸钠（短期[3.91，3.54-4.28，p<0.0001]、中期[2.89，2.58-3.20，p<0.0001]和长期[3.91，3.55-4.28，p<0.0001]）、肉毒杆菌毒素（短期[1.23，0.67-1.78，p<0.0001]）和富血小板血浆（中期[2.62，1.36-3.88，p<0.0001]）治疗外侧肱骨上髁炎的效果均有改善。聚多卡醇（聚二氧六环酮）、抑肽酶和富含血小板的血浆治疗跟腱病的效果并不优于安慰剂，而富血小板血浆治疗与离心运动治疗相比并没有更有效。
尽管皮质类固醇注射在短期内有效，但对于外侧肱骨上髁炎的长期治疗，非皮质类固醇注射可能更有益。然而，由于腱病部位之间的疗效存在差异，因此不应将注射的反应普遍化。
该译文是基于给定的英文文本进行翻译的，可能存在理解偏差或不够地道的情况，仅供参考。
