Department of General Practice, University of Oslo, Oslo, Norway.
BMJ Open. 2013 Oct 29;3(10):e003564. doi: 10.1136/bmjopen-2013-003564.
OBJECTIVES: To evaluate the current evidence for the efficacy of corticosteroid injection and non-electrotherapeutic physiotherapy compared with control for treating lateral epicondylitis. DESIGN: Systematic review. PARTICIPANTS: We searched five databases in September 2012 for randomised controlled studies with a minimum quality rating. Of the 640 studies retrieved, 11 were included, representing 1161 patients of both sexes and all ages. INTERVENTIONS: Corticosteroid injection and non-electrotherapeutic physiotherapy. OUTCOME MEASURES: Relative risk (RR) or standardised mean difference (SMD) for overall improvement, pain and grip strength at 4-12, 26 and 52 weeks of follow-up. RESULTS: Corticosteroid injection gave a short-term reduction in pain versus no intervention or non-steroidal anti-inflammatory drugs (SMD -1.43, 95% CI -1.64 to -1.23). At intermediate follow-up, we found an increase in pain (SMD 0.32, 95% CI 0.13 to 0.51), reduction in grip strength (SMD -0.48, 95% CI -0.73 to -0.24) and negative effect on the overall improvement effect (RR 0.66 (0.53 to 0.81)). For corticosteroid injection versus lidocaine injection, the evidence was conflicting. At long-term follow-up, there was no difference on overall improvement and grip strength, with conflicting evidence for pain. Manipulation and exercise versus no intervention showed beneficial effect at short-term follow-up (overall improvement RR 2.75, 95% CI 1.30 to 5.82), but no significant difference at intermediate or long-term follow-up. We found moderate evidence for short-term and long-term effects of eccentric exercise and stretching versus no intervention. For exercise versus no intervention and eccentric or concentric exercise and stretching versus stretching alone, we found moderate evidence of no short-term effect. CONCLUSIONS: Corticosteroid injections have a short-term beneficial effect on lateral epicondylitis, but a negative effect in the intermediate term. Evidence on the long-term effect is conflicting. Manipulation and exercise and exercise and stretching have a short-term effect, with the latter also having a long-term effect.
目的：评估皮质类固醇注射和非电疗物理疗法与对照相比治疗外侧肱骨上髁炎的疗效的现有证据。
设计：系统评价。
参与者：我们于 2012 年 9 月检索了五个数据库，以寻找最低质量评分的随机对照研究。在检索到的 640 项研究中，有 11 项研究纳入，共纳入了 1161 名男女患者和各年龄段患者。
干预措施：皮质类固醇注射和非电疗物理疗法。
结局指标：整体改善、疼痛和握力的相对风险（RR）或标准化均数差（SMD），随访 4-12、26 和 52 周。
结果：皮质类固醇注射与无干预或非甾体抗炎药相比，短期可减轻疼痛（SMD-1.43，95%CI-1.64 至-1.23）。在中期随访时，我们发现疼痛增加（SMD0.32，95%CI0.13 至 0.51），握力下降（SMD-0.48，95%CI-0.73 至-0.24），整体改善效果受到负面影响（RR0.66（0.53 至 0.81））。对于皮质类固醇注射与利多卡因注射相比，证据相互矛盾。在长期随访时，整体改善和握力方面无差异，疼痛方面证据相互矛盾。手法和运动与无干预相比，在短期随访时具有有益的效果（整体改善 RR2.75，95%CI1.30 至 5.82），但在中期或长期随访时无显著差异。我们发现短期和长期进行离心运动和伸展与无干预相比，具有中度证据。对于运动与无干预、离心或向心运动和伸展与单独伸展相比，我们发现短期无效果的证据为中度。
结论：皮质类固醇注射对外侧肱骨上髁炎有短期的有益效果，但在中期有负面影响。长期效果的证据相互矛盾。手法和运动以及运动和伸展具有短期效果，后者也具有长期效果。
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