肱骨外上髁炎的非手术治疗：随机对照试验的系统评价
Non-surgical treatment of lateral epicondylitis: a systematic review of randomized controlled trials.
作者信息
Sims Susan E G, Miller Katherine, Elfar John C, Hammert Warren C
机构信息
Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY 14642 USA.
University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Box 601, Rochester, NY 14642 USA.
出版信息
Hand (N Y). 2014 Dec;9(4):419-46. doi: 10.1007/s11552-014-9642-x.
BACKGROUND
Non-surgical approaches to treatment of lateral epicondylitis are numerous. The aim of this systematic review is to examine randomized, controlled trials of these treatments.
METHODS
Numerous databases were systematically searched from earliest records to February 2013. Search terms included "lateral epicondylitis," "lateral elbow pain," "tennis elbow," "lateral epicondylalgia," and "elbow tendinopathy" combined with "randomized controlled trial." Two reviewers examined the literature for eligibility via article abstract and full text.
RESULTS
Fifty-eight articles met eligibility criteria: (1) a target population of patients with symptoms of lateral epicondylitis; (2) evaluation of treatment of lateral epicondylitis with the following non-surgical techniques: corticosteroid injection, injection technique, iontophoresis, botulinum toxin A injection, prolotherapy, platelet-rich plasma or autologous blood injection, bracing, physical therapy, shockwave therapy, or laser therapy; and (3) a randomized controlled trial design. Lateral epicondylitis is a condition that is usually self-limited. There may be a short-term pain relief advantage found with the application of corticosteroids, but no demonstrable long-term pain relief. Injection of botulinum toxin A and prolotherapy are superior to placebo but not to corticosteroids, and botulinum toxin A is likely to produce concomitant extensor weakness. Platelet-rich plasma or autologous blood injections have been found to be both more and less effective than corticosteroid injections. Non-invasive treatment methods such as bracing, physical therapy, and extracorporeal shockwave therapy do not appear to provide definitive benefit regarding pain relief. Some studies of low-level laser therapy show superiority to placebo whereas others do not.
CONCLUSIONS
There are multiple randomized controlled trials for non-surgical management of lateral epicondylitis, but the existing literature does not provide conclusive evidence that there is one preferred method of non-surgical treatment for this condition. Lateral epicondylitis is a condition that is usually self-limited, resolving over a 12- to 18-month period without treatment.
LEVEL OF EVIDENCE
Therapeutic Level II. See Instructions to Authors for a complete description of level of evidence.
背景
治疗外侧上髁炎的非手术方法众多。本系统评价的目的是研究这些治疗方法的随机对照试验。
方法
从最早记录到2013年2月，对众多数据库进行了系统检索。检索词包括“外侧上髁炎”、“外侧肘部疼痛”、“网球肘”、“外侧上髁疼痛”和“肘部肌腱病”并与“随机对照试验”组合。两名评价者通过文章摘要和全文检查文献的合格性。
结果
58篇文章符合合格标准：（1）以外侧上髁炎症状患者为目标人群；（2）用以下非手术技术评估外侧上髁炎的治疗：皮质类固醇注射、注射技术、离子导入法、肉毒杆菌毒素A注射、注射增殖疗法、富血小板血浆或自体血注射、支具固定、物理治疗、冲击波疗法或激光疗法；（3）随机对照试验设计。外侧上髁炎通常是一种自限性疾病。应用皮质类固醇可能有短期缓解疼痛的优势，但没有明显的长期疼痛缓解效果。注射肉毒杆菌毒素A和注射增殖疗法优于安慰剂，但不优于皮质类固醇，且肉毒杆菌毒素A可能会导致伴随的伸肌无力。已发现富血小板血浆或自体血注射比皮质类固醇注射更有效和效果更差。支具固定、物理治疗和体外冲击波疗法等非侵入性治疗方法似乎在缓解疼痛方面没有明确益处。一些低强度激光疗法的研究显示优于安慰剂，而其他研究则不然。
结论
有多项关于外侧上髁炎非手术治疗的随机对照试验，但现有文献并未提供确凿证据表明存在一种首选的非手术治疗方法。外侧上髁炎通常是一种自限性疾病，未经治疗可在12至18个月内自行缓解。
证据水平
治疗性II级。有关证据水平的完整描述，请参阅作者须知。
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