Qian Xuankun, Lin Qiao, Wei Kongkong, Hu Bin, Jing Pengju, Wang Jianmin
Department of Orthopedics Surgery, The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China(∗)(†)(¶)(§).
Department of Oncological Surgery, The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China(‡).
PM R. 2016 Aug;8(8):780-91. doi: 10.1016/j.pmrj.2016.02.008. Epub 2016 Mar 9.
To compare the efficacy and safety of autologous blood products (ABPs) and corticosteroid injections (CSIs) in the treatment of lateral epicondylitis.
Meta-analysis.
We systematically searched EMBASE, PubMed, the Cochrane Library, and Web of Science to identify randomized controlled trials (RCTs) that compared ABPs with CSIs for the treatment of lateral epicondylitis without language and publication date restriction through April 2015.
Two investigators independently included and assessed the quality of each eligible study according to the method recommended by the Cochrane Collaboration. Available data about the main outcomes were extracted from each study and heterogeneity was assessed using the Q statistic and the inconsistency index (I(2)). We also evaluated the publication bias and conducted a subgroup analysis. Review Manager 5.2 software was used for data syntheses and analyses, and the standardized mean difference (SMD) or mean difference (MD) was estimated by using random effects models with a 95% confidence interval (CI). To investigate the efficacy among different trial durations, the follow-up times were divided into short periods (2-4 weeks), intermediate periods (6-24 weeks) and long-term periods (≥24 weeks).
Ten RCTs (n = 509) were included in this meta-analysis. The pooled analysis showed that CSIs were more effective than ABPs for pain relief in the short term (SMD = 0.88; 95% CI = 0.31-1.46%; P = .003). However, in the intermediate term, ABPs exhibited a better therapeutic effect for pain relief (SMD = -0.38; 95% CI = -0.70 to -0.07%; P = .02), function (SMD = -0.60; 95% CI = -1.13 to -0.08%; P = .03), disabilities of the arm, shoulder, and hand (MD = -11.04; 95% CI = -21.72 to -0.36%; P = .04), and Nirschl stage (MD = -0.81; 95% CI = -1.11 to -0.51%; P < .0001). In the long term, ABPs were superior to CSIs for pain relief (SMD = -0.94; 95% CI = -1.32 to -0.57%; P < .0001) and Nirschl stage (MD = -1.04; 95% CI = -1.66 to -0.42%; P = .001). Moreover, for grip strength recovery, no significant difference was found between the 2 therapies (P > .05).
Limited evidence supports the conclusion that CSIs are superior to ABPs for pain relief in the short term; however, this result was reversed in the intermediate and long term. ABPs seemed to be more effective at restoring function in the intermediate term. Because of the small sample size and the limited number of high-quality RCTs, more high-quality RCTs with large sample sizes are required to validate this result.
比较自体血制品（ABP）与皮质类固醇注射（CSI）治疗外侧上髁炎的疗效和安全性。
荟萃分析。
我们系统检索了EMBASE、PubMed、Cochrane图书馆和科学网，以识别在2015年4月前比较ABP与CSI治疗外侧上髁炎的随机对照试验（RCT），检索不受语言和发表日期限制。
两名研究者根据Cochrane协作网推荐的方法独立纳入并评估每项合格研究的质量。从每项研究中提取有关主要结局的可用数据，并使用Q统计量和不一致指数（I²）评估异质性。我们还评估了发表偏倚并进行了亚组分析。使用Review Manager 5.2软件进行数据合成和分析，并使用随机效应模型估计标准化均数差（SMD）或均数差（MD），其95%置信区间（CI）。为研究不同试验持续时间的疗效，将随访时间分为短期（2 - 4周）、中期（6 - 24周）和长期（≥24周）。
本荟萃分析纳入了10项RCT（n = 509）。汇总分析表明，短期内CSI在缓解疼痛方面比ABP更有效（SMD = 0.88；95%CI = 0.31 - 1.46%；P = 0.003）。然而，在中期，ABP在缓解疼痛（SMD = -0.38；95%CI = -0.70至 -0.07%；P = 0.02）、功能（SMD = -0.60；95%CI = -1.13至 -0.08%；P = 0.03）、手臂、肩部和手部功能障碍（MD = -11.04；95%CI = -21.72至 -0.36%；P = 0.04）以及Nirschl分期（MD = -0.81；95%CI = -1.11至 -0.51%；P < 0.0001）方面表现出更好的治疗效果。在长期，ABP在缓解疼痛（SMD = -0.94；95%CI = -1.32至 -0.57%；P < 0.0001）和Nirschl分期（MD = -1.04；95%CI = -1.66至 -0.42%；P = 0.001）方面优于CSI。此外，在握力恢复方面，两种疗法之间未发现显著差异（P > 0.05）。
有限的证据支持短期内CSI在缓解疼痛方面优于ABP的结论；然而，这一结果在中期和长期发生了逆转。ABP在中期恢复功能方面似乎更有效。由于样本量小且高质量RCT数量有限，需要更多大样本量的高质量RCT来验证这一结果。
