Hauser Ross A, Lackner Johanna B, Steilen-Matias Danielle, Harris David K
Caring Medical Regenerative Medicine Clinics, Oak Park, IL, USA.
InQuill Medical Communications, Soquel, CA, USA.
Clin Med Insights Arthritis Musculoskelet Disord. 2016 Jul 7;9:139-59. doi: 10.4137/CMAMD.S39160. eCollection 2016.
The aim of this study was to systematically review dextrose (d-glucose) prolotherapy efficacy in the treatment of chronic musculoskeletal pain.
Electronic databases PubMed, Healthline, OmniMedicalSearch, Medscape, and EMBASE were searched from 1990 to January 2016.
Prospectively designed studies that used dextrose as the sole active prolotherapy constituent were selected.
Two independent reviewers rated studies for quality of evidence using the Physiotherapy Evidence Database assessment scale for randomized controlled trials (RCTs) and the Downs and Black evaluation tool for non-RCTs, for level of evidence using a modified Sackett scale, and for clinically relevant pain score difference using minimal clinically important change criteria. Study population, methods, and results data were extracted and tabulated.
Fourteen RCTs, 1 case-control study, and 18 case series studies met the inclusion criteria and were evaluated. Pain conditions were clustered into tendinopathies, osteoarthritis (OA), spinal/pelvic, and myofascial pain. The RCTs were high-quality Level 1 evidence (Physiotherapy Evidence Database ≥8) and found dextrose injection superior to controls in Osgood-Schlatter disease, lateral epicondylitis of the elbow, traumatic rotator cuff injury, knee OA, finger OA, and myofascial pain; in biomechanical but not subjective measures in temporal mandibular joint; and comparable in a short-term RCT but superior in a long-term RCT in low back pain. Many observational studies were of high quality and reported consistent positive evidence in multiple studies of tendinopathies, knee OA, sacroiliac pain, and iliac crest pain that received RCT confirmation in separate studies. Eighteen studies combined patient self-rating (subjective) with psychometric, imaging, and/or biomechanical (objective) outcome measurement and found both positive subjective and objective outcomes in 16 studies and positive objective but not subjective outcomes in two studies. All 15 studies solely using subjective or psychometric measures reported positive findings.
Use of dextrose prolotherapy is supported for treatment of tendinopathies, knee and finger joint OA, and spinal/pelvic pain due to ligament dysfunction. Efficacy in acute pain, as first-line therapy, and in myofascial pain cannot be determined from the literature.
本研究旨在系统评价葡萄糖（右旋糖）注射疗法治疗慢性肌肉骨骼疼痛的疗效。
检索1990年至2016年1月期间的电子数据库PubMed、Healthline、OmniMedicalSearch、Medscape和EMBASE。
选择前瞻性设计的研究，这些研究使用葡萄糖作为唯一的活性注射疗法成分。
两名独立评审员使用物理治疗证据数据库随机对照试验（RCT）评估量表和非RCT的唐斯和布莱克评估工具对研究的证据质量进行评分，使用改良的萨克特量表对证据水平进行评分，并使用最小临床重要变化标准对临床相关疼痛评分差异进行评分。提取研究人群、方法和结果数据并制成表格。
14项RCT、1项病例对照研究和18项病例系列研究符合纳入标准并进行了评估。疼痛情况分为肌腱病、骨关节炎（OA）、脊柱/骨盆和肌筋膜疼痛。这些RCT是高质量的1级证据（物理治疗证据数据库≥8），发现葡萄糖注射在胫骨结节骨软骨炎、肘部外侧 epicondylitis、创伤性肩袖损伤、膝关节OA、手指OA和肌筋膜疼痛方面优于对照组；在颞下颌关节的生物力学测量而非主观测量方面；在一项短期RCT中相当，但在一项长期RCT中在腰痛方面更优。许多观察性研究质量较高，并且在肌腱病、膝关节OA、骶髂关节疼痛和髂嵴疼痛的多项研究中报告了一致的阳性证据，这些研究在单独的研究中得到了RCT的证实。18项研究将患者自评（主观）与心理测量、影像学和/或生物力学（客观）结果测量相结合，发现16项研究中主观和客观结果均为阳性，两项研究中客观结果为阳性但主观结果不为阳性。所有15项仅使用主观或心理测量方法的研究均报告了阳性结果。
支持使用葡萄糖注射疗法治疗肌腱病、膝关节和手指关节OA以及因韧带功能障碍引起的脊柱/骨盆疼痛。从文献中无法确定其作为一线疗法在急性疼痛和肌筋膜疼痛中的疗效
