Arirachakaran Alisara, Boonard Manusuk, Yamaphai Sarunpong, Prommahachai Akom, Kesprayura Suraphol, Kongtharvonskul Jatupon
Orthopedics Department, Police General Hospital, Bangkok, Thailand.
Orthopedics Department, Srinakarin Hospital, Khonkan, Thailand.
Eur J Orthop Surg Traumatol. 2017 Apr;27(3):381-390. doi: 10.1007/s00590-016-1839-y. Epub 2016 Aug 23.
Treatment of calcific tendinitis using extracorporeal shock wave therapy (ESWT), ultrasound-guided percutaneous lavage (UGPL or barbotage), subacromial corticosteroid injection (SAI) and combined treatment is still controversial. This systematic review and meta-regression aimed to compare clinical outcomes between treatments. Relevant RCTs were identified using PubMed and Scopus search engines to date of September 23, 2015. Seven of 920 studies identified were eligible. Compared to the other treatments, the results of this study indicate that ESWT significantly improved CMS and VAS when compared to placebo. Barbotage plus ESWT significantly improved CMS, VAS and decreased size of calcium deposit when compared to ESWT, while barbotage plus SAI significantly improved CMS and decreased size of calcium deposit when compared to SAI. There have no different adverse effects of all treatment groups. Multiple active treatment comparisons indicated that barbotage plus SAI significantly improved VAS and size of calcium deposit when compared to other groups, while barbotage plus SAI improved CMS when compared to other groups. But there was no significant difference. The network meta-analysis suggested that combined US-guided needling and subacromial corticosteroid injection significantly decreased shoulder pain VAS, improved CMS score and decreased the size of calcium deposits, while also lowering risks of adverse event when compared to barbotage plus ESWT, ESWT and subacromial corticosteroid injection; therefore, the evidence points to UGPL as being the treatment of choice for nonsurgical options of treatment in calcific tendinitis of the shoulder. Level of evidence I.
使用体外冲击波疗法（ESWT）、超声引导下经皮灌洗（UGPL或灌洗法）、肩峰下皮质类固醇注射（SAI）以及联合治疗来处理钙化性肌腱炎仍存在争议。本系统评价和Meta回归旨在比较各治疗方法之间的临床疗效。截至2015年9月23日，使用PubMed和Scopus搜索引擎检索相关随机对照试验（RCT）。在检索到的920项研究中，有7项符合纳入标准。与其他治疗方法相比，本研究结果表明，与安慰剂相比，ESWT能显著改善Constant-Murley肩关节功能评分（CMS）和视觉模拟评分（VAS）。与ESWT相比，灌洗法加ESWT能显著改善CMS、VAS，并减小钙沉积大小；与SAI相比，灌洗法加SAI能显著改善CMS并减小钙沉积大小。所有治疗组的不良反应无差异。多项积极治疗比较表明，与其他组相比，灌洗法加SAI能显著改善VAS和钙沉积大小，与其他组相比，灌洗法加SAI能改善CMS，但差异无统计学意义。网状Meta分析表明，与灌洗法加ESWT、ESWT和肩峰下皮质类固醇注射相比，超声引导下针刺联合肩峰下皮质类固醇注射能显著降低肩部疼痛VAS、改善CMS评分并减小钙沉积大小，同时还能降低不良事件风险；因此，证据表明UGPL是肩部钙化性肌腱炎非手术治疗的首选方法。证据等级I。
