Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, Iran University of Medical Sciences, Tehran, Iran.
Medical Students Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Arch Phys Med Rehabil. 2018 Apr;99(4):766-775. doi: 10.1016/j.apmr.2017.08.484. Epub 2017 Sep 21.
To review the literature and assess the comparative effectiveness of ultrasound-guided versus landmark-guided local corticosteroid injections in patients with carpal tunnel syndrome (CTS).
Cochrane Central Register of Controlled Trials, MEDLINE (PubMed), Embase (Ovid), and Web of Science (from inception to February 1, 2017).
Randomized controlled trials (RCTs) comparing ultrasound-guided injection with landmark-guided injection in patients with CTS were included.
Two authors independently screened abstracts and full texts. The outcomes of interest were Symptom Severity Scale (SSS) and Functional Status Scale (FSS) scores of the Boston Carpal Tunnel Questionnaire and 4 electrodiagnostic parameters, including compound muscle action potential (CMAP), sensory nerve action potential (SNAP), distal motor latency (DML), and distal sensory latency (DSL).
Overall, 569 abstracts were retrieved and checked for eligibility; finally, 3 RCTs were included (181 injected hands). Pooled analysis showed that ultrasound-guided injection was more effective in SSS improvement (mean difference [MD], -.46; 95% confidence interval [CI], -.59 to -.32; P<.00001), whereas no significant difference was observed between the 2 methods in terms of the FSS (MD, -.25; 95% CI, -.56 to .05; P=.10). There were also no statistically significant differences in improvements of CMAP (MD, 1.54; 95% CI, 0.01 to 3.07; P=.05), SNAP (MD, -0.02; 95% CI, -6.27 to 6.23; P>.99), DML (MD, .05; 95% CI, -.30 to .39; P=.80), or DSL (MD, .00; 95% CI, -.65 to .65; P>.99).
This review suggested that ultrasound-guided injection was more effective than landmark-guided injection in symptom severity improvement in patients with CTS; however, no significant differences were observed in functional status or electrodiagnostic improvements between the 2 methods.
回顾文献并评估腕管综合征（CTS）患者中超声引导与解剖标志引导局部皮质类固醇注射的比较效果。
考克兰中心对照试验注册库、MEDLINE（PubMed）、Embase（Ovid）和 Web of Science（从建库至 2017 年 2 月 1 日）。
纳入比较 CTS 患者超声引导注射与解剖标志引导注射的随机对照试验（RCT）。
两位作者独立筛选摘要和全文。主要结局指标为波士顿腕管问卷的症状严重程度评分（SSS）和功能状态评分（FSS），以及 4 项电诊断参数，包括复合肌肉动作电位（CMAP）、感觉神经动作电位（SNAP）、运动神经潜伏期（DML）和感觉神经潜伏期（DSL）。
共检索到 569 篇摘要，并对其进行了资格审查；最终纳入 3 项 RCT（181 只注射手）。汇总分析显示，超声引导注射在 SSS 改善方面更有效（均数差[MD]，-.46；95%置信区间[CI]，-.59 至 -.32；P<.00001），而在 FSS 方面，两种方法之间无显著差异（MD，-.25；95% CI，-.56 至.05；P=.10）。CMAP（MD，1.54；95% CI，0.01 至 3.07；P=.05）、SNAP（MD，-0.02；95% CI，-6.27 至 6.23；P>.99）、DML（MD，.05；95% CI，-.30 至.39；P=.80）或 DSL（MD，.00；95% CI，-.65 至.65；P>.99）的改善也无统计学意义。
本综述表明，超声引导注射在 CTS 患者的症状严重程度改善方面优于解剖标志引导注射；然而，两种方法在功能状态或电诊断改善方面无显著差异。
