Challoumas Dimitris, Kirwan Paul D, Borysov Dmytro, Clifford Christopher, McLean Michael, Millar Neal L
Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland.
Br J Sports Med. 2019 Feb;53(4):251-262. doi: 10.1136/bjsports-2018-099552. Epub 2018 Oct 9.
To produce a best evidence synthesis of the clinical effects of topical glyceryl trinitrate (GTN) in the treatment of tendinopathies.
A systematic review of published randomised controlled trials (RCTs) of the use of GTN in patients with tendinopathy.
MEDLINE, Embase, Scopus and CINAHL from database inception to January 2018.
We examined RCTs comparing the effects of topical GTN with either placebo or other treatments on tendinopathy. Overall quality of each eligible study was determined based on a combined assessment of internal validity, external validity and precision. The level of evidence for each assessed parameter was rated based on the system by van Tulder .
A total of 10 eligible RCTs were identified including patients with tendinopathy of the rotator cuff (n=4), wrist extensors (n=3), Achilles (n=2) and patellar (n=1) tendons. For all tendinopathies, improvements in pain were significant when comparing GTN versus placebo in the short term (<8 weeks; poor evidence). Significant improvements in midterm outcomes for treatment with GTN versus placebo included the following: patient satisfaction (strong evidence); chances of being asymptomatic with activities of daily living (strong evidence); range of movement (moderate evidence); strength (moderate evidence); pain (at night and with activity; poor evidence) and local tenderness (poor evidence). Patients treated with topical GTN reported a higher incidence of headaches than those who received placebo (moderate evidence).
Treatment of tendinopathies with topical GTN for up to 6 months appears to be superior to placebo and may therefore be a useful adjunct to the treating healthcare professions.
对局部应用硝酸甘油（GTN）治疗肌腱病的临床效果进行最佳证据综合分析。
对已发表的关于GTN用于肌腱病患者的随机对照试验（RCT）进行系统评价。
从数据库建立至2018年1月的MEDLINE、Embase、Scopus和CINAHL。
我们考察了比较局部应用GTN与安慰剂或其他治疗方法对肌腱病疗效的RCT。根据内部效度、外部效度和精确性的综合评估来确定每项合格研究的总体质量。根据van Tulder的系统对每个评估参数的证据水平进行评级。
共确定了10项合格的RCT，包括肩袖肌腱病（n = 4）、腕伸肌肌腱病（n = 3）、跟腱肌腱病（n = 2）和髌腱肌腱病（n = 1）患者。对于所有肌腱病，短期内（<8周；证据质量低）比较GTN与安慰剂时，疼痛改善显著。GTN与安慰剂治疗中期结果的显著改善包括：患者满意度（证据充分）；日常生活活动无症状的几率（证据充分）；活动范围（证据中等）；力量（证据中等）；疼痛（夜间和活动时；证据质量低）和局部压痛（证据质量低）。局部应用GTN治疗的患者头痛发生率高于接受安慰剂治疗的患者（证据中等）。
局部应用GTN治疗肌腱病长达6个月似乎优于安慰剂，因此可能是治疗医护专业人员的有用辅助手段。
