Bateman Marcus, Littlewood Chris, Rawson Beth, Tambe Amol A
Orthopaedic Department, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK.
Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences and Keele Clinical Trials Unit, David Weatherall Building, Keele University, Staffordshire, UK.
Shoulder Elbow. 2019 Feb;11(1):35-44. doi: 10.1177/1758573217745041. Epub 2017 Dec 11.
There is no consensus on the most suitable treatment for tennis elbow but, in the USA, surgical intervention is increasing despite a lack of supportive research evidence. The aim of this systematic review was to provide a balanced update based on all relevant published randomized controlled trials conducted to date.
An electronic search of MEDLINE, EMBASE, CINAHL, BNI, AMED, PsycINFO, HBE, HMIC, PubMed, TRIP, Dynamed Plus and The Cochrane Library was complemented by hand searching. Risk of bias was assessed using the Cochrane Risk of Bias Tool and data were synthesized narratively, based on levels of evidence, as a result of heterogeneity.
Twelve studies of poor methodological quality were included. The available data suggest that surgical interventions for tennis elbow are no more effective than nonsurgical and sham interventions. Surgical technique modifications may enhance effectiveness compared to traditional methods but have not been tested against a placebo.
Current research evidence suggests that surgery for tennis elbow is no more effective than nonsurgical treatment based on evidence with significant methodological limitations. Given the recalcitrant nature of tennis elbow for some patients, further research in the form of a high-quality placebo-controlled surgical trial with an additional conservative arm is required to usefully inform clinical practice.
对于网球肘最适宜的治疗方法尚无共识，但在美国，尽管缺乏支持性研究证据，手术干预仍在增加。本系统评价的目的是根据迄今开展的所有相关已发表随机对照试验提供一个全面的更新。
对MEDLINE、EMBASE、CINAHL、BNI、AMED、PsycINFO、HBE、HMIC、PubMed、TRIP、Dynamed Plus和Cochrane图书馆进行电子检索，并辅以手工检索。使用Cochrane偏倚风险工具评估偏倚风险，由于存在异质性，基于证据水平对数据进行叙述性综合分析。
纳入了12项方法学质量较差的研究。现有数据表明，网球肘的手术干预并不比非手术和假手术干预更有效。与传统方法相比，手术技术改良可能会提高疗效，但尚未与安慰剂进行对照测试。
目前的研究证据表明，基于存在显著方法学局限性的证据，网球肘手术并不比非手术治疗更有效。鉴于网球肘对某些患者具有顽固性，需要开展高质量的安慰剂对照手术试验并增加一个保守治疗组的进一步研究，以便为临床实践提供有益参考。
