超声与体外冲击波治疗网球肘疗效的比较研究：一项随机对照试验的荟萃分析。

BACKGROUND: Tennis elbow or lateral epicondylitis is a common source of pain among craftsmen. Although it cannot be completely resolved, extracorporeal shock wave therapy (ESWT) and ultrasonics (US) have been found to be effective for tennis elbow as highlighted in previously published randomized controlled trials (RCTs) and reviews. However, the efficacy of these two therapies in treating tennis elbow is unknown. This meta-analysis compares the effectiveness of ESWT and US in relieving pain and restoring the functions of tennis elbow following tendinopathy. METHODS: RCTs published in the PubMed, Embase, Cochrane Library, and SpringerLink databases comparing ESWT and US in treating tennis elbow were identified by a software and manual search. The risk of bias and clinical relevance of the included studies were assessed. Publication bias was explored using funnel plot and statistical tests (Egger's test and Begg's test). The major outcomes of the studies were analyzed using the Review Manager 5.3. RESULTS: Five RCTs comprising five patients were included in the present meta-analysis. The results revealed a significantly lower VAS score of pain in the ESWT group (1 month: MD = 4.47, p = 0.0001; 3 months: MD = 20.32, p < 0.00001; and 6 months: MD = 4.32, p < 0.0001) compared to US. Besides, the grip strength was markedly higher 3 months after the intervention in ESWT (MD = 8.87, p < 0.00001) than in the US group. Although no significant difference was observed in the scores of the elbow function after 3 months of treatment (SMD = 1.51, p = 0.13), the subjective scores of elbow functions were found to be better in the ESWT group (SMD = 3.34; p = 0.0008) compared to the US group. CONCLUSIONS: Although there was no significant difference in the elbow function evaluation scores between ESWT and US, the superiority of the ESWT group in the VAS of pain (both at 1 month, 3 months, and 6 months follow-ups) raised grip strength in ESWT group and the scores for subjective evaluation of efficacy indicated that ESWT offers more effective therapy for lateral epicondylitis than US therapy.

背景：网球肘或外上髁炎是工匠常见的疼痛源。尽管无法完全解决，但体外冲击波疗法（ESWT）和超声（US）已被发现对网球肘有效，这在前瞻性随机对照试验（RCT）和综述中得到了强调。然而，这两种疗法治疗网球肘的效果尚不清楚。这项荟萃分析比较了 ESWT 和 US 在治疗肌腱病引起的网球肘时缓解疼痛和恢复功能的效果。

方法：通过软件和手动搜索，确定了在 PubMed、Embase、Cochrane 图书馆和 SpringerLink 数据库中发表的比较 ESWT 和 US 治疗网球肘的 RCTs。评估了纳入研究的偏倚风险和临床相关性。使用漏斗图和统计检验（Egger 检验和 Begg 检验）探讨发表偏倚。使用 Review Manager 5.3 分析研究的主要结果。

结果：本荟萃分析纳入了 5 项 RCT，共纳入了 5 名患者。结果显示，ESWT 组的疼痛视觉模拟评分（VAS）明显更低（1 个月：MD=4.47，p=0.0001；3 个月：MD=20.32，p<0.00001；6 个月：MD=4.32，p<0.0001）。此外，ESWT 组干预后 3 个月握力明显更高（MD=8.87，p<0.00001）。虽然治疗 3 个月后肘部功能评分无显著差异（SMD=1.51，p=0.13），但 ESWT 组肘部功能的主观评分明显更好（SMD=3.34；p=0.0008）。

结论：尽管 ESWT 和 US 在肘部功能评估评分方面没有显著差异，但 ESWT 在疼痛 VAS 方面（1 个月、3 个月和 6 个月随访时）的优势提高了 ESWT 组的握力，并且 ESWT 组的疗效主观评估评分更高，表明 ESWT 比 US 治疗更有效治疗外上髁炎。