From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School; the University of Michigan; and the Biostatistics and Informatics Unit, Clinical Trial Center, Chang Gung Memorial Hospital and Chang Gung University.
Plast Reconstr Surg. 2021 Jan 1;147(1):112-125. doi: 10.1097/PRS.0000000000007440.
Lateral epicondylitis is a common overuse injury affecting approximately 1 to 3 percent of the population. Although symptoms may disappear spontaneously within 1 year, the clinical guidelines for conservative treatment are not clear. The authors' objective was to examine the outcomes of nonsurgical treatments for lateral epicondylitis through a meta-analysis and provide a treatment recommendation using the available evidence.
The authors searched the PubMed, EMBASE, Scopus, and Web of Science databases to identify primary research articles studying conservative treatments (electrophysiotherapy, physical therapy, and injections) for lateral epicondylitis. The authors included randomized controlled trials published in peer-reviewed journals. Data related to outcomes (pain, grip strength, Patient-Rated Tennis Elbow Evaluation score, and Disabilities of the Arm, Shoulder and Hand score) and complications were extracted.
Fifty-eight randomized controlled trials were included in the meta-analysis. Electrophysiotherapy was effective in improving pain [mean difference, -10.0 (95 percent CI, -13.8 to -6.1)], Patient-Rated Tennis Elbow Evaluation score [mean difference, -10.7 (95 percent CI, -16.3 to -5.0)], and Disabilities of the Arm, Shoulder and Hand score [mean difference, -11.9 (95 percent CI, -15.8 to -7.9)]; and physical therapy improved pain [mean difference, -6.0 (95 percent CI, -9.7 to -2.3)] and Patient-Rated Tennis Elbow Evaluation scores [mean difference, -7.5 (95 percent CI, -11.8 to -3.2)] compared to placebo. Injections did not improve any outcome measures. Patients who received electrophysiotherapy and injections reported higher adverse effects than physical therapy patients.
Patients who received electrophysiotherapy and physical therapy reported statistically and clinically improved scores in pain and function compared to placebo. Injections may put patients at higher risk for adverse effects compared to other conservative treatments. When managing lateral epicondylitis conservatively, electrophysiotherapy and physical therapy should be prioritized before other interventions.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.
外侧肱骨上髁炎是一种常见的过度使用损伤，影响约 1%至 3%的人群。尽管症状可能在 1 年内自行消失，但保守治疗的临床指南尚不清楚。作者的目的是通过荟萃分析研究外侧肱骨上髁炎的非手术治疗结果，并根据现有证据提供治疗建议。
作者检索了 PubMed、EMBASE、Scopus 和 Web of Science 数据库，以确定研究外侧肱骨上髁炎保守治疗（电疗、物理治疗和注射）的原始研究文章。作者纳入了发表在同行评议期刊上的随机对照试验。提取与结局（疼痛、握力、患者自评网球肘评估评分和上肢功能障碍评分）和并发症相关的数据。
荟萃分析纳入了 58 项随机对照试验。电疗在改善疼痛[平均差值，-10.0（95%置信区间，-13.8 至-6.1）]、患者自评网球肘评估评分[平均差值，-10.7（95%置信区间，-16.3 至-5.0）]和上肢功能障碍评分[平均差值，-11.9（95%置信区间，-15.8 至-7.9）]方面有效；物理治疗在改善疼痛[平均差值，-6.0（95%置信区间，-9.7 至-2.3）]和患者自评网球肘评估评分[平均差值，-7.5（95%置信区间，-11.8 至-3.2）]方面优于安慰剂。注射治疗并未改善任何结局指标。接受电疗和注射治疗的患者报告的不良反应发生率高于接受物理治疗的患者。
与安慰剂相比，接受电疗和物理治疗的患者在疼痛和功能方面的评分均有统计学和临床意义上的改善。与其他保守治疗相比，注射治疗可能使患者面临更高的不良反应风险。在保守治疗外侧肱骨上髁炎时，应优先考虑电疗和物理治疗，而不是其他干预措施。
临床问题/证据水平：治疗性，I 级。
