Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland.
Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland.
Knee Surg Sports Traumatol Arthrosc. 2021 Aug;29(8):2553-2563. doi: 10.1007/s00167-020-06390-x. Epub 2021 Jan 9.
The purpose of this overview is to summarise the findings of meta-analyses of randomised controlled trials that compare conservative treatment options for frozen shoulder.
The authors conducted an electronic literature search for meta-analyses published using PubMed, Web of Science and the Cochrane Library. Two researchers independently applied selection criteria and assessed quality of meta-analyses using A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2). Short-, medium- and long-term outcomes were synthesised narratively.
A total of 319 studies were identified, of which 8 meta-analyses were eligible for inclusion. All included meta-analyses were judged to be low or critically low quality according to AMSTAR-2, however, their data synthesis and interpretation was considered valid. Physiotherapy, intra-articular and subacromial corticosteroid injection (CSI), and arthrographic distension/hydrodilatation with corticosteroid were reported with sufficient evidence. Intra-articular CSI and arthrographic distension/hydrodilatation with corticosteroid provide advantages over placebo in short-term pain relief, range of motion (ROM) and shoulder function, with improvements in ROM continuing into the medium and long term. Arthrographic distension/hydrodilatation with corticosteroid provides medium-term and long-term improvements in ROM over intra-articular CSI and physiotherapy. Proprioceptive neuromuscular facilitation provides advantages over conventional physiotherapy for pain improvement and external rotation in the short term.
Arthrographic distension/hydrodilatation with corticosteroid provides superior pain relief in the short term and improvement in range of motion across all time frames for frozen shoulder when compared to CSI or physiotherapy.
Level IV.
本文旨在总结对比较肩周炎保守治疗选择的随机对照试验的荟萃分析结果。
作者通过 PubMed、Web of Science 和 Cochrane Library 进行了电子文献检索，以寻找荟萃分析。两位研究人员独立应用选择标准，并使用评估系统评价的测量工具（AMSTAR-2）评估荟萃分析的质量。短、中、长期结果以叙述性方式进行综合。
共确定了 319 项研究，其中 8 项荟萃分析符合纳入标准。根据 AMSTAR-2，所有纳入的荟萃分析均被判定为低质量或极低级质量，但它们的数据综合和解释被认为是有效的。物理治疗、关节内和肩峰下皮质类固醇注射（CSI）以及关节造影扩张/液压扩张联合皮质类固醇有足够的证据支持。关节内 CSI 和关节造影扩张/液压扩张联合皮质类固醇在短期疼痛缓解、活动范围（ROM）和肩部功能方面优于安慰剂，ROM 的改善持续到中期和长期。关节造影扩张/液压扩张联合皮质类固醇在 ROM 方面优于关节内 CSI 和物理治疗，具有中、长期的改善。本体感觉神经肌肉促进法在短期改善疼痛和外旋方面优于传统物理治疗。
与 CSI 或物理治疗相比，关节造影扩张/液压扩张联合皮质类固醇在短期内提供了更好的疼痛缓解，并在所有时间范围内改善了肩周炎的活动范围。
IV 级。
