Graduate Program in Physical Education, Federal University of Sergipe, Av Marechal Rondon, s/n, Rosa Elze, São Cristovão, Sergipe, 49100-000, Brazil.
Department of Physical Therapy, Federal University of Sergipe, Av Marechal Rondon, s/n, Rosa Elze, São Cristovão, Sergipe, 49100-000, Brazil.
Chiropr Man Therap. 2021 Dec 2;29(1):49. doi: 10.1186/s12998-021-00408-y.
BACKGROUND: Corticosteroid injection and dry needling have been used in the treatment of musculoskeletal conditions, but it is unclear which intervention is the most effective. The purpose of this study was to compare the effects of corticosteroid injection and dry needling for musculoskeletal conditions at short-, medium-, and long-term follow-up. METHODS: Electronic databases were searched up to 31 October 2021. Two researchers independently screened titles, abstracts and full-text articles. Randomized clinical trials (RCTs) that investigated the effectiveness of dry needling compared to corticosteroid injection in patients over 18 years with a musculoskeletal condition were included in the review. The studies had to report pain and/or disability as outcome. Risk of bias was assessed by using the revised Cochrane Collaboration tool (RoB 2.0). Quality of evidence was evaluated by using the GRADE approach. RESULTS: Six studies were included (n = 384 participants). Four musculoskeletal conditions were investigated. There is very low-quality evidence that CSI is superior to DN for reducing heel pain (plantar fasciitis) and lateral elbow pain at short- and medium-term follow-up, but not for myofascial pain and greater trochanteric pain. There is very low-quality evidence that DN is more effective than CSI at long-term follow-up for reducing pain in people with plantar fasciitis and lateral epicondylitis. Very low-certainty evidence shows that there is no difference between DN and CSI for disability at short-term follow-up. One study showed that CSI is superior to DN at medium-term follow-up and another observed that DN is superior to CSI for reducing disability at long-term. CONCLUSIONS: There are no differences between DN and CSI in pain or disability for myofascial pain and greater trochanteric pain syndrome. Very-low certainty evidence suggests that CSI is superior to DN at shorter follow-up periods, whereas DN seems to be more effective than CSI at longer follow-up durations for improving pain in plantar fasciitis and lateral epicondylitis. Large RCTs with higher methodological quality are needed in order to draw more incisive conclusions. PROSPERO REGISTRATION NUMBER: CRD42020148650.
背景：皮质类固醇注射和干针疗法已用于治疗肌肉骨骼疾病，但尚不清楚哪种干预措施最有效。本研究的目的是比较皮质类固醇注射和干针疗法在肌肉骨骼疾病的短期、中期和长期随访中的效果。
方法：检索电子数据库至 2021 年 10 月 31 日。两名研究人员独立筛选标题、摘要和全文文章。纳入了比较干针疗法与皮质类固醇注射治疗 18 岁以上肌肉骨骼疾病患者的有效性的随机临床试验（RCT）。研究必须报告疼痛和/或残疾作为结局。使用修订后的 Cochrane 协作工具（RoB 2.0）评估偏倚风险。使用 GRADE 方法评估证据质量。
结果：纳入了 6 项研究（n=384 名参与者）。调查了 4 种肌肉骨骼疾病。有非常低质量的证据表明，CSI 在短期和中期随访时比 DN 更能减轻足跟痛（足底筋膜炎）和外侧肘部疼痛，但不能减轻肌筋膜疼痛和大转子疼痛。有非常低质量的证据表明，DN 在长期随访时比 CSI 更能减轻足底筋膜炎和外侧上髁炎患者的疼痛。非常低确定性证据表明，DN 和 CSI 在短期随访时对残疾的影响没有差异。一项研究表明，CSI 在中期随访时优于 DN，另一项研究观察到，DN 在长期随访时比 CSI 更能减轻残疾。
结论：在肌筋膜疼痛和大转子疼痛综合征中，DN 和 CSI 在疼痛或残疾方面没有差异。非常低确定性证据表明，CSI 在较短的随访期优于 DN，而在较长的随访期，DN 似乎比 CSI 更能改善足底筋膜炎和外侧上髁炎的疼痛。需要进行具有更高方法学质量的大型 RCT，以得出更有见地的结论。
PROSPERO 注册号：CRD42020148650。
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