The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong, China.
Department of Family and Community Medicine, Pennsylvania State University, Hershey, PA.
Arch Phys Med Rehabil. 2022 Nov;103(11):2209-2218. doi: 10.1016/j.apmr.2022.01.166. Epub 2022 Feb 28.
To systematically review the effectiveness of hypertonic dextrose prolotherapy (DPT) on pain intensity and physical functioning in patients with lateral elbow tendinosis (LET) compared with other active non-surgical treatments.
Systematic search of Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Web of Science, PubMed, Dimensions, Global Health, NHS Health Technology Assessment, Allied and Complementary Medicine, and OVID nursing database from inception to June 15, 2021, without language restrictions.
Two reviewers independently identified parallel or crossover randomized controlled trials that evaluated the effectiveness of DPT in LET. The search identified 245 records; data from 8 studies (354 patients) were included.
Two reviewers independently extracted data and assessed included studies. The Cochrane Risk of Bias 2 tool was used to evaluate risk of bias. The Grading of Recommendation Assessment, Development, and Evaluation approach was used to assess quality of the evidence.
Pooled results favored the use of DPT in reducing tennis elbow pain intensity compared with active controls at 12 weeks postenrollment, with a standardized mean difference of -0.44 (95% confidence interval, -0.88 to -0.01, P=.04) and of moderate heterogeneity (I=49%). Pooled results also favored the use of DPT on physical functioning compared with active controls at 12 weeks, with Disabilities of the Arm, Shoulder and Hand scores achieving a mean difference of -15.04 (95% confidence interval, -20.25 to -9.82, P<.001) and of low heterogeneity (I=0.0%). No major related adverse events have been reported.
DPT is superior to active controls at 12 weeks for decreasing pain intensity and functioning by margins that meet criteria for clinical relevance in the treatment of LET. Although existing studies are too small to assess rare adverse events, for patients with LET, especially those refractory to first-line treatments, DPT can be considered a nonsurgical treatment option in carefully selected patients. Further high-quality trials with comparison with other injection therapies are needed.
系统评价高渗葡萄糖葡聚糖注射疗法（DPT）治疗外侧肘肌腱病（LET）患者疼痛强度和身体功能的有效性，与其他积极的非手术治疗相比。
系统检索 Cochrane 对照试验中心注册库、MEDLINE、EMBASE、Web of Science、PubMed、Dimensions、全球健康、NHS 健康技术评估、辅助和补充医学以及 OVID 护理数据库，从建库至 2021 年 6 月 15 日，无语言限制。
两位审查员独立确定了评估 LET 中 DPT 有效性的平行或交叉随机对照试验。搜索共确定 245 条记录；纳入了 8 项研究（354 例患者）的数据。
两位审查员独立提取数据并评估纳入的研究。使用 Cochrane 偏倚风险 2 工具评估偏倚风险。使用推荐评估、制定与评价分级方法评估证据质量。
汇总结果表明，与积极对照相比，DPT 在 12 周时更能降低网球肘疼痛强度，标准化均数差为-0.44（95%置信区间，-0.88 至 -0.01，P=.04），存在中度异质性（I=49%）。汇总结果还表明，DPT 在 12 周时在身体功能方面优于积极对照，手臂、肩部和手残疾评分的平均差值为-15.04（95%置信区间，-20.25 至 -9.82，P<.001），异质性低（I=0.0%）。没有报告与治疗相关的重大不良事件。
DPT 在 12 周时在降低疼痛强度和功能方面优于积极对照，其疗效具有临床相关性，可满足 LET 治疗的标准。尽管现有研究规模太小，无法评估罕见的不良事件，但对于 LET 患者，尤其是对一线治疗无反应的患者，DPT 可以被视为精心选择的患者的一种非手术治疗选择。需要进一步开展高质量的与其他注射治疗比较的试验。
