Department of Basic Sciences, Faculty of Physical Therapy, Ahram Canadian University, 4th Industrial Zone, Banks Complex، 6th of October City, Giza, Egypt.
Department of Physical Therapy for Orthopedics & Sport Injuries, October 6 University, Central Axis, 6th of October City, Giza, Egypt.
J Ultrasound. 2023 Sep;26(3):593-604. doi: 10.1007/s40477-022-00684-1. Epub 2022 May 6.
Corticosteroid (CS) can be injected in a blind fashion (landmark-guided) or with ultrasound (US) guidance, and this may contribute to varying clinical results. We conducted this systematic review and meta-analysis to assess the effectiveness of US-guided versus landmark CS injections in the treatment of adult patients with shoulder pain.
We searched MEDLINE (via PubMed), Scopus, Web of Science, EBSCO, and Cochrane Library for randomized controlled trials (RCTs) comparing US-guided versus landmark CS injection regarding visual analogue scale (VAS), functional scores, disability scores, abduction degree, and side effects. The data were pooled as mean difference (MD), standardized mean difference (SMD), or risk ratios (RRs), with 95% confidence intervals (CIs), using R software (meta package 4.9-0) for windows. Subgroup analysis and leave-one-out analysis were conducted.
Eighteen RCTs, with a total of 1010 patients, were included in this meta-analysis. The pooled estimate favored the US-guided over landmark CS injection in terms of the mean change of VAS between 6 weeks and baseline (SMD = - 0.48, 95% CI [- 0.79, - 0.17]), the shoulder functional scores (SMD = 0.35, 95% CI [0.05, 0.65]) and shoulder abduction degree (MD = 8.78, 95% CI [3.11, 14.46]). Whilst no significant difference was found between the compared group regarding the overall shoulder disability scores (SMD = - 0.51, 95% CI (- 1.25, 0.22]) and side effects (RR = 0.45, 95% CI [0.15, 1.34]). None of the eligible study analyzed the cost-effectiveness of the US-guided method compared with the landmark method for CS injection.
Our analysis showed that US-guided CS injection was effective in the treatment of various shoulder diseases. Further research on the cost-effectiveness of US-guided CS methods is needed.
皮质类固醇（CS）可进行盲法（基于体表标志）或超声（US）引导下注射，这可能会导致不同的临床结果。我们进行了这项系统评价和荟萃分析，以评估 US 引导与基于体表标志 CS 注射治疗成人肩部疼痛的效果。
我们检索了 MEDLINE（通过 PubMed）、Scopus、Web of Science、EBSCO 和 Cochrane 图书馆，以比较 US 引导与基于体表标志 CS 注射治疗成人肩部疼痛的随机对照试验（RCT），比较视觉模拟量表（VAS）、功能评分、残疾评分、外展程度和不良反应。使用 R 软件（适用于 Windows 的 meta 包 4.9-0）汇总数据为均数差（MD）、标准化均数差（SMD）或风险比（RR），置信区间（CI）为 95%。进行了亚组分析和剔除单因素分析。
这项荟萃分析纳入了 18 项 RCT，共 1010 例患者。荟萃分析结果表明，在 6 周和基线之间 VAS 的平均变化（SMD=-0.48，95%CI[-0.79，-0.17]）、肩部功能评分（SMD=0.35，95%CI[0.05，0.65]）和肩部外展程度（MD=8.78，95%CI[3.11，14.46]）方面，US 引导优于基于体表标志 CS 注射。而两组间总体肩部残疾评分（SMD=-0.51，95%CI[-1.25，0.22]）和不良反应（RR=0.45，95%CI[0.15，1.34]）方面无显著差异。纳入的研究均未分析 US 引导 CS 注射方法与基于体表标志 CS 注射方法的成本效益。
我们的分析表明，US 引导 CS 注射在治疗各种肩部疾病方面是有效的。需要进一步研究 US 引导 CS 方法的成本效益。
