皮质类固醇注射治疗足底筋膜炎的作用：一项系统评价与荟萃分析。
The role of corticosteroid injections in treating plantar fasciitis: A systematic review and meta-analysis.
作者信息
Seth Ishith, Bulloch Gabriella, Seth Nimish, Lower Kirk, Rodwell Aaron, Rastogi Anish, Gibson Damien, Bedi Harvinder
机构信息
Department of Surgery, Peninsula Health, Victoria 3199, Australia; Faculty of Medicine and Science, Central Clinical School, Monash University, Victoria 3004, Australia.; Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales 2500, Australia.
Faculty of Science, Medicine and Health, University of Melbourne, Victoria 3010, Australia.
出版信息
Foot (Edinb). 2023 Mar;54:101970. doi: 10.1016/j.foot.2023.101970. Epub 2023 Feb 3.
BACKGROUND
Plantar fasciitis is a recurrent cause of heel pain and is often treated by corticosteroid infections (CSI). The current study reviewed and analysed the role of CSI with platelet rich plasma (PRP), and CSI with extracorporeal shock wave therapy (EWST) for plantar fasciitis treatment.
METHODS
PubMed, Medline, Web of Science, Embase, Cochrane, and Google Scholar databases were searched for relevant studies. Preferred Reporting in Systematic Review & Meta-Analysis (PRISMA) guidelines were used to search relevant studies published from infinity to April 2021. The risk of bias was performed using Cochrane Collaboration's tool. GRADE assessment was used for quality of evidence. Data analysis was performed with the use of R software and P < 0.05 was considered statistically significant. CSI was compared with PRP and EWST.
RESULTS
Eighteen studies comprising 1180 patients were included in this meta-analysis. When compared to PRP, CSI with lignocaine/lidocaine had significantly higher mean difference on visual analogue scale (VAS) pain scores at 3 months (0.62 [0.13; 1.12], P = 0.01) and 6 months (MD = 1.49 [0.22; 2.76], P = 0.02). At 6 months, VAS scores were higher in the CSI group than the ESWT group (MD = 0.8 [0.38; 1.22], P = 0.1). At 6 months, a significant reduction in the American Orthopaedic Foot and Ankle Score (AOFAS) was observed in the CSI group compared to PRP (MD = - 11.53 [- 16.62; - 6.43], P < 0.0001).
CONCLUSION
Patients suffering from plantar fasciitis, PRP achieved better VAS scores compared to CSI at 3 and 6-month follow-up. In addition, ESWT had better VAS score outcomes at 6 months compared to CSI. Regarding AOFAS score, PRP was more efficacious than CSI at 6 months of follow-up. Only through the development of high-quality, large-scale longitudinal studies, will the findings and conclusions of this meta-analysis be strengthened and influence our clinical practice in the treatment of plantar fasciitis.
LEVEL OF CLINICAL EVIDENCE
II.
背景
足底筋膜炎是足跟痛的常见复发原因，常采用皮质类固醇注射（CSI）治疗。本研究回顾并分析了CSI联合富血小板血浆（PRP）以及CSI联合体外冲击波疗法（EWST）在治疗足底筋膜炎中的作用。
方法
检索了PubMed、Medline、Web of Science、Embase、Cochrane和谷歌学术数据库中的相关研究。使用系统评价与Meta分析的首选报告（PRISMA）指南检索从创刊至2021年4月发表的相关研究。采用Cochrane协作工具进行偏倚风险评估。使用GRADE评估证据质量。使用R软件进行数据分析，P<0.05被认为具有统计学意义。将CSI与PRP和EWST进行比较。
结果
本Meta分析纳入了18项研究，共1180例患者。与PRP相比，利多卡因/赛罗卡因联合CSI在3个月时视觉模拟量表（VAS）疼痛评分的平均差异显著更高（0.62[0.13；1.12]，P=0.01），在6个月时也是如此（MD=1.49[0.22；2.76]，P=0.02）。在6个月时，CSI组的VAS评分高于ESWT组（MD=0.8[0.38；1.22]，P=0.1）。在6个月时，与PRP相比，CSI组的美国矫形足踝协会评分（AOFAS）显著降低（MD=-11.53[-16.62；-6.43]，P<0.0001）。
结论
对于足底筋膜炎患者，在3个月和6个月的随访中，PRP的VAS评分优于CSI。此外，在6个月时，EWST的VAS评分结果优于CSI。关于AOFAS评分，在6个月的随访中，PRP比CSI更有效。只有通过开展高质量、大规模的纵向研究，才能加强本Meta分析的结果和结论，并影响我们在足底筋膜炎治疗中的临床实践。
临床证据水平
II级。
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