Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
Department of Pain Management, Jiangyin People's Hospital Affiliated to Nantong University, Wuxi, 214400, China.
J Orthop Surg Res. 2023 Apr 3;18(1):272. doi: 10.1186/s13018-023-03747-z.
To compare the clinical effectiveness of three common shoulder injections mentioned in the guidelines [corticosteroid, sodium hyaluronate (SH) and platelet-rich plasma (PRP)] on rotator cuff tears.
The PubMed, Embase and Cochrane Library databases were systematically searched up to June 1, 2022, for randomized controlled trials (RCTs) and prospective studies on the three injection therapies for rotator cuff tears. The main results were pain relief and functional improvement at 1-5 months and over 6 months, pooled using a network meta-analysis and ranked by SUCRA score. The risk of bias of the included studies was assessed using the Cochrane Collaboration tool.
Twelve RCTs and 4 prospective studies comprising a total of 1115 patients were included in the review. Three prospective studies were judged to be at high risk of selection bias and performance bias, and one was considered as having a high risk of detection bias. SH injection ranked first in the short term in pain relief (MD: - 2.80; 95%CI - 3.91, - 1.68) and functional improvement (MD:19.17; 95%CI 12.29, 26.05), while PRP injection obtained better results in the long term in both pain relief (MD: - 4.50; 95%CI - 4.97, - 4.03) and functional improvement (MD:11.11; 95%CI 0.53,21.68).
PRP injection has the potential to successfully treat rotator cuff tears as an alternative to corticosteroids in the long term, in terms of either therapeutic efficiency or adverse effects, followed by SH injection. More research is needed to make high-quality recommendations on treatment options for injection treatments of rotator cuff tears.
比较指南中提到的三种常见肩部注射治疗（皮质类固醇、透明质酸钠[SH]和富含血小板的血浆[PRP]）治疗肩袖撕裂的临床疗效。
系统检索了 PubMed、Embase 和 Cochrane Library 数据库，截至 2022 年 6 月 1 日，以获取关于三种注射疗法治疗肩袖撕裂的随机对照试验（RCT）和前瞻性研究。主要结果是 1-5 个月和 6 个月以上的疼痛缓解和功能改善，使用网络荟萃分析进行汇总，并按 SUCRA 评分进行排名。使用 Cochrane 协作工具评估纳入研究的偏倚风险。
共纳入 1115 例患者的 12 项 RCT 和 4 项前瞻性研究。3 项前瞻性研究被认为存在选择偏倚和实施偏倚的高风险，1 项研究被认为存在检测偏倚的高风险。SH 注射在短期疼痛缓解（MD：-2.80；95%CI：-3.91，-1.68）和功能改善（MD：19.17；95%CI：12.29，26.05）方面排名第一，而 PRP 注射在长期疼痛缓解（MD：-4.50；95%CI：-4.97，-4.03）和功能改善（MD：11.11；95%CI：0.53，21.68）方面的效果更好。
PRP 注射在长期治疗肩袖撕裂方面，无论是疗效还是不良反应，都有可能成功替代皮质类固醇，其次是 SH 注射。需要更多的研究来为肩袖撕裂注射治疗的治疗方案提供高质量的建议。
