Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China.
Department of Rehabilitation, Chengdu Second People's Hospital, Chengdu, 610000, China.
Asian J Surg. 2024 Jan;47(1):89-99. doi: 10.1016/j.asjsur.2023.04.104. Epub 2023 May 4.
The comparative effect of commonly used conservative treatments for carpal tunnel syndrome remained controversial. The purpose of this study was to compare the clinical effect of local corticosteroid injection and physical therapy for the treatment of carpal tunnel syndrome. A systematic literature search of PubMed, EMBASE, and Cochrane library was conducted to identify relevant randomized clinical trials published before 21st Mar 2023. Two independent reviewers assayed quality of included studies using the Cochrane collaboration risk of bias tool. Relevant data were extracted and pooled analyses were conducted. Outcome measurements included Boston Carpal Tunnel Syndrome Questionnaire, visual analogue scale and some electrophysiology tests, while the former two were set as the primary outcomes. Subgroup analysis and sensitive analysis were performed and publication bias was evaluated. Heterogeneity among the included studies was examined using the I statistic. After selection, 12 studies were identified eligibility for inclusion. Only one study was found to have a high risk of bias. Pooled data of primary outcomes did not show any differences between treatments, and subgroup analysis supported the results. However, patients treated with local corticosteroid injection showed better improvement in distal motor latency (p = 0.002) and compound muscle action potential (p = 0.04). Some studies failed to pass the sensitive analysis, indicating the related analysis might be not so stable. A slight publication bias was observed in subgroup analysis of function scales, among three publication bias test. In conclusion, compared to physical therapy, local corticosteroid injection might have better treatment effects on carpal tunnel syndrome.
常用保守治疗方法治疗腕管综合征的比较效果仍存在争议。本研究旨在比较局部皮质类固醇注射和物理疗法治疗腕管综合征的临床效果。系统检索了 PubMed、EMBASE 和 Cochrane 图书馆，以确定 2023 年 3 月 21 日前发表的相关随机临床试验。两名独立评审员使用 Cochrane 协作风险偏倚工具评估纳入研究的质量。提取相关数据并进行汇总分析。结局测量包括波士顿腕管综合征问卷、视觉模拟量表和一些电生理学测试，而前两者被设定为主要结局。进行了亚组分析和敏感性分析，并评估了发表偏倚。使用 I 统计量检查纳入研究之间的异质性。经过筛选，确定了 12 项符合纳入标准的研究。只有一项研究被发现存在高偏倚风险。主要结局的汇总数据显示两种治疗方法之间没有差异，亚组分析支持这一结果。然而，接受局部皮质类固醇注射治疗的患者在远端运动潜伏期（p=0.002）和复合肌肉动作电位（p=0.04）方面的改善更好。一些研究未能通过敏感性分析，表明相关分析可能不太稳定。在功能量表的亚组分析中观察到轻微的发表偏倚，在三种发表偏倚检验中。总之，与物理疗法相比，局部皮质类固醇注射可能对腕管综合征有更好的治疗效果。
