Arrambide-Garza Francisco Javier, Guerrero-Zertuche Juventino Tadeo, Alvarez-Villalobos Neri Alejandro, Quiroga-Garza Alejandro, Espinosa-Uribe Abraham, Vilchez-Cavazos Felix, Salinas-Alvarez Yolanda, Rivera-Perez Juan Antonio, Elizondo-Omaña Rodrigo Enrique
Universidad Autonoma de Nuevo Leon, School of Medicine, Human Anatomy Department, Mexico.
Universidad Autonoma de Nuevo Leon, School of Medicine, 360 Research Development Center, Monterrey, Mexico; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA; Instituto Mexicano del Seguro Social, Nuevo Leon Delegation, Monterrey, Mexico.
Arch Phys Med Rehabil. 2024 Apr;105(4):760-769. doi: 10.1016/j.apmr.2023.08.026. Epub 2023 Sep 9.
To compare the efficacy of rotator interval (RI) vs posterior approach (PA) ultrasound (US) guided corticosteroid injections into the glenohumeral (GH) joint in primary frozen shoulder (PFS).
A systematic literature search for all relevant studies on Medline, Scopus, Embase, Web of Science, and Cochrane Central, up to January 2023 was conducted.
Randomized controlled trials that directly compared the US-guided corticosteroid injection into the RI and GH joint using PA in patients clinically and radiographically diagnosed with PFS.
The primary outcome was pain, and the secondary outcomes were function, and range of motion (ROM). Two authors independently assessed the risk of bias using the Cochrane risk-of-bias tool version 2. A random-effects model and generic inverse variance method were performed. Effect sizes were estimated using mean difference (MD) and standardized mean difference (SMD).
A total of 5 clinical trials involving 323 subjects were included for the meta-analysis. US-guided corticosteroid injections into the RI revealed significant pain relief (MD 1.33 [95% confidence interval (CI) 0.20 to 2.46]; P=.02) and significant functional improvement (SMD 1.31 [95% CI 0.11 to 2.51]; P=.03) compared with the PA after 12 weeks.
The results suggest the injection of corticosteroid into RI space is more effective than PA after 12 weeks in improving both pain and functional scores in patients with PFS.
比较在原发性冻结肩（PFS）中，肩胛下肌间隙（RI）与后路（PA）超声（US）引导下糖皮质激素注射入盂肱（GH）关节的疗效。
对截至2023年1月的Medline、Scopus、Embase、Web of Science和Cochrane Central上所有相关研究进行了系统文献检索。
对临床和影像学诊断为PFS的患者，直接比较RI和PA超声引导下糖皮质激素注射入GH关节的随机对照试验。
主要结局为疼痛，次要结局为功能和活动范围（ROM）。两位作者使用Cochrane偏倚风险工具第2版独立评估偏倚风险。采用随机效应模型和通用逆方差法。使用平均差（MD）和标准化平均差（SMD）估计效应量。
共纳入5项涉及323名受试者的临床试验进行荟萃分析。与PA相比，RI超声引导下糖皮质激素注射在12周后显示出显著的疼痛缓解（MD 1.33 [95%置信区间（CI）0.20至2.46]；P = 0.02）和显著的功能改善（SMD 1.31 [95%CI 0.11至2.51]；P = 0.03）。
结果表明，在改善PFS患者的疼痛和功能评分方面，12周后将糖皮质激素注射到RI间隙比PA更有效。
