非甾体抗炎药注射与类固醇注射治疗上下肢骨科疾病的比较：一项系统评价与荟萃分析

Nonsteroidal Anti-Inflammatory Drug Injections versus Steroid Injections in the Management of Upper and Lower Extremity Orthopedic Conditions: A Systematic Review with Meta-Analysis.

作者信息

Rhim Hye Chang, Ruiz Joseph, Taseh Atta, Afunugo Wilma, Crockett Zack, Schon Jason, Pan Xiaoyu, Shin Jaehyung, Schowalter Sean, Jang Ki-Mo, Robinson David M

机构信息

Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, MA 02115, USA.

Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02115, USA.

出版信息

J Clin Med. 2024 Feb 17;13(4):1132. doi: 10.3390/jcm13041132.

DOI:10.3390/jcm13041132

PMID:38398445

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10889729/

Abstract

BACKGROUND

Although corticosteroid injections are an effective treatment for musculoskeletal pathologies, they may not be suitable for all patients. The purpose of this systematic review was to compare clinical outcomes between patients who received NSAID and corticosteroid injections for various orthopedic conditions.

METHODS

Medline, Embase, Web of Science, and Cochrane Central Register of Controlled Trials were searched, and meta-analyses were performed using a random-effects model for outcomes presented in three or more studies. Other studies were qualitatively analyzed.

RESULTS

A total of 28 articles with 2113 patients were included. A meta-analysis of five studies in patients with shoulder impingement syndrome demonstrated that there was no significant difference in the pain visual analogue scale (VAS) between subacromial NSAID injections and corticosteroid injections at 1 month [weighted mean difference (WMD) -0.244; 95% CI, -1.232 to 0.745; I, 94.5%]. For patients with knee osteoarthritis, a meta-analysis of three studies demonstrated that there was no significant difference between intraarticular NSAID injections and corticosteroid injections in pain VAS at 1 month (WMD 0.754; 95% CI, -0.413 to 1.921; I, 90.2%) and 3 months (WMD-0.089; 95% CI, -0.345 to 0.166; I, 0%). A review of the studies assessing pain outcomes for hip osteoarthritis, adhesive capsulitis, and plantar fasciitis showed no significant differences between the NSAID and corticosteroid groups.

CONCLUSION

NSAID injections may be safe and effective alternatives to steroid injections, especially in shoulder impingement syndrome and knee osteoarthritis.

摘要

背景

尽管皮质类固醇注射是治疗肌肉骨骼疾病的有效方法，但并非适用于所有患者。本系统评价的目的是比较接受非甾体抗炎药（NSAID）和皮质类固醇注射治疗各种骨科疾病的患者的临床结局。

方法

检索了Medline、Embase、科学引文索引和Cochrane对照试验中心注册库，并对三项或更多研究中呈现的结局采用随机效应模型进行荟萃分析。对其他研究进行定性分析。

结果

共纳入28篇文章，涉及2113例患者。对五项肩峰撞击综合征患者研究的荟萃分析表明，肩峰下NSAID注射和皮质类固醇注射在1个月时疼痛视觉模拟量表（VAS）上无显著差异[加权平均差（WMD）-0.244；95%可信区间（CI），-1.232至0.745；I²，94.5%]。对于膝骨关节炎患者，三项研究的荟萃分析表明，关节内NSAID注射和皮质类固醇注射在1个月时疼痛VAS上无显著差异（WMD 0.754；95%CI，-0.413至1.921；I²，90.2%），在3个月时也无显著差异（WMD -0.089；95%CI，-0.345至0.166；I²，0%）。对评估髋骨关节炎、粘连性囊炎和足底筋膜炎疼痛结局的研究综述表明，NSAID组和皮质类固醇组之间无显著差异。