Department of Orthopaedics, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou 730050, China.
Department of Quality Management, Lanzhou Petrochemical General Hospital, Lanzhou 730050, China.
J Tradit Chin Med. 2024 Apr;44(2):243-250. doi: 10.19852/j.cnki.jtcm.20231226.002.
To assess the efficacy and safety of extracorporeal shockwave therapy (ESWT) combined with sodium hyaluronate (HA) for the treatment of knee osteoarthritis (KOA).
PubMed, Embase, the Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang database, China Science and Technology Journal Database, and SinoMed were searched from inception to July 2020. The quality of the randomized controlled trials was evaluated independently by two reviewers according to the criteria in the Cochrane Collaboration for Systematic Reviews. The identified articles were then screened individually using EndnoteX9 for eligibility in this Meta-analysis. The heterogeneity among the articles was evaluated using I2.
A total of 17 studies, comprising 2000 individuals, were included in this Meta-analysis. The results showed that a significant improvement was observed in knee pain and function based on the clinical efficacy of ESWT combined with HA. Statistical analysis of clinical efficacy showed that [relative risk () = 1.21, 95% confidence interval () (1.12, 1.30), 0.01]. Statistical analysis of visual analog scale showed that [standardized mean difference () = －2.84, 95% (－4.01, －1.66), 0.01]. Western Ontario and McMaster University osteoarthritis index statistical analysis showed that [ = －1.57, 95% (－2.52, －0.61), 0.01]. Lysholm score statistical analysis showed that [ = 1.71, 95% (0.98, 2.44), 0.01]. In addition, only minor side effects, such as redness and swelling of the skin, were observed.
Medium to low quality evidence showed that ESWT combined with HA offers an inexpensive, well-tolerated, safe, and effective method to improve pain and functionality in patients with KOA. However, tightly controlled, randomized, large multicenter trials are warranted to validate the current findings.
评估体外冲击波疗法（ESWT）联合透明质酸钠（HA）治疗膝骨关节炎（KOA）的疗效和安全性。
检索 PubMed、Embase、Cochrane 图书馆、Web of Science、中国知网、万方数据库、中国科技期刊数据库和中国生物医学文献数据库，从建库至 2020 年 7 月。由两位评价员按照 Cochrane 协作网系统评价的标准独立评价纳入的随机对照试验的质量。使用 EndnoteX9 对纳入的文章进行个体筛选，以确定是否符合本 Meta 分析的纳入标准。采用 I2 评价异质性。
共纳入 17 项研究，包括 2000 例患者。Meta 分析结果显示，ESWT 联合 HA 治疗 KOA 的临床疗效显著改善了膝关节疼痛和功能。临床疗效的统计分析显示[相对危险度（RR）=1.21，95%置信区间（CI）（1.12，1.30）， 0.01]。视觉模拟评分（VAS）的统计分析显示[标准化均数差（SMD）=－2.84，95%CI（－4.01，－1.66）， 0.01]。Wester Ontario 和 McMaster 大学骨关节炎指数（WOMAC）的统计分析显示[差值（MD）=－1.57，95%CI（－2.52，－0.61）， 0.01]。Lysholm 评分的统计分析显示[MD=1.71，95%CI（0.98，2.44）， 0.01]。此外，仅观察到轻微的副作用，如皮肤红肿。
中低质量证据表明，ESWT 联合 HA 是一种治疗 KOA 患者疼痛和功能的廉价、耐受性好、安全有效的方法。然而，需要严格控制、随机、多中心的大型临床试验来验证当前的研究结果。
