Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.
Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China.
Orthop Surg. 2024 Nov;16(11):2598-2607. doi: 10.1111/os.14212. Epub 2024 Aug 28.
Chronic lateral epicondylitis (LE), normally known as tennis elbow, is often managed by conservative treatments. Extracorporeal shock wave therapy (ESWT) and local corticosteroid injection (LCI) are among the most commonly used conservative treatments. However, the comparison between these two interventions remains controversial. This study aimed to compare the effectiveness and safety of ESWT and LCI for chronic LE. A systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. PubMed, EMBASE, Cochrane Library, and Web of Science were searched for eligible studies until April 20, 2024. Meta-analyses were conducted using Manager V.5.4.1. Pooled effect sizes were expressed as the weighted mean difference (WMD) or odds ratio (OR), with 95% confidence intervals (CIs). A total of six randomized controlled trials (RCTs) were included. Compared with LCI, ESWT had inferior change in visual analogue scale (Δ VAS) (WMD, 1.14; 95% CI, 0.80 to 1.48; I = 20%; p < 0.001), Δ grip strength (WMD, -4.01; 95% CI, -5.57 to -2.44; I = 36%; p < 0.001), change in patient-rated tennis elbow evaluation (Δ PRTEE) score (WMD, 8.64; 95% CI, 4.70 to 12.58; I = 0%; p < 0.001) at 1-month follow-up, but superior Δ VAS (WMD, -1.15; 95% CI, -1.51 to -0.80; I = 6%; p < 0.001), Δ grip strength (WMD, 2.04; 95% CI, 0.90 to 3.18; I = 3%; p = 0.0005), Δ PRTEE score (WMD, -9.50; 95% CI, -14.05 to -4.95; I = 58%; p < 0.001) at 3-month follow-up, and superior Δ VAS (WMD, -1.81; 95% CI, -2.52 to -1.10; I = 33%; p < 0.001), Δ grip strength (WMD, 3.06; 95% CI, 0.90 to 5.21; I = 0%; p = 0.005) at 6-month follow-up. The two groups had a similarly low rate of adverse events (OR, 0.69; 95% CI, 0.05 to 8.60; I = 67%; p = 0.77), all of which were mild. Both ESWT and LCI are effective and safe in treating chronic LE. Compared with LCI, ESWT showed inferior short-term (1-month) but superior long-term (3-month and 6-month) outcomes regarding pain relief and function recovery, with a similar rate of mild adverse events.
慢性外侧肱骨上髁炎（LE），通常称为网球肘，通常通过保守治疗来管理。体外冲击波疗法（ESWT）和局部皮质类固醇注射（LCI）是最常用的保守治疗方法之一。然而，这两种干预措施的比较仍然存在争议。本研究旨在比较 ESWT 和 LCI 治疗慢性 LE 的效果和安全性。根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，进行了系统评价和荟萃分析。搜索了 PubMed、EMBASE、Cochrane 图书馆和 Web of Science 以获取符合条件的研究，截至 2024 年 4 月 20 日。使用 Manager V.5.4.1 进行荟萃分析。汇总效应大小表示为加权均数差（WMD）或优势比（OR），置信区间（CI）为 95%。共纳入了 6 项随机对照试验（RCT）。与 LCI 相比，ESWT 在视觉模拟量表（Δ VAS）（WMD，1.14；95%CI，0.80 至 1.48；I=20%；p<0.001）、握力变化（WMD，-4.01；95%CI，-5.57 至-2.44；I=36%；p<0.001）、患者评定网球肘评估（Δ PRTEE）评分（WMD，8.64；95%CI，4.70 至 12.58；I=0%；p<0.001）方面的变化在 1 个月随访时较差，但在 Δ VAS（WMD，-1.15；95%CI，-1.51 至-0.80；I=6%；p<0.001）、握力变化（WMD，2.04；95%CI，0.90 至 3.18；I=3%；p=0.0005）、Δ PRTEE 评分（WMD，-9.50；95%CI，-14.05 至-4.95；I=58%；p<0.001）方面的变化在 3 个月随访时较好，并且在 Δ VAS（WMD，-1.81；95%CI，-2.52 至-1.10；I=33%；p<0.001）、握力变化（WMD，3.06；95%CI，0.90 至 5.21；I=0%；p=0.005）方面的变化在 6 个月随访时较好。两组不良反应发生率均较低（OR，0.69；95%CI，0.05 至 8.60；I=67%；p=0.77），均为轻度。ESWT 和 LCI 治疗慢性 LE 均有效且安全。与 LCI 相比，ESWT 在缓解疼痛和功能恢复方面具有短期（1 个月）较差但长期（3 个月和 6 个月）较好的效果，且轻度不良反应发生率相似。
