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体外冲击波治疗大转子疼痛综合征:随机临床试验的系统评价和荟萃分析。

Extracorporeal Shockwave Therapy for Greater Trochanteric Pain Syndrome: A Systematic Review with Meta-Analysis of Randomized Clinical Trials.

机构信息

Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts.

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

出版信息

JBJS Rev. 2024 Aug 20;12(8). doi: e24.00091. eCollection 2024 Aug 1.

Abstract

BACKGROUND

Greater trochanteric pain syndrome (GTPS) affects 17.6% of adults aged 50 to 79 years, particularly women. While exercise therapy and corticosteroid injections (CSIs) are common treatments, their limitations include inadequate pain control and potential tendon weakening. Extracorporeal shockwave therapy (ESWT) is an emerging alternative for GTPS. This systematic review assessed ESWT's efficacy in GTPS by evaluating pain and functional outcomes at different follow-up intervals.

METHODS

A literature search of PubMed, Embase, and Web of Science for randomized clinical trials (RCTs) was conducted comparing ESWT with other GTPS treatments up to March 1, 2024. Two reviewers independently extracted data, assessing study quality using the Cochrane risk-of-bias tool. A random-effects pairwise meta-analysis compared ESWT with other treatments.

RESULTS

Eight RCTs involving 754 patients (169 male, 585 female patients) were included. Seven RCTs were deemed high risk of bias, and 1 RCT had some concerns. Five RCTs investigated focused on focused ESWT, and 3 examined radial ESWT. ESWT provided significantly lower pain scores than other treatments at 2 to 4 months (standardized mean difference = -0.431; 95% confidence interval [CI], -0.82 to -0.039; I2 = 83%). Functional improvement (Lower Extremity Functional Scale) was significantly higher at 6 months (weighted mean difference = 6.68; 95% CI, 3.11-10.25; I2 = 0%) but did not exceed the minimal clinically important difference. Focused ESWT provided greater pain reduction than radial ESWT.

CONCLUSION

Three weekly ESWT sessions offer short-term pain relief at 2 to 4 months for patients with GTPS, especially with focused ESWT. Functional improvements at 6 months were notable but not clinically significant. These findings suggest ESWT may complement or serve as an alternative to CSIs and exercise. However, caution is needed when interpreting these results due to high risk of bias with the included RCTs and heterogeneity across the studies. Further high-quality trials are needed to confirm ESWT's long-term benefits over other treatments.

LEVEL OF EVIDENCE

Level II. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

大转子疼痛综合征(GTPS)影响 17.6%的 50 岁至 79 岁成年人,尤其是女性。运动疗法和皮质类固醇注射(CSIs)是常见的治疗方法,但它们存在疼痛控制不足和潜在的肌腱弱化等局限性。体外冲击波疗法(ESWT)是 GTPS 的一种新兴替代疗法。本系统评价通过评估不同随访时间的疼痛和功能结果,评估 ESWT 在 GTPS 中的疗效。

方法

对截至 2024 年 3 月 1 日PubMed、Embase 和 Web of Science 中比较 ESWT 与其他 GTPS 治疗的随机临床试验(RCT)进行文献检索。两位审查员独立提取数据,使用 Cochrane 偏倚风险工具评估研究质量。采用随机效应成对荟萃分析比较 ESWT 与其他治疗方法。

结果

纳入 8 项 RCT,共 754 例患者(169 例男性,585 例女性)。7 项 RCT 被认为存在高偏倚风险,1 项 RCT 存在一些关注。5 项 RCT 专门研究聚焦式 ESWT,3 项研究放射式 ESWT。ESWT 在 2 至 4 个月时疼痛评分明显低于其他治疗方法(标准化均数差=-0.431;95%置信区间[-0.82 至-0.039];I2=83%)。6 个月时功能改善(下肢功能量表)明显更高(加权均数差=6.68;95%置信区间[3.11-10.25];I2=0%),但未超过最小临床重要差异。聚焦式 ESWT 比放射式 ESWT 更能减轻疼痛。

结论

对于 GTPS 患者,每周进行 3 次 ESWT 治疗可在 2 至 4 个月时短期缓解疼痛,尤其是聚焦式 ESWT。6 个月时的功能改善显著,但无临床意义。这些发现表明 ESWT 可能补充或替代 CSIs 和运动疗法。然而,由于纳入的 RCT 存在高偏倚风险和研究之间存在异质性,因此在解释这些结果时需要谨慎。需要进一步开展高质量试验来确认 ESWT 相对于其他治疗方法的长期益处。

证据水平

二级。详见作者指南,以获取完整的证据水平描述。

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