超声引导穿刺灌洗治疗肩袖钙化性肌腱炎的Meta分析

Efficacy of ultrasound-guided percutaneous lavage for rotator cuff calcific tendinopathy: a meta-analysis

目的系统评价超声引导穿刺灌洗(ultrasound-guided percutaneous lavage,UGPL)治疗肩袖钙化性肌腱炎的临床疗效。方法计算机检索Pub Med、The Cochrane Library、EMbase、WanFang Data、CBM、VIP和CNKI数据库,搜集有关UGPL治疗肩袖钙化性肌腱炎的随机对照试验(RCT),检索时限均从建库至2017年11月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入7个RCT,包括587例患者。Meta分析结果显示:与体外冲击波疗法(extracorporeal shock wave therapy,ESWT)相比,UGPL治疗肩袖钙化性肌腱炎在12月后的视觉模拟评分(the visual analogue scale,VAS)[MD=–1.96,95%CI(–2.18,–1.75),P<0.000 01]、钙沉积平均粒径[MD=–3.13,95%CI(–5.05,–1.22),P<0.001]、钙化灶清除[RR=1.65,95%CI(1.36,2.01),P<0.000 01]等方面更优,其差异有统计学意义。而两组随访6周后VAS评分[MD=–0.85,95%CI(–2.84,1.14),P=0.40]和并发症发生率[RR=1.20,95%CI(0.03,49.69),P=0.93]的差异无统计学意义。结论当前证据表明,UGPL治疗肩袖钙化性肌腱炎具有较好的临床效果,相对于ESWT,UGPL在临床疼痛缓解和钙化灶清除上更有优势。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objectives To systematically review the clinical efficacy of ultrasound-guided percutaneous lavage（UGPL） for calcifying tendinitis of rotator cuff. Methods PubMed, The Cochrane Library, EMbase, WanFang Data,CBM, VIP and CNKI databases were electronically searched to collect the randomized controlled trials（RCTs） of ultrasound-guided percutaneous irrigation for calcifying tendinitis of rotator cuff from inception to September 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed by using RevMan 5.3 software. Results A total of 7 RCTs involving 587 patients were included. The results of meta-analysis showed that： there were significant differences between the UGPL group and extracorporeal shock wave therapy（ESWT） group in 12-month follow-up visual analogue scale（VAS）（MD=–1.96, 95%CI –2.18 to –1.75,P〈0.000 01）, the average particle size of the calcium deposition（MD=–3.13, 95%CI –5.05 to –1.22, P〈0.001）, the calcification disappearance rate（RR=1.65, 95%CI 1.36 to 2.01, P〈0.000 01）. However, there were no significant differences between the two groups in 6-week follow-up VAS（MD=–0.85, 95%CI –2.84 to 1.14, P=0.40）, and the complications（RR=1.20, 95%CI 0.03 to 49.69, P=0.93）. Conclusions Current evidence shows that UGPL has certain clinical effect for t he calcifying tendinitis of rotator cuff. Compared with ESWT, UGPL may be superior in clinical pain relief and calcification clearance. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.