体外冲击波治疗冻结肩的疗效及安全性的meta分析

Effectiveness and safety of extracorporeal shockwave therapy in frozen shoulder:a meta-analysis

目的评价体外冲击波治疗冻结肩的疗效和安全性。方法计算机检索PubMed、Embase、The Cochrane Library、中国知网和维普数据库,检索时间为各数据库建库以来至2020年11月,检索关于体外冲击波治疗冻结肩的随机对照试验文献。手动检索既往已发表的相关综述中的参考文献,根据纳入排除标准筛选文献并提取有效数据,使用RevMan 5.3软件进行Meta分析。结果最终纳入34篇随机对照试验文献。与对照组相比,体外冲击波在缓解疼痛(MD=-0.87,95%CI:-0.93~-0.81,P<0.00001,I^(2)=67%)和改善肩关节功能(MD=1.21,95%CI:0.87~1.56,P<0.00001,I^(2)=68%)两方面更有优势,且安全性良好(MD=4.72,95%CI:0.37~60.21,P=0.23,I^(2)=82%)。因结果异质性较大,根据评估时间进行亚组分析发现,在3个月以内,体外冲击波对改善疼痛(治疗结束时:MD=-1.01,95%CI:-1.09~-0.92,P<0.00001,I^(2)=49%;治疗结束后3个月内:MD=-0.81,95%CI:-0.96~-0.67,P<0.00001,I^(2)==33%)及改善肩关节功能(治疗结束时:MD=1.63,95%CI:1.37~1.89,P<0.00001,I^(2)=0%;治疗结束后3个月内:MD=0.71,95%CI:0.41~1.00,P<0.00001,I^(2)=0%)的效果较对照组好;3个月及以后,体外冲击波对于改善疼痛未显示出明显优势(MD=-0.69;95%CI:-0.79~-0.58,P<0.00001,I^(2)=89%)。体外冲击波改善肩关节外旋的证据尚不充分(MD=8.94,95%CI:2.41~15.47,P<0.007,I^(2)=94%)。结论体外冲击波能有效减轻冻结肩患者的疼痛和改善其肩功能,并且具有良好的安全性。

Objective To evaluate the effectiveness and safety of extracorporeal shockwave therapy(ESWT)on frozen shoulder.Methods PubMed,Embase,The Cochrane Library,China National Knowledge Infrastructure(CNKI),and VIP Information database were conducted from inception to November 2020.Randomized controlled trials(RCTs)with regard to effectiveness and safety of extracorporeal shockwave therapy in frozen shoulder were included.References from previously published reviews were manually searched,screened according to inclusion and exclusion criteria and valid data were extracted for Meta-analysis using RevMan 5.3 software.Results Thirty-four RCTs were included.Compared with the control group,ESWT had advantages in relieving pain(MD=-0.87,95%CI:-0.93to-0.81,P<0.00001,I^(2)=67%)and improving shoulder function(MD=1.21,95%CI:0.87 to 1.56,P<0.00001,I^(2)=68%),with good safety(MD=4.72,95%CI:0.37 to 60.21,P=0.23,I^(2)=82%).Because of the heterogeneity,subgroup analysis was performed according to the time of assessment:within 3 months,the effect of ESWT on pain(at the end of treatment:MD=-1.01,95%CI:-1.09 to-0.92,P<0.00001,I^(2)=49%;within 3 months after end of treatment:MD=-0.81,95%CI:-0.96 to-0.67,P<0.00001,I^(2)=33%)and shoulder function(at the end of treatment:MD=1.63,95%CI:1.37 to 1.89,P<0.00001,I^(2)=0%;MD=0.71,95%CI:0.41 to 1.00,P<0.00001,I^(2)=0%)were better than that of the control group,with statistically significant differences.However,after 3 months ESWT didn’t show better in relieving pain(MD=-0.69,95%CI:-0.79 to-0.58,P<0.00001,I^(2)=89%).The evidence of ESWT to improve shoulder rotation is insufficient(MD=8.94,95%CI:2.41 to 15.47,P<0.007,I^(2)=94%).Conclusion ESWT can effectively relieve pain and improve shoulder function in frozen shoulder patients with good safety.