类固醇激素肩关节注射对偏瘫肩痛康复效果的Meta分析

Effectiveness of steroids injection in sub-acromial or intra-articular shoulder for hemiplegic shoulder pain treatment:a meta-analysis

目的:评价类固醇激素肩关节注射对偏瘫肩痛(HSP)患者的康复效果,为HSP康复提供循证依据。方法:计算机检索Web of Science、EMBASE、The Cochrane Library、PubMed、中国知网(CNKI)、万方数据库、维普数据库(VIP)中从建库至2020年7月发表的有关类固醇激素与空白/安慰剂肩关节注射疗效比较的随机对照试验(RCT)。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和StataSE 12.0软件进行统计分析。结果:最终纳入9篇文献,其中英语文献5篇,中文文献4篇,共416人。与空白/安慰剂相比,类固醇激素肩关节注射可以显著降低HSP患者的疼痛[SMD=0.93,95%CI(0.71,1.14),Z=8.46,P<0.01],改善日常生活活动能力[SMD=-0.42,95%CI(-0.65,-0.20),Z=3.71,P=0.0002]和上肢运动功能[SMD=-1.02,95%CI(-1.68,-0.36),Z=3.02,P=0.003],提高肩关节前屈[MD=-15.41,95%CI(-23.30,-7.52),Z=3.83,P=0.0001]、外展[MD=-12.16,95%CI(-15.67,-8.65),Z=6.79,P<0.01]、外旋[MD=-8.47,95%CI(-9.94,-7.00),Z=11.30,P<0.01]和内旋ROM[MD=-2.95,95%CI(-4.57,-1.32),Z=3.56,P=0.0004]。结论:类固醇激素肩关节注射能安全、有效地促进降低HSP患者疼痛,促进上肢功能康复。

Objective:To provide evidence-based basis for hemiplegic shoulder pain(HSP)rehabilitation and evaluate the efficacy of steroids injection for HSP treatment.Methods:An extensive search of related literature from Web of Science,EMBASE,The Cochrane Library,PubMed,CNKI,Wanfang,VIP database was performed from the inception to July 2020.The randomized controlled trails(RCTs)comparing the effects of steroids injection in sub-acromial or intra-articular shoulder with blank/placebo were collected.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies,then meta-analysis was performed by using RevMan 5.3 software and StataSE12.0.Results:Totally,9 RCTs including 416 cases were finally included with 5 English articles and 4 Chinese articles.As compared with blank/placebo group,HSP patients’pain was significantly reduced[SMD=0.93,95%CI(0.71,1.14),Z=8.46,P<0.01],activities of daily living[SMD=-0.42,95%CI(-0.65,-0.20),Z=3.71,P=0.0002]and functional level of upper extremity significantly improved[SMD=-1.02,95%CI(-1.68,-0.36),Z=3.02,P=0.003],and shoulder flexion[MD=-15.41,95%CI(-23.30,-7.52),Z=3.83,P=0.0001],abduction[MD=-12.16,95%CI(-15.67,-8.65),Z=6.79,P<0.01],external rotation[MD=-8.47,95%CI(-9.94,-7.00),Z=11.30,P<0.01]and internal rotation[MD=-2.95,95%CI(-4.57,-1.32),Z=3.56,P=0.0004]significantly increased in steroids injection group.Conclusion:Steroids injection can safely and effectively reduce the pain of HSP patients and promote the upper limb rehabilitation.