体外冲击波疗法治疗肩袖肌腱病的Meta分析

Extracorporeal shock wave therapy for rotator cuff tendinopathy: a meta-analysis

目的系统评价体外冲击波疗法(ESWT)治疗肩袖肌腱病的有效性和安全性,以期为临床实践提供参考依据。方法计算机检索CENTRAL、MEDLINE、EMbase、CINAHL Plus、PEDro、CNKI、CBM、WanFang Data和VIP数据库,搜集国内外有关ESWT治疗肩袖肌腱病的随机对照试验(RCT),检索时限均从建库至2021年1月11日。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11篇文献的12个RCT,包括529例患者,包括试验组273例,对照组256例。Meta分析结果显示,在疼痛改善上,ESWT与假ESWT对疼痛的改善,两组差异无统计学意义[SMD=-1.08,95%CI(-2.45,0.29),P=0.12];ESWT改善疼痛优于电针[SMD=-7.15,95%CI(-8.50,-5.80),P<0.000 01];ESWT作为辅助治疗与单用针灸疗法相比,对疼痛的改善两组差异无统计学意义[SMD=-4.32,95%CI(-11.93,3.29),P=0.27]。在Constant-Murley肩关节功能评分(CMS)上,ESWT对CMS的改善优于假ESWT[SMD=1.31,95%CI(0.08,2.53),P=0.04];ESWT与其他疗法对CMS的改善差异无统计学意义[SMD=0.13,95%CI(-2.07,2.33),P=0.91];ESWT作为辅助治疗与单用针灸疗法对CMS的改善差异无统计学意义[SMD=1.68,95%CI(-0.69,4.05),P=0.16]。结论当前有限证据显示,ESWT可能会改善肩袖肌腱病患者的肩关节功能,但对肩袖肌腱病患者疼痛的改善尚不明确。受纳入研究数量和质量的限制,上述结论尚需更多高质量研究予以验证。

Objective To systematically review the efficacy and safety of extracorporeal shock wave therapy(ESWT) in the treatment of rotator cuff tendinopathy to provide evidence for clinical practice. Methods Databases including CENTRAL, MEDLINE, EMbase, CINAHL plus, PEDro, CNKI, CBM, WanFang Data, and VIP were searched to collect randomized controlled trials(RCTs) of ESWT in the treatment of rotator cuff tendinopathy from inception to January 11th, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. Results A total of 12 RCTs from 11 articles were included, including 529 subjects(273 in the case group and 256 in the control group). Meta-analysis showed that no significant difference between ESWT and placebo in pain improvement(SMD=-1.08, 95% CI-2.45 to 0.29,P=0.12), superior pain improvement in ESWT group than electroacupuncture group(SMD=-7.15, 95%CI-8.50 to-5.80,P<0.000 01), and no significant difference in pain improvement between ESWT as adjuvant therapy and acupuncture alone(SMD=-4.32, 95%CI-11.93 to 3.29, P=0.27). Regarding the Constant–Murley score(CMS) for shoulder joint function, ESWT was associated with an improved CMS compared with placebo(SMD=1.31, 95%CI 0.08 to 2.53,P=0.04). There was no significant difference in the improvement in the CMS between ESWT and other treatments(SMD=0.13, 95%CI-2.07 to 2.53, P=0.91). There was no significant difference in the improvement in the CMS between ESWT as adjuvant therapy and acupuncture alone(SMD=1.68, 95%CI-0.69 to 4.05, P=0.16). Conclusions ESWT may improve shoulder joint function in patients with rotator cuff tendinopathy, and the alleviation of pain in patients with rotator cuff tendinopathy requires further investigation. Due to the limited quality and quantity of included studies, the above conclusions requires further investigation by more high-quality studies.