体外冲击波与封闭疗法治疗网球肘疗效对比的meta分析

Meta-analysis of the comparison between extracorporeal shock wave and block therapy in the treatment of tennis elbow

目的系统评价体外冲击波与封闭疗法治疗网球肘的疗效。方法计算机检索知网、万方、维普、CBM、PubMed、Embase、Cochrane Library等中英文文献数据库,查找体外冲击波与封闭疗法治疗网球肘的随机对照试验(RCT),检索时限均为建库至2022年4月。由两名研究人员根据纳入和排除标准独立检索、筛选文献,根据Cochrane评价工具对RCT进行独立评估。采用RevMan 5.3及Stata 14.0软件进行meta分析。结果最终纳入10篇RCT,包括646例患者。与封闭疗法组比较,体外冲击波组在治疗结束时、治疗结束4周、治疗结束12周的效果无明显提升(P>0.05),在治疗结束24周[MD=-1.62,95%置信区间(95%CI):-2.89~-0.34,P=0.01]及治疗结束48周(MD=-0.79,95%CI:-1.20~-0.37,P=0.0002)的疼痛改善效果更好。治疗结束12周时,两组上肢功能评分改善无明显差异(MD=-3.54,95%CI:-10.02~2.94,P=0.28)。体外冲击波组较封闭疗法组在治疗结束4周时握力较大(MD=-5.86,95%CI:-8.59~-3.13,P<0.0001),但在治疗结束12周时两组治疗握力效果差异无统计学意义(MD=-2.01,95%CI:-4.52~0.49,P=0.12)。体外冲击波组临床疗效优于封闭疗法(OR=3.154,95%CI:2.060~4.827,P<0.05)。体外冲击波组复发率低于封闭疗法组(RR=0.463,95%CI:0.289~0.740,P<0.05)。结论与封闭疗法比较,体外冲击波治疗能进一步提高疼痛改善效果、握力和临床疗效,降低治疗后的复发率。

Objective To systematically evaluate the efficacy of extracorporeal shock wave and block therapy in the treatment of tennis elbow.Methods A computerized search of Chinese and English literature databases,such as China National Knowledge Infrastructure,WanFang,VIP,Chinese BioMedical Literature Database,PubMed,Embase,and Cochrane Library,was conducted to find randomized controlled trials(RCTs)of extracorporeal shock wave and block therapy for tennis elbow,and the search time was from the establishment of the database to April 2022.Two researchers independently searched and screened the literature according to the inclusion and exclusion criteria and independently evaluated the RCTs according to the Cochrane evaluation tool.The meta-analysis was carried out by using RevMan 5.3 and Stata 14.0 software.Results A total of 10 RCTs,including 646 patients,were ultimately included.Compared with block therapy for tennis elbow,the effect of extracorporeal shock wave group was not significantly improved at the end of treatment,4 weeks after treatment and 12 weeks after treatment(P>0.05),and pain improvement was better at 24 weeks after treatment[MD=-1.62,95%confidence interval(95%CI):-2.89--0.34,P=0.01]and 48 weeks after treatment(MD=-0.79,95%CI:-1.20--0.37,P=0.0002).And after 12 weeks of treatment,there was no significant difference in the improvement of upper limb function score between the two groups(MD=-3.54,95%CI:-10.02-2.94,P=0.28).The grip strength of the extracorporeal shock wave group was greater than that of the block therapy group at the end of 4 weeks(MD=-5.86,95%CI:-8.59--3.13,P<0.0001),but there was no significant difference in the grip strength between the two groups at the end of 12 weeks(MD=-2.01,95%CI:-4.52-0.49,P=0.12).The clinical effect of the extracorporeal shock wave group was better than that of blocking therapy(OR=3.154,95%CI:2.060-4.827,P<0.05).The recurrence rate of the extracorporeal shock wave group was lower than that of the blocking therapy group(RR=0.463,95%CI:0.289-0.740,P<0.05).Conclusion Compared with blocking therapy,extracorporeal shock wave can further improve the pain improvement effect,grip strength and clinical efficacy,and reduce the recurrence rate after treatment.