Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials
Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials
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DOI：
10.1016/s0140-6736(10)61160-9
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发表时间：
2010-11-20
期刊：
影响因子：
168.9
通讯作者：
Vicenzino, Bill
中科院分区：
文献类型：
--
作者：
Coombes, Brooke K.;Bisset, Leanne;Vicenzino, Bill
背景：肌腱病变的循证治疗指南很少。我们对随机试验进行了系统回顾，以确定注射治疗的临床疗效和不良事件风险。方法我们检索了8个数据库，没有语言、出版物或日期限制。我们纳入了评估一次或多次腱鞘注射与安慰剂或非手术干预治疗肌腱病变疗效的随机试验，在改良物理治疗证据数据库量表上得分超过50%。我们采用随机效应模型进行了荟萃分析，并估计了相对风险和标准化平均差异（SMDs）。临床疗效的主要终点是方案定义的短期（4周，范围0-12）、中期（26周，13-26）或长期（52周，>= 52）疼痛评分。不良事件也有报道。结果：共纳入3824项试验，41项符合纳入标准，为2672名受试者提供数据。我们在许多高质量的随机对照试验中发现，与其他干预措施相比，皮质类固醇注射在短期内减轻了疼痛，但这种效果在中期和长期被逆转。例如，在对外上髁痛治疗的汇总分析中，与不进行短期干预相比，皮质类固醇注射在减轻疼痛方面有很大的效果（定义为SMD >.8） (SMD 1.44, 95% CI 1.17-1.71, p
Background Few evidence-based treatment guidelines for tendinopathy exist. We undertook a systematic review of randomised trials to establish clinical efficacy and risk of adverse events for treatment by injection.Methods We searched eight databases without language, publication, or date restrictions. We included randomised trials assessing efficacy of one or more peritendinous injections with placebo or non-surgical interventions for tendinopathy, scoring more than 50% on the modified physiotherapy evidence database scale. We undertook meta-analyses with a random-effects model, and estimated relative risk and standardised mean differences (SMDs). The primary outcome of clinical efficacy was protocol-defined pain score in the short term (4 weeks, range 0-12), intermediate term (26 weeks, 13-26), or long term (52 weeks, >= 52). Adverse events were also reported.Findings 3824 trials were identified and 41 met inclusion criteria, providing data for 2672 participants. We showed consistent findings between many high-quality randomised controlled trials that corticosteroid injections reduced pain in the short term compared with other interventions, but this effect was reversed at intermediate and long terms. For example, in pooled analysis of treatment for lateral epicondylalgia, corticosteroid injection had a large effect (defined as SMD>0.8) on reduction of pain compared with no intervention in the short term (SMD 1.44, 95% CI 1.17-1.71, p