The Effectiveness of Extracorporeal Shock Wave Therapy in Lower Limb Tendinopathy A Systematic Review
The Effectiveness of Extracorporeal Shock Wave Therapy in Lower Limb Tendinopathy A Systematic Review
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DOI：
10.1177/0363546514531911
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发表时间：
2015-03-01
影响因子：
4.8
通讯作者：
Barton, Christian
中科院分区：
文献类型：
--
作者：
Mani-Babu, Sethu;Morrissey, Dylan;Barton, Christian
背景：越来越多的证据表明，体外冲击波疗法（ESWT）治疗下肢肌腱病变，包括大转子疼痛综合征（GTPS）、髌骨肌腱病（PT）和跟腱病（AT）的有效性。目的：评价ESWT对下肢肌腱病变的治疗效果。研究设计：系统评价和荟萃分析。方法：检索PubMed （Medline）、Embase、Web of Knowledge、Cochrane和CINAHL从成立到2013年2月的所有研究，以调查ESWT在GTPS、PT和AT中的有效性。使用PubMed和谷歌Scholar进行引文跟踪。排除了动物和非英语语言研究。质量评估由2名独立审稿人进行，并在提供足够数据时计算效应量。结果：共确定了20项研究，其中13项研究提供了足够的数据来计算效应量。能量水平、脉冲次数、疗程次数和局部麻醉剂的使用在不同的研究中有所不同。此外，目前的证据受到低参与者人数和一些方法学弱点的限制，包括不充分的随机化。中度证据表明，在短期（12个月）内，ESWT比家庭训练和皮质类固醇注射对GTPS更有效。有限的证据表明，ESWT比其他非手术治疗（包括非甾体抗炎药、物理治疗和运动计划）更有效，长期与髌骨肌腱切开术相当。中度证据表明，ESWT在短期内比插入性AT的偏心负荷更有效，与中间部分AT的偏心负荷相当。此外，有适度的证据表明，在中段AT中结合ESWT和偏心加载可能比单独偏心加载产生更好的结果。结论：体外冲击波治疗是一种有效的干预措施，尤其在其他非手术治疗失败的情况下，应考虑对GTPS、PT和AT进行体外冲击波治疗。
Background: There is accumulating evidence for the effectiveness of extracorporeal shock wave therapy (ESWT) when treating lower limb tendinopathies including greater trochanteric pain syndrome (GTPS), patellar tendinopathy (PT), and Achilles tendinopathy (AT).Purpose: To evaluate the effectiveness of ESWT for lower limb tendinopathies.Study Design: Systematic review and meta-analysis.Methods: PubMed (Medline), Embase, Web of Knowledge, Cochrane, and CINAHL were searched from inception to February 2013 for studies of any design investigating the effectiveness of ESWT in GTPS, PT, and AT. Citation tracking was performed using PubMed and Google Scholar. Animal and non-English language studies were excluded. A quality assessment was performed by 2 independent reviewers, and effect size calculations were computed when sufficient data were provided.Results: A total of 20 studies were identified, with 13 providing sufficient data to compute effect size calculations. The energy level, number of impulses, number of sessions, and use of a local anesthetic varied between studies. Additionally, current evidence is limited by low participant numbers and a number of methodological weaknesses including inadequate randomization. Moderate evidence indicates that ESWT is more effective than home training and corticosteroid injection in the short (12 months) term for GTPS. Limited evidence indicates that ESWT is more effective than alternative nonoperative treatments including nonsteroidal anti-inflammatory drugs, physical therapy, and an exercise program and equal to patellar tenotomy surgery in the long term for PT. Moderate evidence indicates that ESWT is more effective than eccentric loading for insertional AT and equal to eccentric loading for midportion AT in the short term. Additionally, there is moderate evidence that combining ESWT and eccentric loading in midportion AT may produce superior outcomes to eccentric loading alone.Conclusion: Extracorporeal shock wave therapy is an effective intervention and should be considered for GTPS, PT, and AT particularly when other nonoperative treatments have failed.