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首页> 外文期刊>The Lancet >Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials.
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Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials.

机译：皮质类固醇注射剂和其他注射剂治疗肌腱病的疗效和安全性：随机对照试验的系统评价。

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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<0.0001), but no intervention was favoured at intermediate term (-0.40, -0.67 to -0.14, p<0.003) and long term (-0.31, -0.61 to -0.01, p=0.05). Short-term efficacy of corticosteroid injections for rotator-cuff tendinopathy is not clear. Of 991 participants who received corticosteroid injections in studies that reported adverse events, only one (0.1%) had a serious adverse event (tendon rupture). By comparison with placebo, reductions in pain were reported after injections of sodium hyaluronate (short [3.91, 3.54-4.28, p<0.0001], intermediate [2.89, 2.58-3.20, p<0.0001], and long [3.91, 3.55-4.28, p<0.0001] terms), botulinum toxin (short term [1.23, 0.67-1.78, p<0.0001]), and prolotherapy (intermediate term [2.62, 1.36-3.88, p<0.0001]) for treatment of lateral epicondylalgia. Lauromacrogol (polidocanol), aprotinin, and platelet-rich plasma were not more efficacious than was placebo for Achilles tendinopathy, while prolotherapy was not more effective than was eccentric exercise. INTERPRETATION: Despite the effectiveness of corticosteroid injections in the short term, non-corticosteroid injections might be of benefit for long-term treatment of lateral epicondylalgia. However, response to injection should not be generalised because of variation in effect between sites of tendinopathy. FUNDING: None.
机译：背景：关于肌腱病的循证治疗指南很少。我们对随机试验进行了系统评价，以建立临床疗效和注射不良反应的风险。方法：我们搜索了八个数据库，没有语言，出版物或日期限制。我们纳入了一项随机试验，评估使用安慰剂或非手术干预措施进行的一次或多次腹膜内注射对肌腱病的疗效，在改良的理疗证据数据库规模上得分超过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均值差（SMD）。临床疗效的主要结果是短期（4周，范围0-12），中期（26周，13-26）或长期（52周，> / = 52）中方案定义的疼痛评分。还报告了不良事件。结果：共鉴定了3824项试验，其中41项符合纳入标准，为2672名参与者提供了数据。在许多高质量的随机对照试验中，我们显示出一致的发现，即与其他干预措施相比，皮质类固醇注射液可在短期内减轻疼痛，但中长期可逆转这种效应。例如，在侧上epi上痛的综合治疗分析中，与短期内未进行干预相比，皮质类固醇注射对减轻疼痛有很大的作用（定义为SMD> 0.8）（SMD 1.44，95％CI 1.17-1.71，p < 0.0001），但在中期（-0.40，-0.67至-0.14，p <0.003）和长期（-0.31，-0.61至-0.01，p = 0.05）时不建议干预。皮质类固醇激素注射治疗肩袖肌腱病的近期疗效尚不清楚。在报告不良事件的研究中接受皮质类固醇注射的991名参与者中，只有一名（0.1％）患有严重的不良事件（肌腱破裂）。与安慰剂相比，注射透明质酸钠后疼痛有所减轻（短[3.91、3.54-4.28，p <0.0001]，中度[2.89、2.58-3.20，p <0.0001]和长[3.91、3.55-4.28] ，p <0.0001]术语），肉毒杆菌毒素（短期[1.23、0.67-1.78，p <0.0001]）和prolotherapy（中期[2.62、1.36-3.88，p <0.0001]）用于治疗外侧上con上痛。十二指肠肌腱病的Lauromacrogol（polidocanol），抑肽酶和富含血小板的血浆没有比安慰剂有效，而前旋疗法没有比离心运动有效。解释：尽管短期内皮质类固醇注射剂有效，但非皮质类固醇注射剂可能有益于长期治疗外侧上d上肌痛。但是，由于肌腱病变部位之间的作用差异，对注射的反应不应一概而论。资金：无。

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