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首页> 外文期刊>American Journal of Sports Medicine >Comparative Efficacy and Safety of Nonsurgical Treatment Options for Enthesopathy of the Extensor Carpi Radialis Brevis: A Systematic Review and Meta-analysis of Randomized Placebo-Controlled Trials
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Comparative Efficacy and Safety of Nonsurgical Treatment Options for Enthesopathy of the Extensor Carpi Radialis Brevis: A Systematic Review and Meta-analysis of Randomized Placebo-Controlled Trials

机译：伸肌射击肠道肠道的非诊断选项的比较疗效和安全性：随机安慰剂对照试验的系统综述与荟萃分析

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Background: Numerous treatment options have been proposed for enthesopathy of the extensor carpi radialis brevis (eECRB). Purpose: To (1) compare the efficacy and safety of nonsurgical treatment options for eECRB described in randomized placebo-controlled trials at short-term, midterm, and long-term follow-up and (2) evaluate outcomes in patients receiving placebo. Study Design: Systematic review and meta-analysis. Methods: Following PRISMA guidelines, 4 electronic databases were searched for randomized placebo-controlled trials for eECRB. Studies reporting visual analog scale (VAS) for pain scores and/or grip strength were included. Random- or fixed-effects meta-analysis was employed to compare treatments with at least 2 eligible studies using the standardized mean difference and odds ratio. The study protocol was registered at PROSPERO (ID: CRD42018075009). Results: Thirty-six randomized placebo-controlled trials, evaluating 11 different treatment modalities, with a total of 2746 patients were included. At short-term follow-up, only local corticosteroid injection improved pain; however, it was associated with pain worse than placebo at long-term follow-up. At midterm follow-up, laser therapy and local botulinum toxin injection improved pain. At long-term follow-up, extracorporeal shock wave therapy provided pain relief. With regard to grip strength, only laser therapy showed better outcomes in comparison with placebo. While there was no difference among various treatments in the odds ratio of an adverse event, they all increased adverse events compared with placebo. In placebo-receiving patients, a sharp increase in the percentage of patients reporting mild pain or less was observed from 2% at short-term follow-up to 92% at midterm follow-up. Conclusion: Most patients experienced pain resolution after receiving placebo within 4 weeks of follow-up. At best, all treatments provided only small pain relief while increasing the odds of adverse events. Therefore, if clinicians are inclined to provide a treatment for particular patients, they may consider a pain relief regimen for the first 4 weeks of symptom duration. Patient-specific factors should be considered when deciding on treatment or watchful waiting.
机译：背景：已经提出了许多治疗方案，用于伸长型Carpi Radialis Brevis（EECRB）的患者。目的：至（1）比较短期，中期和长期随访的随机安慰剂对照试验中描述的eSCRB治疗方案的功效和安全性，（2）患者接受安慰剂的患者的结果。研究设计：系统评论和荟萃分析。方法：在PRISMA指南之后，搜索4个电子数据库的eSCRB的随机安慰剂对照试验。包括疼痛评分和/或抓地力的视觉模拟量表（VAS）的研究。采用随机或固定效应的META分析来比较使用标准化平均差异和差距的至少2个合格研究的治疗方法。研究方案在Prospero注册（ID：CRD42018075009）。结果：三十六种随机安慰剂对照试验，评估11种不同的治疗方式，共有2746名患者。在短期随访中，只有当地皮质类固醇注射改善疼痛;然而，在长期随访中，它与安慰剂的疼痛有关。在中期随访中，激光治疗和局部肉毒杆菌毒素注射液改善了疼痛。在长期随访中，体外冲击波疗法提供了疼痛缓解。关于抓握强度，与安慰剂相比，激光治疗表现出更好的结果。虽然在不良事件的赔率比中的各种治疗中没有差异，但与安慰剂相比，它们都增加了不良事件。在安慰剂接受患者中，在中期随访期间，在短期随访中观察到报告温和疼痛或更低的患者患者百分比的急剧增加。结论：大多数患者在随访后4周内接受安慰剂后经历了疼痛分辨率。尽其所述，所有护理只提供小的疼痛缓解，同时增加了不良事件的几率。因此，如果临床医生倾向于为特定患者提供治疗，他们可能会考虑症状持续时间的前4周的疼痛缓解方案。在决定治疗或观察等待时，应考虑特定于患者的因素。

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