■足底筋膜炎(PF)是成人慢性足跟痛的最常见原因。体外冲击波疗法(ESWT)是当前指南中推荐的方法,小针刀对肌肉骨骼疼痛产生可接受的临床效果。
■系统地比较小针刀与ESWT治疗PF的疗效。
■本评论已在国际前瞻性系统评论注册(即,\"PROSPERO\",CRD42023448813)。两位作者在电子数据库中搜索了比较小针刀与ESWT治疗PF的随机对照试验(RCT),并收集结果,包括疗效,疼痛强度,和功能。使用Cochrane手册偏差风险工具评估偏差风险,并根据Jadad量表评估随机对照试验的质量。同一位作者独立地从纳入的研究中提取数据,已导入到ReviewManager版本5.4.1(哥本哈根:北欧科克伦中心,科克伦合作,2020)进行荟萃分析。
■最初的文献检索检索到886项研究,其中6人最终被纳入本研究。Meta分析显示疗效无显著差异(OR=1.87;95%CI[0.80,4.37],p=.15)也没有短期疼痛改善(MD=2.20;95%CI[-2.77,7.16],p=.39)在小针刀和ESWT之间。然而,小针刀在中期疼痛改善方面可能比ESWT更有效(MD=9.11;95%CI[5.08,13.15],p<.00001)和长期随访(MD=10.71;95%CI[2.18,19.25],p<.00001)。亚组分析显示,在所有随访中,小针刀联合皮质类固醇注射在减轻疼痛强度方面具有统计学意义(MD=4.84;95%CI[1.33,8.36],p=.007;MD=10.99;95%CI[8.30,13.69],p<.00001;MD=17.87;95%CI[15.26,20.48],p<.00001)。荟萃分析显示短期无统计学差异(MD=1.34;95%CI[-3.19,5.86],p=.56)和中期(MD=2.75;95%CI[-1.21,6.72],p=17)针刀组和ESWT组之间的功能改善。在中等质量研究的亚组分析中,小针刀对中期功能改善有良好的效果(MD=1.58;95%CI[0.52,2.65],p=.004),异质性低(χ2=0.77,p=0.038,I2=0%)。结论:减轻疼痛和改善功能是治疗PF的关键。因此,使用小针刀治疗可能优于ESWT。这项系统评价和荟萃分析的结果可能为PF患者提供替代治疗方案,并且更可靠,支持使用小针刀的循证建议。
UNASSIGNED: Plantar fasciitis (PF) is the most common cause of chronic heel pain among adults. Extracorporeal shock wave therapy (ESWT) is the recommended in the current guidelines, and the small needle-knife yields acceptable clinical effects for musculoskeletal pain.
UNASSIGNED: To systematically compare the efficacy of the small needle-knife versus ESWT for the treatment of PF.
UNASSIGNED: The present
review was registered in the International Prospective Register of Systematic Reviews (i.e., \"PROSPERO\", CRD42023448813). Two of the authors searched electronic databases for randomized controlled trials (RCTs) comparing the small needle-knife versus ESWT for the treatment of PF, and collected outcomes including curative effect, pain intensity, and function. Risk of bias was assessed using the Cochrane Handbook Risk of Bias tool and the quality of the RCTs was evaluated according to the Jadad Scale. The same authors independently performed data extraction from the included studies, which were imported into
Review Manager version 5.4.1(Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2020) for meta-analysis.
UNASSIGNED: The initial literature search retrieved 886 studies, of which 6 were eventually included in this study. Meta-analysis revealed no significant difference in curative effect (OR = 1.87; 95 % CI [0.80, 4.37], p = .15) nor short-term pain improvement (MD = 2.20; 95 % CI [-2.77, 7.16], p = .39) between the small needle-knife and ESWT. However, the small needle-knife may be more effective than ESWT for pain improvement in mid-term (MD = 9.11; 95 % CI [5.08, 13.15], p< .00001) and long-term follow-ups (MD = 10.71; 95 % CI [2.18, 19.25], p< .00001). Subgroup analysis revealed that the small needle-knife combined with a corticosteroid injection yielded a statistically significant difference in reduction of pain intensity at all follow-ups (MD = 4.84; 95 % CI [1.33, 8.36], p = .007; MD = 10.99; 95 % CI [8.30, 13.69], p< .00001; MD = 17.87; 95 % CI [15.26, 20.48], p< .00001). Meta-analysis revealed no statistical differences in short-term (MD = 1.34; 95 % CI [-3.19, 5.86], p = .56) and mid-term (MD = 2.75; 95 % CI [-1.21, 6.72], p = . 17) functional improvement between the needle-knife and ESWT groups. In a subgroup analysis of moderate-quality studies, the small needle-knife demonstrated a favorable effect on mid-term functional improvement (MD = 1.58; 95 % CI [0.52, 2.65], p = .004), with low heterogeneity (χ2 = 0.77, p = .038, I2 = 0 %). Conclusion: Pain reduction and functional improvement are essential for the treatment of PF. Therefore, treatment using the small needle-knife may be superior to ESWT. Results of this systematic
review and meta-analysis may provide alternative treatment options for patients with PF as well as more reliable, evidence-based recommendations supporting use of the small needle-knife.