目的:研究体外冲击波疗法(ESWT)是否有效减轻疼痛和残疾,在改善功能方面,肩袖钙化性肌腱病患者的生活质量和钙化完全吸收率。探讨ESWT的哪一种模式在高(HE)-SWT和低能量(LE)-SWT之间以及在局灶性(F)-SWT和径向(R)-SWT之间带来最大的临床改善。
方法:MEDLINE,EMBASE,CENTRAL数据库,和PEDro数据库直到2024年2月都被搜索。进一步调查研究记录。使用修订的CochraneRoB工具(RoB2)评估偏倚(RoB)的风险。证据的确定性按等级评定。
结果:纳入21项随机对照试验。没有人被认为是整体低RoB。比较ESWT和超声引导针手术(USGNP),汇总结果显示,在<24周和<48周时,USGNP在疼痛方面存在显着差异(MD=1.17,p=0.004,I2=59%;MD=1.31,p=0.004,I2=42%,分别)。比较ESWT和假ESWT,汇总结果报告了24周时在疼痛和功能方面有利于ESWT的临床显着差异(MD=-5.72,p<0.00001,I2=0%;标准化平均差=2.94,p=0.02I2=98%,分别)。比较HE-SWT和LE-SWT,在<24周时,HE-SWT在疼痛和功能方面具有统计学和临床优势(MD=-1.83,p=0.03,I2=87%;MD=14.60,p=0.002,I2=77%,分别),并在12周时显示出明显更高的钙化完全吸收率(风险比=2.53,p=0.001,I2=0%)。F-SWT和R-SWT在减轻疼痛方面表现同样有效,提高残疾和吸收率。通过分级方法,证据的确定性被评为非常低。
结论:在<24周和<48周时,USGNP在减轻疼痛方面在统计学上优于ESWT。在24周时,ESWT在疼痛减轻和功能改善方面在临床上优于假ESWT。HE-SWT在临床上比LE-SWT更有效地减轻疼痛,在<24周时改善功能,并在12周时解决钙化沉积物,而F-SWT和R-SWT之间没有差异。
OBJECTIVE: To investigate if Extracorporeal Shock Wave therapy (ESWT) is effective in reducing pain and disability, in improving function, quality of life and complete resorption rate of calcification in patients with Rotator Cuff Calcific
Tendinopathy. To investigate which modality of ESWT brings the greatest clinical improvements between High (HE)-SWT and Low Energy (LE)-SWT and between Focal (F)-SWT and Radial (R)-SWT.
METHODS: MEDLINE, EMBASE, CENTRAL Database, and PEDro databases until February 2024 were searched. Study registers were further investigated. The Risk of Bias (RoB) was assessed with the Revised Cochrane RoB Tool (RoB 2). The certainty of evidence was rated with GRADE.
RESULTS: Twenty-one randomized controlled trials were included. None was judged as overall low RoB. Comparing ESWT and Ultrasound Guided Needling Procedures (USGNP), the pooled results reported a significant difference favoring USGNP in pain at <24 and <48 weeks (MD = 1.17, p = 0.004, I2 = 59%; MD = 1.31, p = 0.004, I2 = 42%, respectively). Comparing ESWT and sham-ESWT, the pooled results reported a clinically significant difference favoring ESWT in pain and function at 24 weeks (MD = -5.72, p < 0.00001, I2 = 0%; Standardized Mean Difference = 2.94, p = 0.02 I2 = 98%, respectively). Comparing HE-SWT and LE-SWT, HE-SWT was statistically and clinically superior in pain and function at <24 weeks (MD = -1.83, p = 0.03, I2 = 87%; MD = 14.60, p = 0.002, I2 = 77%, respectively) and showed a significantly higher complete resorption rate of calcification at 12 weeks (Risk Ratio = 2.53, p = 0.001, I2 = 0%). F-SWT and R-SWT appear equally effective in reducing pain, improving disability and resorption rate. The certainty of evidence was rated as very low through GRADE approach.
CONCLUSIONS: USGNP was statistically superior to ESWT in pain reduction at <24 and <48 weeks. ESWT was clinically better to sham-ESWT in pain reduction and function improvement at 24 weeks. HE-SWT was clinically more effective than LE-SWT in reducing pain, improving function at <24 weeks, and resolving calcific deposits at 12 weeks, while no differences between F-SWT and R-SWT were reported.