目的: 系统评价体外冲击波治疗膝关节骨关节炎的有效性。方法: 检索CNKI、CBM、维普、万方、Pubmed数据库从建库截至2021年6月8日收录的有关体外冲击波疗法治疗膝关节骨关节炎的临床随机对照试验(Randomized controlled trial,RCT),由2名研究人员独立客观进行筛选、提取、评价,使用Revman 5.3软件对提取的资料作Meta分析。结果: 符合纳入标准12项研究,累计1 043例病例,Meta分析结果显示,体外冲击波组在视觉模拟评分(Visual Analogue Scale,VAS)评分、西安大略及麦克马斯特大学骨关节炎指标(The Western Ontario and McMaster Universities Osteoarthritis Index,WOMAC)评分方面均优于对照组。结论: 体外冲击波疗法治疗膝关节骨关节炎患者的临床疗效较好,但由于纳入研究数量较少且诸多偏倚风险评价不明确,仍需高质量、大样本的随机对照研究加以佐证。
Objective: To systematically evaluate the validity and preponderance of extracorporeal shockwave therapy for knee osteoarthritis. Methods: Searched the database of CNKI, CBM, VIP, WanFang and Pubmed about the clinical randomized controlled trial of extracorporeal shockwave therapy for knee osteoarthritis before June 8, 2021. The RCTs, about extracorporeal shockwave treatment of knee osteoarthritis in governor vessel was concealed, extracted and evaluated independently and objectively by two researchers. The extracted data were analyzed by Meta with Revman5.3 software. Results: 12 studies met the inclusion criteria with 1043 cases. The results of Meta-analysis showed that VAS, WOMAC in the extracorporeal shockwave group were superior to those in the control group. Conclusion: extracorporeal shockwave has obvious clinical effect on patients with disturbance of knee osteoarthritis. However, due to the small number of included studies and unclear bias risk assessment, it still needs to be supported by high-quality,large-sample randomized controlled trials.
[1] Abramson SB, Attur M. Developments in the scientific understanding of osteoarthritis[J].Arthritis Res Ther, 2009, 11(3): 1-9.
[2] Herrero-Beaumont G, Roman-Blas JA, Bruyère O, et al. Clinical settings in knee osteoarthritis: Pathophysiology guides treatment[J].Maturitas, 2017, 96: 54-57.
[3] Sliepen M, Brandes M, Rosenbaum D. Current physical activity monitors in hip and knee osteoarthritis: a review[J].Arthritis Care Res, 2017, 69(10): 1460-1466.
[4] Ondresik M, Azevedo Maia FR, da Silva Morais A, et al. Management of knee osteoarthritis.Current status and future trends[J].Biotechnol.Bioeng, 2017, 114(4): 717-739.
[5] Peat G, McCarney R, Croft P. Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care[J].Ann.Rheum Dis, 2001, 60(2): 91-97.
[6] Silverwood V, Blagojevic-Bucknall M, Jinks C, et al. Current evidence on risk factors for knee osteoarthritis in older adults: a systematic review and meta-analysis[J].Osteoarthr.Cartil, 2015, 23(4): 507-515.
[7] Nicolson PJA, Bennell KL, Dobson FL, et al. Interventions to increase adherence to therapeutic exercise in older adults with low back pain and/or hip/knee osteoarthritis: a systematic review and meta-analysis[J].Br J Sports Med, 2017, 51(10): 791-799.
[8] McColl GJ.Pharmacological therapies for the treatment of osteoarthritis[J].Med J Aust, 2001, 175(S3): S108-S111.
[9] Gracitelli GC, Moraes VY, Franciozi CES, et al. Surgical interventions (microfracture, drilling, mosaicplasty, and allograft transplantation) for treating isolated cartilage defects of the knee in adults[J].Cochrane Database Syst Rev, 2016,9 (9): CD010675.
[10] Schmitz C, Császár NBM, Milz S, et al. Efficacy and safety of extracorporeal shock wave therapy for orthopedic conditions: a systematic review on studies listed in the PEDro database[J].Br Med Bull, 2015, 116(1): 115-138.
[11] Ueberle F. Shock wave technology[M].Extracorporeal shock waves in orthopaedics.Berlin: Springer, 1998: 59-87.
[12] Rompe JD, Furia J, Weil L, et al.Shock wave therapy for chronic plantar fasciopathy[J].Br Med Bull, 2007, 81(1): 183-208.
[13] 吴在德, 吴肇汉. 外科学[M].北京: 人民卫生出版社, 2003: 426.
[14] Lee JK, Lee BY, Shin WY, et al. Effect of extracorporeal shockwave therapy versus intra-articular injections of hyaluronic acid for the treatment of knee osteoarthritis[J].Ann Rehabil Med., 2017, 41(5): 828-835.
[15] Lizis P, Kobza W, Manko G. Extracorporeal shockwave therapy vs.kinesiotherapy for osteoarthritis of the knee: a pilot randomized controlled trial[J].J Back Musculoskelet Rehabil, 2017, 30(5): 1121-1128.
[16] Imamura M, Alamino S, Hsing WT, et al. Radial extracorporeal shock wave therapy for disabling pain due to severe primary knee osteoarthritis[J].J Rehabil Med, 2017, 49(1): 54-62.
[17] 何子微, 赵维彪. 关节镜下膝关节清理术联合体外冲击波治疗膝关节骨性关节炎的疗效分析[J].沈阳医学院学报, 2016, 18(5): 347-349.
[18] 刘彧. 体外冲击波疗法对绝经后女性早中期膝骨关节炎的疗效观察[D].石家庄: 河北医科大学, 2016.
[19] 刘搏宇, 李宏宇, 金先跃, 等. 独活寄生汤联合体外冲击波治疗膝关节骨关节炎的效果[J].广东医学, 2015, 36(23): 3709-3711.
[20] 孟彧, 吴嫚, 王宏沛, 等. 冲击波联合关节腔内注射在膝骨关节炎治疗中的应用[J].中国疼痛医学杂志, 2016, 22(8): 638-639.
[21] 席立成, 李宏宇, 赵子星, 等 .体外冲击波治疗早中期膝关节骨性关节炎效果观察及其机制[J].山东医药, 2016, 56(48): 60-62.
[22] 张田, 刘文波, 李华, 等. 放射状冲击波治疗膝骨关节炎的临床研究[J].中国医学创新, 2017, 14(30): 36-40.
[23] 李涛, 宋奇志, 裴建祥, 等. 体外冲击波治疗早中期膝关节骨关节炎的近期临床疗效观察[J].重庆医学, 2017, 46(3): 338-340.
[24] 穆莹, 姚鹏. 放散式体外冲击波治疗膝骨关节炎伴膝关节周围韧带钙化的疗效观察[J].中国现代医学杂志, 2021, 31(11): 43-48.
[25] 蔡春雨, 梁小旦, 单红星. 体外冲击波联合氨基葡萄糖治疗膝骨关节炎的疗效分析[J].右江医学, 2021, 49(2): 126-129.
[26] Zhang W, Moskowitz RW, Nuki G, et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part Ⅱ: OARSI evidence-based, expert consensus guidelines[J].Osteoarthr.Cartil, 2008, 16(2): 137-162.
[27] Wang CJ, Weng LH, Ko JY, et al. Extracorporeal shockwave therapy shows chondroprotective effects in osteoarthritic rat knee[J].Arch Orthop Trauma Surg, 2011, 131(8): 1153-1158.
[28] Kawcak CE, Frisbie DD, McIlwraith CW. Effects of extracorporeal shock wave therapy and polysulfated glycosaminoglycan treatment on subchondral bone, serum biomarkers, and synovial fluid biomarkers in horses with induced osteoarthritis[J].Am J Vet Res, 2011, 72(6): 772-779.
[29] Gollwitzer H, Saxena A, DiDomenico LA, et al. Clinically relevant effectiveness of focused extracorporeal shock wave therapy in the treatment of chronic plantar fasciitis: a randomized, controlled multicenter study[J].JBJS, 2015, 97(9): 701-708.