{"title":"腕管综合征的保守治疗：系统回顾和网络荟萃分析。","authors":"Yuanhao Chen, Bing Han, Xin Zhang, Chao Guo, Qinghui Han, Zhanjia Zhang, Shilun Hou","doi":"10.1016/j.apmr.2025.04.002","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the comparative efficacy of various conservative treatments for carpal tunnel syndrome (CTS), including manual therapy (MT), local steroid injections, platelet-rich plasma (PRP) injections, extracorporeal shock wave therapy, and low-level laser therapy, through a comprehensive network meta-analysis.</p><p><strong>Data sources: </strong>PubMed, Web of Science, Cochrane Library, Embase, SPORTDiscus, and China National Knowledge Infrastructure databases were searched to identify published studies until April 2024.</p><p><strong>Study selection: </strong>Randomized controlled trials comparing the efficacy of conservative CTS treatments in individuals with CTS were included.</p><p><strong>Data extraction: </strong>Data from the included articles were extracted independently by 2 researchers, with any disagreements resolved through consultation with a third author. The extracted data included the first author's name, country/region, publication year, sample size, participants' age, disease severity, symptom duration, intervention parameters, follow-up period, and reported outcomes.</p><p><strong>Data synthesis: </strong>A total of 49 randomized controlled trials involving 11 conservative treatments and 3323 participants were included. The network meta-analysis showed that MT demonstrated the highest efficacy in both short-term and medium-term pain relief with surface under the cumulative ranking curve values of 87.6% and 99.3%, respectively. Dextrose 5% in water and PRP were closely followed in terms of efficacy. Compared to control groups, low-level laser therapy (standardized mean difference=-1.45; 95% CI, -2.16 to -0.74) and extracorporeal shock wave therapy (standardized mean difference=-1.03; 95% CI, -1.86 to -0.20) also showed significant benefits.</p><p><strong>Conclusions: </strong>This study provides robust evidence that MT and dextrose 5% in water injections are the most effective conservative treatments for CTS which offer valuable insights for clinical decision-making. Further research is needed to assess the long-term efficacy and cost-effectiveness of these interventions.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6000,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Conservative Treatments of Carpal Tunnel Syndrome: A Systematic Review and Network Meta-analysis.\",\"authors\":\"Yuanhao Chen, Bing Han, Xin Zhang, Chao Guo, Qinghui Han, Zhanjia Zhang, Shilun Hou\",\"doi\":\"10.1016/j.apmr.2025.04.002\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To evaluate the comparative efficacy of various conservative treatments for carpal tunnel syndrome (CTS), including manual therapy (MT), local steroid injections, platelet-rich plasma (PRP) injections, extracorporeal shock wave therapy, and low-level laser therapy, through a comprehensive network meta-analysis.</p><p><strong>Data sources: </strong>PubMed, Web of Science, Cochrane Library, Embase, SPORTDiscus, and China National Knowledge Infrastructure databases were searched to identify published studies until April 2024.</p><p><strong>Study selection: </strong>Randomized controlled trials comparing the efficacy of conservative CTS treatments in individuals with CTS were included.</p><p><strong>Data extraction: </strong>Data from the included articles were extracted independently by 2 researchers, with any disagreements resolved through consultation with a third author. The extracted data included the first author's name, country/region, publication year, sample size, participants' age, disease severity, symptom duration, intervention parameters, follow-up period, and reported outcomes.</p><p><strong>Data synthesis: </strong>A total of 49 randomized controlled trials involving 11 conservative treatments and 3323 participants were included. The network meta-analysis showed that MT demonstrated the highest efficacy in both short-term and medium-term pain relief with surface under the cumulative ranking curve values of 87.6% and 99.3%, respectively. Dextrose 5% in water and PRP were closely followed in terms of efficacy. Compared to control groups, low-level laser therapy (standardized mean difference=-1.45; 95% CI, -2.16 to -0.74) and extracorporeal shock wave therapy (standardized mean difference=-1.03; 95% CI, -1.86 to -0.20) also showed significant benefits.</p><p><strong>Conclusions: </strong>This study provides robust evidence that MT and dextrose 5% in water injections are the most effective conservative treatments for CTS which offer valuable insights for clinical decision-making. Further research is needed to assess the long-term efficacy and cost-effectiveness of these interventions.</p>\",\"PeriodicalId\":8313,\"journal\":{\"name\":\"Archives of physical medicine and rehabilitation\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.6000,\"publicationDate\":\"2025-04-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Archives of physical medicine and rehabilitation\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.apmr.2025.04.002\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"REHABILITATION\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of physical medicine and rehabilitation","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.apmr.2025.04.002","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"REHABILITATION","Score":null,"Total":0}
引用次数: 0
摘要
目的：通过综合网络荟萃分析（NMA），评价手工治疗（MT）、局部类固醇注射、富血小板血浆（PRP）注射、体外冲击波治疗（ESWT）、低水平激光治疗（LLLT）等多种保守治疗腕管综合征（CTS）的比较疗效。数据来源：PubMed， Web of Science, Cochrane Library, Embase， SPORTDiscus和CNKI数据库被检索，以确定截至2024年4月发表的研究。研究选择：纳入随机对照试验（RCTs），比较保守CTS治疗对CTS患者的疗效。数据提取：纳入文章的数据由两位研究者独立提取，任何异议均通过与第三作者协商解决。提取的数据包括第一作者姓名、国家/地区、出版年份、样本量、受试者年龄、疾病严重程度、症状持续时间、干预参数、随访期和报告结果。数据综合：共纳入49项随机对照试验，涉及11项保守治疗，3323名受试者。NMA结果显示，MT对短期和中期疼痛的缓解效果最高，其表面在累积排序曲线下分别为87.6%和99.3%。葡萄糖5%水（D5W）和PRP的功效紧随其后。与对照组相比，LLLT（标准化平均差[SMD] = -1.45,95%可信区间[CI] = -2.16至-0.74）和ESWT （SMD = -1.03,95% CI = -1.86至-0.20）也显示出显著的益处。结论：本研究提供了强有力的证据，证明MT和D5W注射是CTS最有效的保守治疗方法，为临床决策提供了有价值的见解。需要进一步的研究来评估这些干预措施的长期疗效和成本效益。
Conservative Treatments of Carpal Tunnel Syndrome: A Systematic Review and Network Meta-analysis.
Objective: To evaluate the comparative efficacy of various conservative treatments for carpal tunnel syndrome (CTS), including manual therapy (MT), local steroid injections, platelet-rich plasma (PRP) injections, extracorporeal shock wave therapy, and low-level laser therapy, through a comprehensive network meta-analysis.
Data sources: PubMed, Web of Science, Cochrane Library, Embase, SPORTDiscus, and China National Knowledge Infrastructure databases were searched to identify published studies until April 2024.
Study selection: Randomized controlled trials comparing the efficacy of conservative CTS treatments in individuals with CTS were included.
Data extraction: Data from the included articles were extracted independently by 2 researchers, with any disagreements resolved through consultation with a third author. The extracted data included the first author's name, country/region, publication year, sample size, participants' age, disease severity, symptom duration, intervention parameters, follow-up period, and reported outcomes.
Data synthesis: A total of 49 randomized controlled trials involving 11 conservative treatments and 3323 participants were included. The network meta-analysis showed that MT demonstrated the highest efficacy in both short-term and medium-term pain relief with surface under the cumulative ranking curve values of 87.6% and 99.3%, respectively. Dextrose 5% in water and PRP were closely followed in terms of efficacy. Compared to control groups, low-level laser therapy (standardized mean difference=-1.45; 95% CI, -2.16 to -0.74) and extracorporeal shock wave therapy (standardized mean difference=-1.03; 95% CI, -1.86 to -0.20) also showed significant benefits.
Conclusions: This study provides robust evidence that MT and dextrose 5% in water injections are the most effective conservative treatments for CTS which offer valuable insights for clinical decision-making. Further research is needed to assess the long-term efficacy and cost-effectiveness of these interventions.
期刊介绍：
The Archives of Physical Medicine and Rehabilitation publishes original, peer-reviewed research and clinical reports on important trends and developments in physical medicine and rehabilitation and related fields. This international journal brings researchers and clinicians authoritative information on the therapeutic utilization of physical, behavioral and pharmaceutical agents in providing comprehensive care for individuals with chronic illness and disabilities.
Archives began publication in 1920, publishes monthly, and is the official journal of the American Congress of Rehabilitation Medicine. Its papers are cited more often than any other rehabilitation journal.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
