| Objective To compare the efficacy of extracorporeal shock wave therapy in the treatment of bone marrow edema.Methods A computerized search of PubMed, EMbase, Web of Science, Cochrane Library, China Knowledge Network, Wanfang, and VIP was used. The search period was from the establishment of the library to January 2024, and the search terms were: "Extracorporeal shockwave therapy, Shock wave therapy, Bone marrow edema syndrome'' to search all domestic and international literature on comparative studies of extracorporeal shockwave therapy for bone marrow edema syndrome. Two researchers independently screened the literature for inclusion and exclusion criteria and extracted the data. Meta-analysis of outcome indicators was performed using Review Manager 5.4 statistical analysis software.Results ① A total of 8 studies met the inclusion criteria, including 4 randomized controlled trials, 2 retrospective cohort studies, and 2 prospective cohort studies, which were included in this Meta-analysis, with a total of 522 patients, of which 296 cases were in the shockwave treatment group and 226 cases in the control group. These included 4 studies on shockwave treatment of knee bone marrow edema, 2 studies on hip bone marrow edema, 1 study on ankle bone marrow edema, and 1 study on pubic bone marrow edema; ② Meta-analysis showed that the pain VAS scores of the shockwave group in the short-term treatment of bone marrow edema were significantly lower than those of the control group [WMD=-1.55, 95% CI (-1.84, -1.26), P<0.000 01]; pain VAS scores in the shockwave group were significantly lower than those in the control group in the intermediate term (3-6 months) of treatment for myeloedema [WMD=-1.46, 95% CI (-2.93, -0.00), P=0.05]; and pain VAS scores in the shockwave group in the long term (12 months and beyond) of treatment for myeloedema were significantly lower than those in the control group [WMD=-1.53, 95% CI (-2.79, -0.26), P=0.02]. There was no significant difference between the joint function scores of the shockwave group and the control group in the short-term (1 month) treatment of myeloedema [WMD=1.14, 95% CI (-1.25, 3.53), P=0.35]; the difference in the joint function scores of the knee joint in the middle of the shockwave treatment was significant [WMD=-1.36, 95% CI (-1.71, -1.01), P<0.000 01]; there was no significant difference in joint function scores between the shockwave group and the control group in the distant (12 months and beyond) treatment of bone marrow edema [WMD=0.47, 95% CI (-1.77, 2.72), P=0.68]. There was no significant difference between the area of bone marrow edema on MRI with shockwave therapy and the control group [WMD=0.43, 95% CI (-3.73, 4.59), P=0.84].Conclusion Extracorporeal shockwave therapy significantly reduces patient pain in the treatment of myeloedema syndrome, with VAS scores superior to those of the control group in the short-, medium-, and long-term. In the medium term (3-6 months), extracorporeal shockwave therapy improved knee function scores (WOMAC arthritis index) significantly better than the control group. However, for short-, medium- and long-term overall bone marrow oedema joint function scores were not significantly different from those of the control group. Extracorporeal shock wave did not show any significant difference between the control group and the extracorporeal shock wave in reducing the area of bone marrow edema on MRI. |
