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[1]趙繼榮,冷向陽,蔣鵬,等.中藥湯劑口服聯(lián)合正骨手法治療腰椎間盤突出癥有效性和安全性的Meta分析[J].中醫(yī)正骨,2021,33(10):29-35.
　ZHAO Jirong,LENG Xiangyang,JIANG Peng,et al.Clinical efficacy and safety of oral application of traditional Chinese drug decoctions combined with bone setting manipulations for treatment of lumbar disc herniation:a meta-analysis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(10):29-35.
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中藥湯劑口服聯(lián)合正骨手法治療腰椎間盤突出癥有效性和安全性的Meta分析()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期數(shù):
2021年10期
頁碼:
29-35
欄目:
文獻(xiàn)研究
出版日期:
2021-10-20

文章信息/Info

Title:
Clinical efficacy and safety of oral application of traditional Chinese drug decoctions combined with bone setting manipulations for treatment of lumbar disc herniation:a meta-analysis
作者:
趙繼榮1; 冷向陽2; 蔣鵬3; 薛旭1; 陳祁青1; 陳文1; 趙寧1; 馬同1; 郭培堯1; ZHAO Jirong1; LENG Xiangyang2; JIANG Peng3; XUE Xu1; CHEN Qiqing1; CHEN Wen1; ZHAO Ning1; MA Tong1; GUO Peiyao1; ZHANG Tianlong1
1.Gansu Provincial Hospital of TCM,Lanzhou 730050,Gansu,China 2.The Affiliated Hospital of Changchun University of Chinese Medicine,Changchun 130021,Jilin,China 3.Gansu University of Chinese Medicine,Lanzhou 730000,Gansu,China
關(guān)鍵詞:
椎間盤移位;  腰椎;  中草藥;  煎劑;  正骨手法;  Meta分析;  系統(tǒng)評(píng)價(jià)
Keywords:
intervertebral disc displacement;  lumbar vertebrae;  drugs; Chinese herbal;  decoction;  bone setting manipulation;  Meta-analysis;  systematic review
摘要:
目的:評(píng)價(jià)中藥湯劑口服聯(lián)合正骨手法治療腰椎間盤突出癥(lumbar disc herniation,LDH)的有效性和安全性。方法:應(yīng)用計(jì)算機(jī)檢索中國知網(wǎng)、萬方數(shù)據(jù)庫、維普網(wǎng)、中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫、Pubmed、Cochrane library、Embase、Web of Science,搜集應(yīng)用中藥湯劑口服聯(lián)合正骨手法治療LDH的隨機(jī)對(duì)照試驗(yàn)文獻(xiàn),檢索時(shí)限均為建庫至2020年12月1日。試驗(yàn)組干預(yù)措施為中藥湯劑口服聯(lián)合正骨手法,對(duì)照組干預(yù)措施為單純中藥湯劑口服或正骨手法。由2位研究者檢索、篩選文獻(xiàn)、提取數(shù)據(jù)并評(píng)價(jià)納入研究的偏倚風(fēng)險(xiǎn)后,采用Revman5.3軟件對(duì)治療總有效率、腰部疼痛視覺模擬量表(visual analogue scale,VAS)評(píng)分、日本骨科學(xué)會(huì)(Japanese Orthopedic Association,JOA)腰痛疾患評(píng)分及并發(fā)癥發(fā)生率進(jìn)行Meta分析,同時(shí)通過改變效應(yīng)模型進(jìn)行敏感性分析。結(jié)果:共納入14篇文獻(xiàn)。Meta分析結(jié)果顯示,試驗(yàn)組的治療總有效率高于對(duì)照組[I2=45%,P=0.040; RR=1.20,95%CI(1.15,1.25),P=0.000]; 試驗(yàn)組在治療開始后20 d以內(nèi)評(píng)價(jià)的腰部疼痛VAS評(píng)分低于對(duì)照組[I2=98%,P=0.000; MD=-2.30,95%CI(-3.87,-0.73),P=0.004],治療開始后20～30 d評(píng)價(jià)的腰部疼痛VAS評(píng)分低于對(duì)照組[I2=92%,P=0.000; MD=-1.18,95%CI(-1.50,-0.86),P=0.000],治療開始后30 d以上評(píng)價(jià)的腰部疼痛VAS評(píng)分低于對(duì)照組[I2=98%,P=0.000; MD=-2.06,95%CI(-3.86,-0.26),P=0.030]; 2組在治療開始后21 d以內(nèi)評(píng)價(jià)的JOA腰痛疾患評(píng)分的差異無統(tǒng)計(jì)學(xué)意義[I2=99%,P=0.000; MD=1.62,95%CI(-8.06,11.30),P=0.740],試驗(yàn)組在治療開始后21 d評(píng)價(jià)的JOA腰痛疾患評(píng)分高于對(duì)照組[I2=0%,P=0.650; MD=4.36,95%CI(3.92,4.80),P=0.000],試驗(yàn)組在治療開始后21 d以上評(píng)價(jià)的JOA腰痛疾患評(píng)分高于對(duì)照組[I2=0%,P=0.630; MD=5.38,95%CI(4.48,6.27),P=0.000]; 僅1項(xiàng)研究報(bào)道了治療后的并發(fā)癥發(fā)生情況,2組均僅發(fā)生局部損傷、胃腸道反應(yīng)、皮膚潮紅等輕微并發(fā)癥,經(jīng)對(duì)癥處理后明顯緩解。改變效應(yīng)模型后,各結(jié)局指標(biāo)結(jié)果無明顯變化,提示本研究Meta分析結(jié)果較為穩(wěn)定。基于治療總有效率和腰部疼痛VAS評(píng)分的漏斗圖均顯示,各研究點(diǎn)分布不完全對(duì)稱,提示可能存在發(fā)表偏倚。證據(jù)質(zhì)量評(píng)價(jià)結(jié)果顯示,4個(gè)結(jié)局指標(biāo)的證據(jù)質(zhì)量均為中或低。結(jié)論:中藥湯劑口服聯(lián)合正骨手法治療LDH具有較好的臨床療效和安全性,療效優(yōu)于單純中藥湯劑口服或正骨手法治療。
Abstract:
Objective:To evaluate the clinical curative effects and safety of oral application of Traditional Chinese Drug(TCD)decoctions combined with bone setting manipulations for treatment of lumbar disc herniation(LDH).Methods:All the randomized controlled trial(RCT)articles about oral application of TCD decoctions combined with bone setting manipulations for treatment of LDH included from database establishing to December 1,2020 were retrieved from the China National Knowledge Internet,Wanfang Database,Vip Database,Chinese Biomedical Literature Database,Pubmed,Cochrane library,Embase and Web of Science through computer.The patients in experimental group were treated with oral application of TCD decoctions and bone setting manipulations,while the ones in control group with oral application of TCD decoctions or bone setting manipulations alone.The articles were retrieved and screened and the information was extracted independently by two researchers according to the inclusion and exclusion criteria.The bias risk of the research in the articles was evaluated by using Cochrane bias risk assessment tools and then a Meta-analysis on total effective rate,low back pain visual analogue scale(VAS)score,Japanese Orthopaedic Association(JOA)low back pain score and complication incidence was conducted by using Revman 5.3 software.The sensitivity analysis was conducted by changing the effect models.Results:Fourteen articles were included in the final analysis.The results of Meta-analysis revealed that the total effective rate was higher in experimental group compared to control group(I2=45%,P=0.040; RR=1.20,95%CI(1.15,1.25),P=0.000).The low back pain VAS scores evaluated within 20 days,from the 20th to the 30th day and at over 30 days after the beginning of the treatment were lower in experimental group compared to control group(I2=98%,P=0.000; MD=-2.30,95%CI(-3.87,-0.73),P=0.004; I2=92%,P=0.000; MD=-1.18,95%CI(-1.50,-0.86),P=0.000; I2=98%,P=0.000; MD=-2.06,95%CI(-3.86,-0.26),P=0.030).There was no statistical difference in JOA low back pain scores evaluated within 21 days after the beginning of the treatment between the 2 groups(I2=99%,P=0.000; MD=1.62,95%CI(-8.06,11.30),P=0.740).The JOA low back pain scores evaluated at 21 days and over 21 days after the beginning of the treatment were higher in experimental group compared to control group(I2=0%,P=0.650; MD=4.36,95%CI(3.92,4.80),P=0.000; I2=0%,P=0.630; MD=5.38,95%CI(4.48,6.27),P=0.000).The postoperative complications were reported in one research,only minor complications such as local injury,gastrointestinal reaction and skin flushing were found in the 2 groups,and the symptoms were greatly relieved after symptomatic supportive treatment.After changing the effect models,no evident change was found in the result of each outcome indicator,which suggested the results of Meta-analysis in this study were relatively stable.Funnel plots were drawn based on total effective rate and low back pain VAS scores respectively,and the asymmetrical funnel plots demonstrated that there might be publication bias.The results of evidence quality evaluation showed that the quality of the 4 outcome indicators was medium or poor.Conclusion:Combination of oral application of TCD decoctions with bone setting manipulations has good clinical curative effects and high safety in treatment of LDH,and its curative effect is better than that of monotherapy of oral application of TCD decoctions or bone setting manipulations.

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備注/Memo

備注/Memo:
基金項(xiàng)目:國家中醫(yī)藥管理局中醫(yī)藥循證能力建設(shè)項(xiàng)目(2019XZZX-GK005)
通訊作者:冷向陽 E-mail:[email protected]
更新日期/Last Update: 1900-01-01