推拿治疗腰椎间盘突出症随机对照试验的系统评价  

System Review Randomized Controlled Trials on Manipulative Therapy in the Treatment of Lumbar Disc Herniation

作　　者：王艳国[1] 郭秀琴 刘凯[3] 朱立国[4] 

机构地区：[1]天津中医药大学第一附属医院,天津300193 [2]天津市滨海新区塘沽中医医院,天津300450 [3]天津中医药大学,天津300193 [4]中国中医科学院望京医院,北京100102

出　　处：《中华中医药学刊》2013年第8期1638-1642,共5页Chinese Archives of Traditional Chinese Medicine

基　　金：国家中医药管理局中医药行业科研专项资助项目(201107004)

摘　　要：目的:评价推拿治疗腰椎间盘突出症的疗效及安全性。方法:计算机检索Cochrane Library、PubMed、EMbase、CBM、CNKI、VIP数据库,全面搜集有关推拿治疗腰椎间盘突出症的随机对照试验。由两名评价者按照Cochrane系统评价员手册5.0.1提取资料并进行方法学质量评估,数据分析采用RevMan 5.1软件。结果:共纳入52个研究。Meta分析结果显示:推拿治疗优于牵引[RR=1.17,95%CI(1.10,1.25)]、中药[RR=1.18,95%CI(1.08,1.30)]、以及其它综合疗法[RR=1.20,95%CI(1.12,1.27],而与微波、西药疗效比较差异无统计学意义;推拿联合其它疗法与其它疗法除推拿+熏蒸vs熏蒸和推拿+针刀vs针刀疗效无统计学意义外,其余各亚组分析均显示推拿联合其它疗法疗效优于其它疗法。结论:推拿治疗腰椎间盘突出症方面具有一定优势。但由于纳入的原始文献质量不高,影响研究结果的论证强度。确切的结论尚需要高质量的临床研究进行进一步验证。Objective：To assess the efficacy and safety of manipulative therapy in the treatment of lumbar disc hernia- tion. Methods：All randomized controlled trials of treating lumbar disc herniation with manipulation were searched from Cocbrane Library,PubMed,EMbase,CBM, CNKI and VIP. Data were extracted and evaluated by two reviewers independ- ently with a specially designed extraction form. Cochrane systematic reviews Handbook 5.0.1 was taken as a reference to quality evaluation of the included studies, and the Cochrane Collaboration RevMan 5. l software was used for data analy- ses. Results ： A total of 52 trials were included. The result of meta- analyses showed that： single - application of manipu- lation is superior to traction group [ RR = 1.17,95% CI（I. 10,1.25） and medicine group [ RR = 1.18 ,95% CI（ 1.08, 1.30） ] ,and other comprehensive therapy [ RR = 1, 20 95% CI （ 1.12, 1.27 ] in effective rate, while no significant differences were noted neither microwave group nor western medicine ; In the trials of comparison between union - appli- cation of manipulation and other treatment, only manipulation plus stifling versus stifling group and manipulation plus needle - knife versus needle - knife were not significantly different. Conclusion ： Both single - application and union - ap- plication of manipulation were effective for Lumbar Disc Herniation and is superior to other treatment. However, the con- clusion was uncertain because the quality of enrolled papers was partly low. Therefore, further high - quaihy randomized controlled trials are required to prove the role of manipulation in the treatment of Lumbar Disc Herniation.

关 键 词：推拿 腰椎间盘突出症 随机对照试验 系统评价 

分 类 号：R244.1[医药卫生—针灸推拿学]