手法治疗颈型颈椎病临床疗效和安全性系统评价  

Systematic reviews for the clinical effects and safety of manipulative therapy on cervical spondylopathy

作　　者：王琼[1,2] 朱国苗[1] 

机构地区：[1]上海中医药大学附属曙光医院,上海201203 [2]上海中医药大学针推学院,上海201203

出　　处：《中华中医药杂志》2014年第12期3716-3723,共8页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：上海市中医药事业发展三年行动计划(海派中医流派传承工程)丁氏推拿项目(No.ZYSNXD-CC-HPGC-JD-011)~~

摘　　要：目的:对手法治疗颈型颈椎病的疗效和安全性进行系统评价。方法:计算机检索中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、维普网(VIP)、Pub Med、EMbase和Cochrane Library数据库,查找有关手法干预颈型颈椎病的临床随机对照试验(RCTs),检索时限从2002年1月至2013年4月。由2位研究人员按照纳入标准和排除标准独立筛选文献、提取资料和进行质量评价,采用Review Marager5.2软件进行数据合并和Meta分析。结果:最终纳入12个RCT,涉及1 902例患者。Meta分析结果显示:1经过1个疗程的治疗后,手法能显著减轻患者疼痛[SMD=0.26,95%CI(0.16,0.35)],提高患者颈部功能(量表[SMD=0.26,95%CI(0.10,0.42)],颈椎活动度[SMD=0.35,95%CI(0.12,0.59)]或[SMD=0.27,95%CI(0.13,0.42)])以及显著改善患者生活质量{PCS[SMD=0.20,95%CI(0.06,0.35)},MCS[SMD=0.00,95%CI(-0.14,0.14)]);2短期随访发现手法有降低疼痛的优势[SMD=0.43,95%CI(0.18,0.68)],但无改善患者颈部功能的{优势[SMD=0.22,95%CI(-0.04,0.47)];3中期随访发现手法有降低疼痛[SMD=0.24,95%CI(0.06,0.43)]及提高患者生活质量的优势{PCS[SMD=0.17,95%CI(0.03,0.31)]},但无改善患者颈部功能的优势[SMD=0.11,95%CI(-0.08,0.30)];4长期随访发现手法仅有改善患者生活质量的优势{PCS[SMD=0.16,95%CI(-0.11,0.32)],MCS[SMD=0.08,95%CI(-0.09,0.25)]},而无降低疼痛[SMD=0.11,95%CI(-0.15,0.36)]及改善患者颈部功能的优势[SMD=0.04,95%CI(-0.11,0.19)]。结论:手法治疗颈型颈椎病具有较好的临床疗效、安全性和中远期随访效应。Objective： To study on the systematic reviews for the clinical effects and safety of manipulative therapy on cervical spondylopathy. Methods： The randomized controlled trials （RCTs） of manipulative therapy on cervical spondylopathy were searched in CNKI, CBM, VIP, PubMed, EMbase and Cochrane Library databases by computer retrieval from January 2002 to April 2013. According to the inclusion and exclusion criteria, 2 researchers independently screened the literature, extracted the data and assessed the quality. Then, the RevMan5.2 software was used to merge the data and conduct a recta-analysis. Results： A total of 12 RCTs involving 1 902 patients were included. Mata-analysis showed that： （1）After a course of treatment, manipulative therapy could relieve the neck pain [SMD=0.26, 95%CI （0.16, 0.35）], improve the function of neck （scale ]SMD=0.26, 95%CI （0.10, 0.42）], improve the range of flexion-extension of cervical spine [SMD=0.35, 95%CI （0.12, 0.59）] or [SMD=0.27, 95%CI （0.13, 0.42）]） as well as significantly improve the life quality {PCS [SMD=0.20, 95%CI （0.06, 0.35）], MCS [SMD=0.00, 95%CI（- 0.14, 0.14）]）.（2）There was an advantage of relief the neck pain for manipulative therapy at short-term follow-up visit [SMD=0.43, 95%CI （0.18, 0.68）], but no advantage on the improvement of the neck function [SMD=0.22, 95%CI （-0.04, 0.47）]; （3）There were advantages of relief the neck pain [SMD=0.24, 95%CI （0.06, 0.43）] and improvement the life quality {PCS [SMD=0.17, 95%CI （0.03, 0.31）], MCS [SMD=-0.02, 95%CI （-0.16, 0.13）]] for manipulative therapy at medium-term follow-up visit, but no advantage of improvement the neck function [SMD=0.11, 95%CI （-0.08, 0.30）]. （4）There was the only advantage of improvement the life quality {PCS [SMD=-0.16, 95%CI （-0.11,0.32）], MCS [SMD=0.08, 95%CI （-0.09, 0.25）]} for manipulative therapy at long-term follow-up visit, but no advantage of relief the neck pain [SMD=0.11, 95%CI （-0.15, 0.36）] and impr

关 键 词：手法 颈型颈椎病 疗效 安全性 系统评价 

分 类 号：R246.9[医药卫生—针灸推拿学]