坐位定点旋转手法与斜扳手法治疗腰椎间盘突出症的系统评价  

Fixed-point rotation manipulation in sitting position versus oblique-pulling manipulation for treatment of lumbar intervertebral disc herniation: a systematic review

作　　者：张人文[1] 莫灼锚 常敏敏 杨彬彬 李冬[1] 陈金凤[1] 舒新农 唐树杰[1] ZHANG Renwen;MO Zhuomao;CHANG Minmin;YANG Binbin;LI Dong;CHEN Jinfeng;SHU Xinnong;TANG Shujie(Jinan University,Guangzhou 510632,Guangdong,China)

机构地区：[1]暨南大学,广东广州510632

出　　处：《中医正骨》2018年第12期30-36,共7页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：广东省自然科学基金项目(2016A030313076);广州市科技计划项目(201607010252)

摘　　要：目的:比较坐位定点旋转手法与斜扳手法治疗腰椎间盘突出症(lumbar intervertebral disc herniation,LIDH)的临床疗效和安全性。方法:应用计算机检索Cochrane Library、Pub Med、Embase、Web of science、CNKI、Wan Fang Data、VIP建库至2018年4月收录的国内外公开发表的、比较坐位旋转手法与斜扳手法治疗LIDH临床疗效的随机对照研究文献或观察性研究文献。由2位研究者独立筛选文献、提取资料。对纳入文献质量进行评价后,进行Meta分析。结果:初检共检出文献2164篇,经筛选最终纳入9篇文献,均为中文文献。纳入文献中7篇为随机对照研究,2篇为观察性研究文献;纳入的研究对象共825例,坐位旋转手法组422例、斜扳手法组403例;结局指标包括有效率、日本整形外科协会(Japanese orthopedic association,JOA)下腰痛评分、疼痛视觉模拟量表(visual analogue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)、SF-36简明健康状况调查表中躯体疼痛(body pain,BP)评分和生理功能(physical function,PF)评分、血清白细胞介素-6(interleukin-6,IL-6)含量。Meta分析结果显示,坐位旋转手法治疗LIDH的有效率及JOA评分和BP评分均高于斜扳手法[RR=1. 09,95%CI(1. 04,1. 15); MD=4. 34,95%CI(3. 01,5. 67); MD=3. 12,95%CI(0. 93,5. 30)],VAS评分低于斜扳手法[MD=-1. 51,95%CI(-2. 02,-1. 01)];但治疗后两种方法 ODI和PF评分的组间比较及末次随访时ODI的组间比较,差异均无统计学意义[MD=-2. 31,95%CI(-10. 87,6. 24); MD=0. 05,95%CI(-4. 39,4. 49); MD=-3. 59,95%CI(-10. 10,2. 29)]。仅1篇文献比较了坐位定点旋转手法和斜扳手法治疗LIDH后的血清IL-6含量,未进行Meta分析。5篇文献报告坐位定点旋转手法和斜扳手法治疗LIDH均未出现明显不良反应,其他4篇文献未提及不良反应。结论:与斜扳手法相比,坐位定点旋转手法治疗LIDH有效率更高,在缓解疼痛方面更有优势,但两种方法在改善腰椎功能Objective:To compare the curative effects and safety of fixed-point rotation manipulation in sitting position versus oblique-pulling manipulation for treatment of lumbar intervertebral disc herniation(LIDH).Methods:All the randomized controlled trial(RCT)articles and observational research articles about the curative effects of fixed-point rotation manipulation in sitting position(group A)versus oblique-pulling manipulation(group B)for treatment of LIDH that published at home and abroad included from database establishing to April 2018 were retrieved from Cochrane Library,Pubmed,Embase,Web of science,China national knowledge internet,WanFang Database and VIP Database through computer.The articles were screened and the information was extracted independently by two searchers.The quality of articles was evaluated and a Meta-analysis was conducted.Results:Two thousand one hundred and sixty-four articles were searched out in the initial stage.After screening,9 Chinese articles(825 patients)were included in the final analysis,including 7 RCT articles and 2 observational research articles,and 422 patients in group A and 403 patients in group B.The outcome indicators included effective rate,Japanese orthopedic association(JOA)low back pain scores,pain visual analogue scale(VAS)scores,Oswestry disability index(ODI),body pain(BP)scores and physical function(PF)scores in SF-36 and serum contents of interleukin-6(IL-6).The results of Meta-analysis demonstrated that the effective rate,JOA scores and BP scores were higher and the VAS scores were lower in group A compared to group B in treatment of LIDH(RR=1.09,95%CI(1.04,1.15);MD=4.34,95%CI(3.01,5.67);MD=3.12,95%CI(0.93,5.30);MD=-1.51,95%CI(-2.02,-1.01)).There was no statistical difference in posttreatment ODI and PF scores and ODI at last follow-up between the 2 groups(MD=-2.31,95%CI(-10.87,6.24);MD=0.05,95%CI(-4.39,4.49);MD=-3.59,95%CI(-10.10,2.29)).The posttreatment serum contents of IL-6 were compared between group A and group B in one article,so no Meta-analysis was cond

关 键 词：椎间盘移位 腰椎 推拿 脊柱 Meta分析 

分 类 号：R274.9[医药卫生—中西医结合]