整骨疗法治疗非特异性下腰痛：解读2016年美国骨科协会的指南  

Interpretation of American Osteopathic Association Guidelines for osteopathic manipulative treatment of nonspecific low back pain

作　　者：谢瑞 朱立国[1] 于杰[1] 李凯明 庄明辉 常晓娟 戴文康 Xie Rui;Zhu Liguo;Yu Jie;Li Kaiming;Zhuang Minghui;Chang Xiaojuan;Dai Wenkang(Wangjing Hospital of China Academy of Chinese Medical Sciences,Beijing 100102,China)

机构地区：[1]中国中医科学院望京医院

出　　处：《中国组织工程研究》2020年第21期3401-3408,共8页Chinese Journal of Tissue Engineering Research

基　　金：十二五国家科技支撑计划(2014BAI08B06)，项目负责人：朱立国;国家自然科学基金资助项目(81674005,81774330)，项目负责人：朱立国;中医药行业科研专项(201407001)，项目负责人：朱立国~~

摘　　要：背景:下腰痛是骨科常见疾病之一,非特异性下腰痛在临床中占到了非常大的比重。为更好的治疗该疾病,2016年美国骨科协会制定了整骨疗法治疗非特异性下腰痛患者的临床指南。目的:通过解读指南让骨科医生以及其他医生、其他卫生专业人员和第三方付费者了解关于适当使用整骨手法治疗非特异性下腰痛患者的潜在建议的证据,帮助临床骨科医生在遇到非特异性下腰痛患者选择治疗方法时提供参考。同时科研工作者可借鉴、学习指南中科学严谨的设计思路与评价方法。方法:指南是建立在先前指南和最新高质量荟萃分析的基础上进行的修订,确定了采用整骨手法治疗非特异性下腰痛为确实有效的治疗手段,明确其推荐等级。文章通过详细解读指南中的相关定义、循证医学的评价方法、具体内容和结果,并结合中国临床实际进行分析与讨论。结果与结论:指南共纳入17项研究,系统评价了整骨手法在治疗急慢性非特异性下腰痛以及妊娠期及产后妇女非特异性下腰痛的治疗效果,结果证实患者在疼痛及功能状态等方面都有极大的改善,美国骨科协会的最终建议是建议骨科医生使用整骨手法治疗下腰痛患者。该治疗方法安全性及科学性较高,适合在国内进行推广。BACKGROUND:Low back pain is one of the common orthopedic diseases,and nonspecific low back pain accounts for a very large proportion of all low back pains in clinic.In order to better treat the disease,in 2016,the American Orthopaedic Association developed a clinical guide for the osteopathic manipulative treatment of nonspecific low back pain.OBJECTIVE:To let orthopedic doctors,other doctors,other health professionals and third-party payers know the evidence of potential suggestions on the proper use of osteopathic manipulative treatment,so as to help clinical orthopedists to provide therapeutic reference for non-specific low back pain as well as to learn from the scientific and rigorous design ideas and evaluation methods in the guides.METHODS:The guideline is a revised version based on the previous guideline and the latest high-quality meta-analyses.It is determined that osteopathic manipulative treatment is an effective treatment for nonspecific low back pain with clear recommended level.In this paper,the definition,evaluation methods,specific contents of the guideline and results of evidence-based medicine regarding the clinical practice in China were analyzed and discussed.RESULTS AND CONCLUSION:Seventeen studies were included in the guidelines,which systematically evaluated the effect of osteopathic manipulative treatment for acute and chronic nonspecific low back pain,as well as for nonspecific low back pain in pregnant and postpartum women.After treatment,great improvement was achieved in pain relief and functional recovery.The final suggestion by the American Orthopaedic Association is to use osteopathic manipulative treatment for low back pain.The treatment method is safe and scientific,which can be generalized in China.

关 键 词：整骨疗法 非特异性下腰痛 整脊疗法 整骨手法治疗 指南解读 系统评价 荟萃分析 

分 类 号：R454[医药卫生—治疗学] R496[医药卫生—临床医学]