正骨手法治疗踝关节扭伤随机对照试验的系统评价  

Systematic Review of Randomized Controlled Trials on Manipulative Treatment of Ankle Sprain

作　　者：王宝剑 高春雨[1,2] 孙武 杨克新[1,2] 张平 魏戌[1,2] 冯敏山 银河[1,2] 王源[1] 张静茹 叶宜颖[1] 李路广 高景华[1,2] WANG Bao-jian;GAO Chun-yu;SUN Wu;YANG Ke-xin;ZHANG Ping;WEI Xu;FENG Min-shan;YIN He;WANG Yuan;ZHANG Jing-ru;YE Yi-ying;LI Lu-guang;GAO Jing-hua(Wangjing Hospital of CACM,Beijing 100102,China;Beijing Key Laboratory of Traditional Chinese Orthopedics and Traumatology,Beijing 100102,China)

机构地区：[1]中国中医科学院望京医院,北京100102 [2]中医正骨技术北京市重点实验室,北京100102

出　　处：《中医药导报》2020年第3期38-42,54,共6页Guiding Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家自然科学基金面上项目(81473694)。

摘　　要：目的:系统评价正骨手法治疗踝关节扭伤的临床疗效及安全性。方法:计算机检索CNKI、VIP、PubMed等数据库中的相关随机对照试验,并采用Review Manager 5.1软件进行Meta分析。结果:最终纳入14篇文献,涉及1112例患者。Meta分析结果显示:单纯正骨手法的愈显率高于其他非手术治疗[RR=1.47,95%CI(1.24,1.74),P<0.000,01];单纯正骨手法Baird-Jackson评分改善优于其他非手术疗法[MD=10.14,95%CI(5.57,14.70),P<0.000,1];单纯正骨手法Takakura评分改善与其他非手术疗法相当[MD=2.16,95%CI(-2.12,6.34),P=0.32];单纯正骨手法VAS评分改善优于其他非手术疗法[MD=-1.78,95%CI(-3.14,-0.43),P=0.01];摇拔戳手法比其他正骨手法更有优势[RR摇拔戳手法=-2.56,95%CI(-4.54,-0.58),P=0.01;RR其他手法=-0.62,95%CI(-1.52,0.28),P=0.18];单纯正骨手法AOFAS踝-后足评分改善优于其他非手术疗法[RR=15.70,95%CI(12.72,18.68),P<0.000,01]。结论:正骨手法治疗踝关节扭伤具有安全、有效的优点,其愈显率及功能评分改善方面明显优于其他非手术疗法,且在缓解踝关节疼痛程度方面,摇拔戳手法比其他正骨手法更有优势。但受纳入研究的数量、质量以及结局指标主观性等限制,本结论尚不能完全确定,仍需高质量证据进一步验证。Objective:To evaluate the clinical efficacy and safety of manipulation in the treatment of ankle sprain by systematic review.Methods:Randomized controlled trials in CNKI,VIP,PubMed and other databases were searched,and Meta-analysis was performed with Review Manager 5.1 software.Results:Totally 14 articles and 1112 patients were included.Meta-analysis showed that the markedly effective rate of simple manipulation were higher than those of other conservative treatments[RR=1.47,95%CI(1.24,1.74),P<0.000,01];Baird-Jackson score of simple manipulation was better than other conservative treatments[MD=10.14,95%CI(5.57,14.70),P<0.000,1];The improvement of Takakura score of simple manipulation was similar to other conservative treatments[MD=2.16,95%CI(-2.12,6.34),P=0.32];The VAS score of simple manipulation was better than other conservative treatments[MD=-1.78,95%CI(-3.14,-0.43),P=0.01],and Shake-Draw-Stab manipulation improved the VAS score better than other manipulations[RRShake-Draw-Stab=-2.56,95%CI(-4.54,-0.58),P=0.01;RRother manipulations=-0.62,95%CI(-1.52,0.28),P=0.18];The AOFAS score of simple manipulation was better than other conserva-tive treatments[RR=15.70,95%CI(12.72,18.68),P<0.000,01].Conclusion:Manipulation is safe and effective in treating ankle sprain.Its markedly effective rate and improvement of functional score are superior to other conservative treatments,and Shake-Draw-Stab manipulation can alleviate ankle pain better than other manipulations.However,due to the limitations of the quantity,quality and subjective outcome indicators of the included studies,this conclusion still needs to be further validated by high-quality evidence.

关 键 词：踝关节扭伤 正骨手法 随机对照试验 系统评价 

分 类 号：R274.32[医药卫生—中医骨伤科学]