超声引导下针刀松解术治疗膝骨关节炎的有效性和安全性Meta分析  

Clinical efficacy and safety of ultrasound-guided release with knife needle for treatment of knee osteoarthritis:a meta analysis

作　　者：葛海雅 鄢来军 张燕 黄泽灵 耿秋东 李楠[2] GE Haiya;YAN Laijun;ZHANG Yan;HUANG Zeling;GENG Qiudong;LI Nan(College of Traditional Chinese Medicine of Fujian University of Traditional Chinese M edicine,Fuzhou 350122,Fujian,China;Key Laboratory of Orthopedics&Traumatology and Rehabilitation of Traditional Chinese Medicine of Ministry of Education,Fuzhou 350122,Fujian,China)

机构地区：[1]福建中医药大学中医学院,福建福州350122 [2]中医骨伤及运动康复教育部重点实验室,福建福州350122

出　　处：《中医正骨》2020年第10期42-46,51,共6页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：福建省自然科学基金资助项目(2019J01349)。

摘　　要：目的:系统评价超声引导下针刀松解术治疗膝骨关节炎(knee osteoarthritis,KOA)的有效性和安全性。方法:计算机检索PubMed、Cochrane Library、中国知网、万方数据库、维普网建库至2019年12月31日收录的所有超声引导下针刀松解术治疗KOA的随机对照研究或半随机对照研究文献。筛选文献、提取数据并评价纳入研究的偏倚风险后,采用Revman5.3软件进行Meta分析。结果:最终纳入8篇文献,涉及446例KOA患者。治疗组采用超声引导下针刀松解治疗,对照组采用普通针刀或针刺治疗。Meta分析结果显示,治疗组的膝关节疼痛视觉模拟量表(visual analogue scale,VAS)评分低于对照组[I2=71%,P=0.001;MD=-1.05,95%CI(-1.50,-0.60),P=0.000];剔除2项研究后,重新进行Meta分析,固定效应模型分析结果显示,治疗组的膝关节疼痛VAS评分低于对照组[I2=0%,P=0.580;MD=-0.78,95%CI(-1.00,-0.57),P=0.000];剔除的2项研究与其余6项研究相比,样本量较少,考虑异质性可能是样本量不足造成的。治疗组的膝关节屈伸活动度大于对照组[I2=0%,P=0.840;MD=4.44,95%CI(0.22,8.66),P=0.040],改良美国特种外科医院膝关节评分高于对照组[I2=54%,P=0.140;MD=10.92,95%CI(5.53,16.31),P=0.000],总有效率高于对照组[I2=0%,P=0.530;OR=2.75,95%CI(1.42,5.31),P=0.003],不良反应发生率低于对照组[I2=0%,P=0.650;OR=0.18,95%CI(0.05,0.66),P=0.009]。结论:现有的证据表明,超声引导下针刀松解术是一种治疗KOA的较为安全有效的方法,其疗效和安全性优于普通针刀或针刺治疗。Objective:To systematically review the clinical efficacy and safety of ultrasound-guided release with knife needle for treatment of knee osteoarthritis(KOA).Methods:All the randomized controlled trial(RCT)articles and controlled clinical trial(CCT)articles about ultrasound-guided release with knife needle for treatment of KOA included from database establishing to December 31,2019 were retrieved from PubMed,Cochrane Library,China national knowledge internet,WanFang Data and VIP Database through computer.The articles were screened and the information was extracted independently by two searchers.The risk of bias of included researches in the articles was assessed by using bias risk assessment tools recommended by Cochrane Handbook and a Meta-analysis was conducted by using Revman5.3 software.Results:Eight articles(446 patients)were included in the final analysis.The patients in treatment group were treated with ultrasound-guided release with knife needle,while the patients in control group were treated with conventional needle-knife therapy or acupuncture.The results of Meta-analysis demonstrated that the knee pain visual analogue scale(VAS)scores were lower in treatment group compared to control group(I^2=71%,P=0.001;MD=-1.05,95%CI(-1.50,-0.60),P=0.000).The Meta-analysis was re-conducted after excluding 2 researches,and the results of analysis of fixed effect model demonstrated that the knee pain VAS scores were lower in treatment group compared to control group(I^2=0%,P=0.580;MD=-0.78,95%CI(-1.00,-0.57),P=0.000).The sampleswere less in the 2 excluded researches compared to the other 6 researches. The heterogeneity might be caused by the insufficient samples.The knee flexion-extension range was greater( I2= 0%,P = 0. 840;MD = 4. 44,95% CI( 0. 22,8. 66),P = 0. 040),the improved Hospital for Special Surgery knee scores were higher( I2= 54%,P = 0. 140;MD = 10. 92,95% CI( 5. 53,16. 31),P = 0. 000),the total effective rate was higher( I2= 0%,P = 0. 530;OR = 2. 75,95% CI( 1. 42,5. 31),P = 0. 003) and the incidence rate

关 键 词：骨关节炎 膝 超声检查 小刀针 META分析 系统评价 

分 类 号：R684.3[医药卫生—骨科学]