中药汤剂口服联合正骨手法治疗腰椎间盘突出症有效性和安全性的Meta分析  

Clinical efficacy and safety of oral application of traditional Chinese drug decoctions combined with bone setting manipulations for treatment of lumbar disc herniation:a meta-analysis

作　　者：赵继荣[1] 冷向阳[2] 蒋鹏 薛旭 陈祁青[1] 陈文[1] 赵宁[1] 马同 郭培尧 张天龙 ZHAO Jirong;LENG Xiangyang;JIANG Peng;XUE Xu;CHEN Qiqing;CHEN Wen;ZHAO Ning;MA Tong;GUO Peiyao;ZHANG Tianlong(Gansu Provincial Hospital of TCM,Lanzhou 730050,Gansu,China;The Affiliated Hospital of Changchun University of Chinese Medicine,Changchun 130021,Jilin,China;Gansu University of Chinese Medicine,Lanzhou 730000,Gansu,China)

机构地区：[1]甘肃省中医院,甘肃兰州730050 [2]长春中医药大学附属医院,吉林长春130021 [3]甘肃中医药大学,甘肃兰州730000

出　　处：《中医正骨》2021年第10期29-35,共7页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：国家中医药管理局中医药循证能力建设项目(2019XZZX-GK005)。

摘　　要：目的:评价中药汤剂口服联合正骨手法治疗腰椎间盘突出症(lumbar disc herniation,LDH)的有效性和安全性。方法:应用计算机检索中国知网、万方数据库、维普网、中国生物医学文献数据库、Pubmed、Cochrane library、Embase、Web of Science,搜集应用中药汤剂口服联合正骨手法治疗LDH的随机对照试验文献,检索时限均为建库至2020年12月1日。试验组干预措施为中药汤剂口服联合正骨手法,对照组干预措施为单纯中药汤剂口服或正骨手法。由2位研究者检索、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软件对治疗总有效率、腰部疼痛视觉模拟量表(visual analogue scale,VAS)评分、日本骨科学会(Japanese Orthopedic Association,JOA)腰痛疾患评分及并发症发生率进行Meta分析,同时通过改变效应模型进行敏感性分析。结果:共纳入14篇文献。Meta分析结果显示,试验组的治疗总有效率高于对照组[I^(2)=45%,P=0.040;RR=1.20,95%CI(1.15,1.25),P=0.000];试验组在治疗开始后20 d以内评价的腰部疼痛VAS评分低于对照组[I^(2)=98%,P=0.000;MD=-2.30,95%CI(-3.87,-0.73),P=0.004],治疗开始后20~30 d评价的腰部疼痛VAS评分低于对照组[I^(2)=92%,P=0.000;MD=-1.18,95%CI(-1.50,-0.86),P=0.000],治疗开始后30 d以上评价的腰部疼痛VAS评分低于对照组[I^(2)=98%,P=0.000;MD=-2.06,95%CI(-3.86,-0.26),P=0.030];2组在治疗开始后21 d以内评价的JOA腰痛疾患评分的差异无统计学意义[I^(2)=99%,P=0.000;MD=1.62,95%CI(-8.06,11.30),P=0.740],试验组在治疗开始后21 d评价的JOA腰痛疾患评分高于对照组[I^(2)=0%,P=0.650;MD=4.36,95%CI(3.92,4.80),P=0.000],试验组在治疗开始后21 d以上评价的JOA腰痛疾患评分高于对照组[I^(2)=0%,P=0.630;MD=5.38,95%CI(4.48,6.27),P=0.000];仅1项研究报道了治疗后的并发症发生情况,2组均仅发生局部损伤、胃肠道反应、皮肤潮红等轻微并发症,经对症处理后明显缓解。改变效应模�Objective:To evaluate the clinical curative effects and safety of oral application of Traditional Chinese Drug(TCD)decoctions combined with bone setting manipulations for treatment of lumbar disc herniation(LDH).Methods:All the randomized controlled trial(RCT)articles about oral application of TCD decoctions combined with bone setting manipulations for treatment of LDH included from database establishing to December 1,2020 were retrieved from the China National Knowledge Internet,Wanfang Database,Vip Database,Chinese Biomedical Literature Database,Pubmed,Cochrane library,Embase and Web of Science through computer.The patients in experimental group were treated with oral application of TCD decoctions and bone setting manipulations,while the ones in control group with oral application of TCD decoctions or bone setting manipulations alone.The articles were retrieved and screened and the information was extracted independently by two researchers according to the inclusion and exclusion criteria.The bias risk of the research in the articles was evaluated by using Cochrane bias risk assessment tools and then a Meta-analysis on total effective rate,low back pain visual analogue scale(VAS)score,Japanese Orthopaedic Association(JOA)low back pain score and complication incidence was conducted by using Revman 5.3 software.The sensitivity analysis was conducted by changing the effect models.Results:Fourteen articles were included in the final analysis.The results of Meta-analysis revealed that the total effective rate was higher in experimental group compared to control group(I^(2)=45%,P=0.040;RR=1.20,95%CI(1.15,1.25),P=0.000).The low back pain VAS scores evaluated within 20 days,from the 20th to the 30th day and at over 30 days after the beginning of the treatment were lower in experimental group compared to control group(I^(2)=98%,P=0.000;MD=-2.30,95%CI(-3.87,-0.73),P=0.004;I^(2)=92%,P=0.000;MD=-1.18,95%CI(-1.50,-0.86),P=0.000;I^(2)=98%,P=0.000;MD=-2.06,95%CI(-3.86,-0.26),P=0.030).There was no statistical difference in JOA

关 键 词：椎间盘移位 腰椎 中草药 煎剂 正骨手法 META分析 系统评价 

分 类 号：R274.9[医药卫生—中西医结合]