手法治疗肩周炎有效性和安全性的Meta分析  

Efficacy and Safety of Manipulative Therapy for Frozen Shoulder:a Meta-analysis

作　　者：方仪德 胡浩 许金海[1,2] 丁兴 马青山 张亚运 王燕妮 莫文[1,2] FANG Yide;HU Hao;XU Jinhai;DING Xing;MA Qingshan;ZHANG Yayun;WANG Yanni;MO Wen(Department of Orthopedics and Traumatology,Longhua Hospital Affiliated to Shanghai University of Chinese Medicine,Shanghai 200032,China;Research Institute of Spine Diseases,Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China)

机构地区：[1]上海中医药大学附属龙华医院骨伤科,上海市200032 [2]上海中医药大学脊柱病研究所,上海市200032

出　　处：《中国全科医学》2024年第5期628-636,共9页Chinese General Practice

基　　金：国家中医药管理局中医药特色技术筛选评价和传承应用项目(GZY-KJS-2020-083)。

摘　　要：背景近年出现较多特色手法治疗肩周炎的随机对照试验(RCT),但缺乏新的关于手法治疗肩周炎有效性和安全性的系统评价。目的通过Meta分析方法评价手法治疗肩周炎的有效性和安全性,通过亚组分析了解包含“摇法”的手法是否较未包含“摇法”的手法效果更优。方法计算机检索PubMed、Cochrane Library、Embase、Medline、中国知网(包括中国硕博士学位论文全文数据库、中国优秀硕士学位论文全文数据库)、中国生物医学文献数据库、万方数据知识服务平台中有关手法治疗肩周炎有效性和安全性的RCT,试验组干预措施为手法,对照组干预措施为非药物疗法,检索时间为建库至2023-03-01。由2名研究人员提取资料,并进行质量评价。采用Revman 5.3软件进行Meta分析。结果最终共纳入12篇文献,893例肩周炎患者,其中试验组451例,对照组442例。Meta分析结果显示,视觉模拟疼痛量表(VAS):手法治疗改善VAS程度优于物理治疗、针灸治疗、常规治疗(SMD=1.09,95%CI=0.81~1.37,P<0.00001;SMD=1.05,95%CI=0.31~1.79,P=0.006;SMD=0.96,95%CI=0.67~1.26,P<0.00001);手法对照物理治疗的亚组分析结果显示,含“摇法”手法与未含“摇法”手法的效果差异显著(Z=4.39,P=0.04)。Constant-Murley(C-M)评分:手法治疗改善C-M评分程度优于物理治疗组(MD=2.79,95%CI=2.27~3.32,P<0.00001)。关节活动度:手法治疗改善被动前屈、被动外展、被动外旋程度优于物理治疗(SMD=1.40,95%CI=0.10~2.70,P=0.03;SMD=1.45,95%CI=0.18~2.71,P=0.02;SMD=1.77,95%CI=0.18~3.36,P=0.03)。亚组分析结果显示,在改善被动前屈和被动外展方面,含“摇法”手法与未含“摇法”手法的效果存在显著差异(Z=7.34,P=0.007;Z=2.25,P=0.03)。总体有效率:手法治疗总体有效率高于物理治疗(RR=1.16,95%CI=1.02~1.32,P=0.03);手法治疗和针灸治疗总体有效率比较,差异无统计学意义(RR=1.24,95%CI=1.00~1.54,P=0.05)。治愈率:手法治疗治愈�Background In recent years,there have been many randomized controlled trials(RCTs)featuring manipulation for frozen shoulder,but there is a lack of new systematic reviews on the efficacy and safety of manipulation for frozen shoulder.Objective To evaluate the efficacy and safety of manipulation in the treatment of frozen shoulder by Meta-analysis,and understand whether“rotation shoulder joint”could affect the effect of manipulative therapy by subgroup.Methods PubMed,Cochrane Library,Embase,Medline,CNKI,China Biomedical Literature Database,Wanfang Data were searched for RCTs on the efficacy and safety of manipulative therapy for frozen shoulder,with manipulative therapy as the intervention of experimental group and non-pharmacological therapy as the intervention of control group from inception to 2023-03-01.Two investigators extracted data and evaluated the quality.Meta-analysis was performed using Revman 5.3 software.Results A total of 12 RCTs were included in this Meta-analysis,with a total of 893 patients with frozen shoulder,including 451 patients in the experimental group and 442 cases in the control group.Results of Meta-analysis showed that the improvement of VAS by manipulative therapy was better than physical therapy,acupuncture therapy and conventional therapy(SMD=1.09,95%CI=0.81-1.37,P<0.00001;SMD=1.05,95%CI=0.31-1.79,P=0.006;SMD=0.96,95%CI=0.67-1.26,P<0.00001);subgroup analysis of manipulative therapy compared with physical therapy showed a significant difference in effect between those with and without“rotation shoulder joint”(Z=4.39,P=0.04).The improvement of Constant-Murley score in manipulative therapy was better than that in physical therapy(MD=2.79,95%CI=2.27-3.32,Z=10.41,P<0.0001).The improvements of passive flexion(SMD=1.40,95%CI=0.10-2.70,P=0.03),passive abduction(SMD=1.45,95%CI=0.18-2.71,P=0.02)and passive external rotation(SMD=1.77,95%CI=0.18-3.36,P=0.03)by manipulative therapy were better than those in the physical therapy group;subgroup analysis showed a significant difference betw

关 键 词：肩周炎 滑囊炎 手法 摇法 随机对照试验 META分析 

分 类 号：R274.31[医药卫生—中医骨伤科学]