中医外治法治疗肩周炎的网状Meta分析  

Network meta-analysis of the Chinese medicine external treatment of frozen shoulder

作　　者：吴振桦 张锡玮[2] 王一品[2] Wu Zhenhua;Zhang Xiwei;Wang Yipin(Liaoning University of Traditional Chinese Medicine,Shenyang Liaoning 110847;Affiliated Hospital of Liaoning University of Traditional Chinese Medicine,Shenyang Liaoning 116600)

机构地区：[1]辽宁中医药大学,辽宁沈阳110847 [2]辽宁中医药大学附属医院,辽宁沈阳116600

出　　处：《山西中医药大学学报》2024年第12期1309-1316,1322,共9页Journal of Shanxi University of Chinese Medicine

基　　金：辽宁省省直医院改革重点临床科室诊疗能力建设项目(LNCCC-D53-2015);沈阳市科技计划项目(22-321-34-10)。

摘　　要：目的:系统评价8种外治法(针刺、针刀、电针、关节松动术、麻醉下松解、推拿、注射及物理治疗)治疗肩周炎(FS)的有效性。方法:检索中国知网、万方、维普、中国生物医学文献数据库(CBM)、PubMed、Embase、Cochrane Library、Web of Science数据库自建库至2023年9月30日,采用8种疗法治疗FS的随机对照试验研究文献。采用纳入及排除标准对文献进行筛选,采用Review Manager 5.4软件进行文献质量评价,采用ADDIS 1.16.6软件进行网状Meta分析,采用Stata 14.0软件制作证据网状图和发表偏倚漏斗图。结果:共纳入22项研究,涵盖1648名患者。结果显示,在治疗有效率方面,麻醉下松解优于关节松动术、推拿、针刺、针刀、注射治疗、电针,物理治疗优于推拿、针刺、针刀、注射治疗、电针,关节松动术优于推拿、针刺、针刀、注射治疗、电针;最优概率排序为麻醉下松解(0.96)>物理治疗(0.04)>关节松动术(0.00)=推拿(0.00)=针刺(0.00)=注射治疗(0.00)=电针(0.00)=针刀(0.00)。在降低VAS评分方面,针刺优于关节松动术、麻醉下松解、物理治疗,注射治疗优于麻醉下松解、物理治疗,推拿优于麻醉下松解;最优概率排序为针刺(0.65)>注射治疗(0.29)>电针(0.06)>推拿(0.00)=关节松动术(0.00)=麻醉下松解(0.00)=物理治疗(0.00)。结论:麻醉下松解与针刺为治疗FS的最佳疗法的概率最大,在整体的治疗策略上,针刺和麻醉下松解是最优选项,对于以疼痛为主的FS,首选针刺疗法;对于粘连导致活动受限的FS,首选麻醉下松解。但在临床实践中,手法治疗(包括关节松动术与推拿)依然是有效的选择。Objective:To systematically evaluate the efficacy of 8 therapies(including acupuncture,acupotomy,electroacupuncture,joint mobilization,release under anesthesia,massage,injection and physical therapy)in the treatment of frozen shoulder(FS).Methods:The databases of CNKI,Wanfang,VIP,China Biology Medicine Disc(CBM),PubMed,Embase,Cochrane Library,and Web of Science were searched from the establishment of the database to September 30,2023.The randomized controlled trial research literature of 8 therapies for FS was searched.Inclusion and exclusion criteria were adopted for literature screening,Review Manager 5.4 software was adopted for literature quality evaluation,ADDIS 1.16.6 software was introduced for network meta-analysis,and Stata 14.0 software was used to make evidence network and publication bias funnel plots.Results:A total of 22 studies involving 1648 patients were included.The results showed that in terms of the effective rate of treatment,release under anesthesia was superior to joint mobilization,massage,acupuncture,acupotomy,injection therapy and electroacupuncture;physical therapy was superior to massage,acupuncture,acupotomy,injection therapy and electroacupuncture;joint mobilization was superior to massage,acupuncture,acupotomy,injection therapy and electroacupuncture.The optimal probability order was release under anesthesia(0.96)>physical therapy(0.04)>joint mobilization(0.00)=massage(0.00)=acupuncture(0.00)=injection therapy(0.00)=electroacupuncture(0.00)=acupotomy(0.00).In terms of reducing VAS score,acupuncture was superior to joint mobilization,release under anesthesia and physical therapy,injection therapy was superior to release under anesthesia and physical therapy,and massage was superior to release under anesthesia.The optimal probability ranking was acupuncture(0.65)>injection therapy(0.29)>electroacupuncture(0.06)>massage(0.00)=joint mobilization(0.00)=release under anesthesia(0.00)=physical therapy(0.00).Conclusion:The best treatments probability of release under anesthesia and acupunct

关 键 词：肩周炎 推拿 关节松动术 有效性 贝叶斯网状Meta分析 

分 类 号：R242[医药卫生—中医临床基础]