慢性下腰痛的治疗方法评价

Therapeutic methods for chronic low back pain

目的:慢性下腰痛治疗方法较多,对其有效性和安全性的评价很重要。资料来源:应用计算机检索Medline和Ovid数据库1990-01/2004-11期间的相关文章,检索词“chroniclowbackpain,rehabilitation/ther-apy”,并限定文章语言为English。资料选择:选取随机对照试验,不限制盲法条件。选取平行对照试验,对照组为安慰对照、假性处理对照或以不同疗法进行对照,治疗组以药物、物理因子、按摩、针刺、运动等方法进行治疗。资料提炼:共收集到26篇关于慢性下腰痛治疗的研究原著,20个试验符合纳入标准,另有1个手术疗效观察性试验被特别纳入,排除的5篇试验中,2篇因系重复的同一研究,3篇为Meta分析研究。资料综合:21个试验包括3358例患者,其中4个试验为药物疗法,1个试验为物理疗法,2个试验为按摩疗法,3个试验为针刺疗法,3个试验为运动疗法,4个试验为综合疗法,4个试验为外科疗法。结论:按摩疗法、激光疗法和运动疗法对慢性下腰痛具有明显的疗效,基本上是安全的,对于非特异慢性下腰痛来说,多学科综合疗法最为有效。关节神经切断术和椎间盘内电热疗法分别对慢性关节源和椎间盘源的腰痛具有确切的疗效,无明显损害作用。

OBJECTIVE:There are many therapeutic methods for chronic low back pain,and th e assessment on the effectiveness and safety is very important. DATA SOURCES:An online search of Medline and Ovid database was undertaken to identify relevant articles published in English from January 1990 to November 20 04 by using the keywords of “ chronic low back pain, rehabilitation/therapy'. STUDY SELECTION:Randomized controlled trials with or without the condition of blindness were searched to select parallel controlled studies.The control group was placebo control,sham- treated control or control with different therapeuti c methods;The treatment groups were treated with drug,physical agent, massage,ac upuncture and exercise. DATA EXTRACTION:Together 26 original articles about chronic low back pain wer e collected,and 20 trials met the inclusion criteria,another observational trial of operative effect was involved specially;Among the 5 deleted trials,2 were re petitive studies and the other 3 were Meta analysis. DATA SYNTHESIS:Totally 3 358 patients were involved in the 21 trials,4 trials of them were drug therapy,1 was physiotherapy,2 were massage therapy,3 were acu puncture therapy,3 were exercise therapy,4 were combined therapy and 4 were surg ical therapy. CONCLUSION:Massage therapy, laser therapy and exercise therapy are effective and safe for chronic low back pain.For nonspecific chronic low back pain,multidi sciplinary therapy is the most effective.Radiofrequency neurotomy and intradisca l electrothermal therapy have definite effects on zygapophysial joint pain and d iscogenic low back pain respectively without any apparent complication.