我国保守疗法治疗颈椎间盘突出症疗效和安全性的系统评价

Conservative in the Treatment of Protrusion of Cervical Vertebra Intervertebral Disc:A Systematic Review

目的评价当前国内保守疗法对颈椎间盘突出症的疗效与安全性。方法按Cochrane系统评价方法,电子检索CBM(1978～2007)、CNKI(1979～2007)、VIP(1989～2007)数据库,纳入保守疗法治疗颈椎间盘突出症的随机及半随机对照试验,评价纳入研究质量,提取有效数据,并用RevMan4.2.2软件进行Meta分析。结果共纳入5个随机对照试验和11个半随机对照试验。结果显示:提升法推拿、推拿与牵引或针刺合用、关节松动术与牵引电疗合用、牵引与中频合用及穴位注射与推拿合用效果良好,但尚无证据证明再加用数种其它疗法对其疗效提高有益。结论多种保守疗法组合应用可能会提高其对颈椎间盘突出症的疗效,但由于纳入研究间存在异质性,无法进行合并分析,使得目前的研究难以为最佳的组合方案提供有力的证据;且由于各研究存在选择性偏倚、实施性偏倚、测量性偏倚的高度可能性,尚需更多的高质量研究提供可靠的证据对其疗效及安全性予以证实。

Objective To evaluate the effect and safety of the conservative treatment for the protrusion of cervical vertebra intervertebral disc. Methods We searched CBM disk （1978-2007）, CNKI （1979-2007）, V1P （1989-2007）. Telephone interviewed the original authors of claimed randomized controlled trials（RCTs） to identify whether they are truly RCTs. Only true RCTs and quasi-randomized controlled trials were included and the quality of them was critically assessed. Results Five RCTs and eleven quasi-randomized controlled trials were identified and included. It showed that lifting-massage, massage combining with traction or acupuncture, articulus mobilization combining with traction and electrotherapy, traction combining with computer intermediate frequency therapeusis and injectio ad acumen combining with massage have marked improvement. But it could hardly draw a conclusion that all the combining therapies had better curative effect. Conclusions Weak evidence shows that combining conservative treatment can improve the curative effect of the protrusion of cervical vertebra intervertebral disc. The results need to be supported by well designed and high quality trials.