针刺与牵引治疗神经根型颈椎病疗效比较的系统评价

Acupuncture Versus Traction for Cervical Spondylotic Radiculopathy A Systematic Review

目的:比较针刺与牵引治疗神经根型颈椎病(CSR)的临床疗效。方法:电子检索PubMed(1950—2008)、Ovid(1950—2008)、EBSCO(1973—2008)、Cohrance图书馆(2008年第2期)、CBM(1978—2006)、CNKI(1979—2008)、VIP(1989—2008)、万方数据库(1998—2008),手工检索中文针灸杂志及有关学术会议论文汇编,收集针刺与牵引治疗CSR的临床随机对照试验,由两名评价者独立提取资料并进行方法学质量评估。选择符合纳入标准的临床试验,采用RevMan4.2.8软件进行统计学分析。结果:8篇文献符合纳入标准,共1546例患者。8项研究均采用有效率为主要结局指标,Meta分析显示:针刺对照牵引具有显著性差异[RR=1.24,95%CI(1.16,1.32),P<0.00001];针刺牵引综合疗法对照牵引疗法也具有显著性差异[RR=1.10,95%CI(1.02,1.18),P=0.008];3项研究采用简化MPQ量表作为次要结局指标,VAS评分[WMD=1.53,95%CI(0.85,2.21),P<0.0001]和PPI评分[WMD=0.61,95%CI(0.50,0.71),P<0.00001]均有显著性差异。结论:针刺治疗CSR是有效的,在有效率和改善疼痛方面对照牵引疗法具有一定优势;牵引疗法配合针刺,能够增强牵引的疗效。但因部分纳入文献质量较低,结论尚不确定,今后尚需高质量的随机对照试验来进一步证明针刺治疗CSR的疗效。

Objective： To assess the efficacy of acupuncture versus traction in the treatment of Cervical Spondylotic Radiculopathy. Methods： Randomized controlled trials（ RCTs）involving acupuncture versus traction in the treatment of Cervical Spondylotic Radiculopathy were searched from PubMed（ 1950 to 2008）, Ovid （ 1950 to 2008 ）, EBSCO （ 1973 to 2008 ）, Cochrane Library （ Issue 2, 2008 ）, CBM （ 1978 to 2006 ）, CNKI （ 1979 to 2008） ,VIP（ 1989 to 2008） and WANFANG Database（ 1998 to 2008）. We also hand searched relevant journals and conference proceedings. Data were extracted and evaluated by two reviewers independently with a specially designed extraction form. The Cochrane Collaboration＇ s RevMan 4.2.8 software was used for data analyses. Results： A total of 8 trials involving 1546 patients were included. Effective rate was used as the primary resultant index in all the eight syudies. Meta-aualyses showed that effective rate between acupuncture group and traction group was significant difference [ RR 1.24,95 % CI（ 1.16 to 1.32）], significant difference was also noted when acupuncture plus traction group versus traction group[ RR1.10,95 % CI （1.02 to 1.18）]. MPQ score was used as the secondary resultant index in these three studies, there were significant differences between treatment group and control group as for VAS[WMD 1.53,95 % CI（0.85 to 2.21） ]and PPI[WMD 0.61,95% CI（0.50 to 0.71 ） ]. Conclusion： Acupuncture treatment is effective for Cervical Spondylotic Radiculopathy and is superior to traction in the aspects of effective rate and pain alleviating. The curative effect of traction treatment could be improved when combining with acupuncture. However, the conclusion was uncertain because the quality of enrolled papers was partly low. Therefore, further high-quaihy randomized controlled trials are required to prove the role of acupuncture in the treatment of Cervical Spondylotic Radiculopathy.