不同针灸方法治疗神经根型颈椎病效果的系统评价

Effects of different acupuncture and moxibustion treatments on cervical spondylotic radiculopathy:A systematic evaluation

目的:运用cochrane评价系统的方法评价当前国内针灸疗法对神经根型颈椎病的有效性与安全性。资料来源:计算机检索CBM(1978-01/2008-10)、CNKI(1979-01/2008-10)、VIP(1989-01/2008-10)3个数据库,辅以手工检索。资料选择:纳入针灸疗法治疗神经根型型颈椎病的随机对照试验并对其进行质量评价。文献来源为随机对照和半随机对照。采用随机方法-选择性偏倚评估、隐蔽分组-选择性偏倚评估、盲法-实施偏倚与测量偏倚、剔除、失访、退出损耗性偏倚评价。结局评价指标:①腹针与常规针灸相比较其有效率。②电针加絮刺火罐与常规针灸相比较其有效率。③腹针与牵引相比较其有效率。④颈椎牵引、电针结合穴位注射与牵引结合推拿比较其有效率。⑤牵引、电针、推拿、TDP结合导引与牵引、理疗、TDP结合运动疗法相比较其有效率。⑥电针结合醋离子导入与单纯电针相比较有效率。⑦仰针灸结合龙氏手法与单纯针灸相比较其有效率。⑧不良反应。结果:选择其中7篇(1416例观察对象),采用随机分组的文章。所有研究均有选择性偏倚、实施测量性偏倚、损耗性偏倚的高度可能性,质量等级均为"C"级。且只有1个研究证明实验组的有效率优于对照组。研究1表明,无足够证据证明腹针治疗神经根型颈椎病的有效率优于常规针灸疗法。研究2表明,无足够证据证明电针加絮刺火罐治疗神经根型颈椎病的有效率优于常规针灸疗法。研究3表明,无足够证据证明腹针疗法治疗神经根型颈椎病有效率优于牵引疗法。研究4表明,颈椎牵引、电针结合穴位注射治疗神经根型颈椎病的有效率优于牵引结合推拿疗法。研究5表明,无足够证据证明牵引、电针、推拿、TDP结合导引治疗神经根型颈椎病的有效率优于牵引、理疗、TDP结合运动疗法。研究6表明,无足够证据证明电针结合醋离子导入治疗神经根型颈椎病的有效率优于单纯电针疗法。研究7表明,无足够证据证明针灸结合龙氏手法治疗神经根型颈椎病的优于单纯针灸疗法。7个研究均未出现不良反应而终止试验。结论:所纳入的7个研究中,由于目前针灸疗法的不统一,质量不高,诊断标准、随访时间、结果测量标准不一致,因此需要开展大样本、多中心,方法学规范的高质量随机对照试验进一步验证。

OBJECTIVE： To evaluate the effect and safety of conservative treatment for treating cervical spondylotic radiculopathy by cochrane evaluation systems. DATA SOURCE： CBM （from January 1978 to October 2008）, CNKI （from January 1978 to October 2008） and VlP （from January 1989 to October 2008） databases were retrieved by computer and partial documents were searched by hands. DATA SELECTION： Randomized controlled trial was adopted in course of acupuncture and moxibustion treatment for cervical spondylotic radiculopathy and its quality was assessed. Data source was randomized and semi-randomized controlled. Some evaluations such as random method-selection bias, allocation concealment-selection bias, blind method-performance bias and measurement bias, exclusion, lose to follow-up, withdraw-attrition bias were chosen. MAIN OUTCOME MEASURES： ①Abdominal acupuncture needles were superior to the conventional method＇s efficiency. ②Electro-acupuncture plus cupping with barbed floc were superior to the conventional method＇s efficiency. ③Abdominal acupuncture were superior to fraction＇s efficiency. ④Cervicai traction, electro-acupuncture combined with point injection and massage were superior to traction＇s efficiency.⑤Traction, electro-acupuncture, massage, TDP-guided were superior to traction, physiotherapy, TDP combined with exercise therapy＇s efficiency. ⑥Vinegar iontophoresis and electro-acupuncture were superior to simple electro-acupuncture＇s efficiency. ⑦Long＇s approach acupuncture was superior to simple acupuncture＇s efficiency. ⑧Adverse reaction. RESULTS： A total of 1 416 subjects were selected from 7 randomized controlled trials. All the studies have selection bias, measurement bias, loss of the high probability of bias, the quality and grade of ＂C＂ grade. And only one study proved that the efficiency of the experimental group was better than that of the control group. Study I showed that there was insufficient evidence suggested that acupuncture treatment of abdominal cervical spondylotic radiculopathy was efficient than conventional acupuncture. Study 2 showed that there was insufficient evidence suggested that electro-acupuncture plus cupping therapy with barbed floc was efficient than conventional acupuncture to cure cervical spondylotic radiculopathy. Study 3 showed that there was insufficient evidence suggested that acupuncture treatment of abdominal cervical spondylotic radiculopathy was efficient than traction. Study 4 showed that the cervical traction, electro-acupuncture combined with acupoint-injection treatment of cervical spondylotic radiculopathy was efficient than traction combined massage therapy. Study 5 showed that there was insufficient evidence suggested that traction, electro-acupuncture, massage, TDP-guided therapy was efficient than traction, physical therapy, TDP combined with exercise therapy. Study 6 showed that there was insufficient evidence suggested that electro-acupuncture combined with vinegar iontophoresis treatment of cervical spondylotic radiculopathy was better than the simple electro-acupuncture therapy. Study 7 showed that there was insufficient evidence suggested that the acupuncture therapy using Long＇s approach was better than simple acupuncture. No adverse reactions appeared to terminate the test in 7 studies. CONCLUSION： The above seven studies mainly present with low quality, absence of a unified curative method, small samples, difference of follow-up time, judgment standard and measurement standard. So more samples, multicenter and more regular randomized controlled trial should be performed.