手法治疗腰椎间盘突出症临床随机对照试验系统评价

Systematic review of clinical randomized controlled trials on manipulative treatment of lumbar disc herniation

目的:评价手法治疗腰椎间盘突出症的有效性和安全性,分析目前临床研究的现状。方法:检索PubMed、OVID、Cochrane图书馆、CBM-disc数据库、CNKI数据库、VIP数据库以及手工检索,共收集手法治疗腰椎间盘突出症文献832篇,其中8篇符合纳入研究标准。Cochrane系统评价手册进行质量评价,并对8篇文献采用RevMan4.2进行Meta分析。结果:纳入的8篇文献共911例患者。8篇文献的治愈率汇总合并OR为3.65,95%CI为[2.15,6.20];有效率汇总合并OR为3.56,95%CI为[2.35,5.38]。手法组对腰椎间盘突出症的治愈率、有效率明显优于其他疗法(除手法之外或药物、或牵引、或针灸、或微波热疗,以下简称"其他疗法")组(P<0.01)。结论:目前纳入研究显示手法治疗腰椎间盘突出症安全、有效,手法对腰椎间盘突出症的治愈率、有效率优于其他疗法。但由于纳入文献的数量有限且质量不是很高,结论尚不确定,需高质量证据来进一步验证。

Objective：To evaluate the clinical results of continuing skeletal traction and impaction granular bone grafting via window in femoral neck for the treatment of avascular necrosis of femoral head.Methods：From August 2000 to October 2004,23 patients（35 hips） with femoral head necrosis were treated by continuing skeletal traction and impacting granular bone grafting via bone window on femoral neck.There were 18 males,5 females,with an average age of 32 years ranging from 19 to 52 years,which included 7 hips of stage Ⅱ,28 hips of stage Ⅲ.All patients had various degrees of hip joint pain and suffered from limited hip motion.The necrotic bone,granulation tissue and hardening zone were completely cleaned via bone window on the femoral neck.The autogenous granular iliac bone was grafted,and impacted persistently.Skeletal traction through femur condyles was applied continually after the operations.The effects before and after operation were compared by the hip pain, function,joint activity and X ray.Results：Regular follow up was carried out after the patients were dismissed from the hospital.The follow up period was 6 months,1 year,2 years,3 years,4 years,5 years respectively.According to Wang＇s standard,the average score was increased from（52.66±12.53）preoperatively to（88.94±5.84）preoperatively at half a year,（89.78±6.18）at 1 year,（86.37±7.46）at 2 years,（84.08±7.57）at 3 years,（83.76±8.08）at 4 years,and （76.83±8.98）at 5 years.Scores of operation were greatly increased and the difference had statistical significance.Conclusion：Continuing skeletal traction after the operation,completely cleaning the necrotic bone and impacting granular bone grafting via window on femoral neck can greatly raise the satisfactory rate of clinical effect and delay the progression of disease for avascular necrosis of femoral head.