低强度激光治疗轻中度腕管综合征有效性的Meta分析

A Meta-analysis of the Effectiveness of Low-intensity Laser on Mild to Moderate Carpal Tunnel Syndrome

目的应用Meta分析方法定量评价低强度激光治疗轻中度腕管综合征的有效性。方法计算机检索Pub Med、Embase、The Cochrane Library、Web of Science、中国期刊全文数据库、万方数据库和维普数据库,筛选与低强度激光治疗轻中度腕管综合征相关的随机对照研究,检索时限均为建库起至2014年1月。由两位评价员按照预先制定的纳入排除标准独立筛选文献,提取数据和评价纳入文献质量。用Rev Man 5.2软件对符合质量标准的随机对照研究进行Meta分析。结果最终纳入9个随机对照研究,共518例患者。Meta分析结果显示:低强度激光组治疗后0周(治疗刚结束时)在缓解疼痛,改善手握力、指捏力和临床症状方面疗效优于对照组,而在改善手功能状态方面两组疗效差异无统计学意义(P>0.05);指捏力在治疗后2周恢复好于对照组;随访12周后在缓解疼痛方面疗效优于对照组,而在改善手握力、临床症状和手功能状态方面两组疗效差异无统计学意义(P>0.05)。结论根据目前研究结果,低强度激光治疗轻中度腕管综合征可以缓解疼痛、改善手无力和临床症状,但在改善手功能状态方面疗效不明显。受纳入研究数量和质量的限制,该研究结论仍需高质量大样本随机对照试验进一步证实。

Objective To evaluate the effectiveness of low-intensity laser in the treatment of mild to moderate carpal tunnel syndrome versus a placebo by using the method of Cochrane systematic review. Methods The randomized controlled trials about Low-intensity laser treatment on mild to moderate carpal tunnel syndrome was collected by using computer to search the databases included PubMed, Embase, the Cochrane Library, Web of Science, CNKI, WanFang Data, VIP. All databases were searched from inception to January,2014. Two researchers independently screened studies accord to the inclusion and exclusion criteria, extracted data and assessed quality of the included studies. RevMan 5.2 software was used for Meta-analysis. Results A total of nine studies （518 cases）were included in this study. The results of Meta-analysis indicated that low-level laser therapy was superior to placebo in pain relief, improvement of hand grip strength, finger pinch strength and clinical symptoms after O-week treatment, but for the improvement of hand function states, no significant differences were found between the two groups （P 〉 0.05） ;low-level laser therapy was of benefit to finger pinch strength after 2-week treatment. After 12-week treat- ment, low-level laser therapy was superior to placebo in pain relief, there ware no statistical difference in improvement of grip strength, clinical symptoms and hand function status （ P 〉 0.05 ）. Conclusion Low-level laser therapy treatment on mild to moderate carpal tunnel syndrame can relieve the pain of wrist and improve hand weakness and clinical symptoms, but there was no statistical difference in improvement of hand function states between the two groups. For the quantity limitation and low methodological quality of the included studies, more high quality randomized controlled trials are need to prove the effectiveness of laser therapy.