射频热凝联合臭氧消融治疗腰椎间盘突出症的Meta分析

THE EFFECTIVENESS AND SAFETY OF A THERAPY COMBING RADIOFREQUENCY THERMOCOAGULATION WITH OXYGEN-OZONE FOR TREATING LUMBAR DISC HERNIATION: A META-ANALYSIS

目的:系统评价单纯射频热凝或臭氧消融与两者联合应用治疗腰椎间盘突出症(lumbar disc herniation,LDH)的疗效及安全性。方法:计算机检索CBM、CNKI、VIP、Embase和Pub Med等数据库,查找射频和臭氧治疗LDH的随机对照试验(randomized controlled trial,RCT),检索时限均为建库至2013年10月。经文献筛选、资料提取并行方法学质量评价后,采用Rev Man 5.2软件进行Meta分析。结果:最终纳入17个RCT,共2041例患者。结果联合治疗的优良率和优秀率均优于单纯射频和臭氧治疗,其差异均有统计学意义[OR=2.51,95%CI(1.65,3.81),P<0.001/OR=2.48,95%CI(1.86,3.31),P<0.001;OR=2.18,95%CI(1.58,3.02),P<0.001/OR=1.69,95%CI(1.33,2.14),P<0.001];联合较单纯治疗能明显降低VAS(visual analogue scale)评分,差异有统计学意义[MD=-0.67,95%CI(-1.01,-0.32),P=0.001/MD=-0.71,95%CI(-1.03,-0.39),P<0.001]。结论:射频热凝和臭氧消融联合治疗在改善LDH患者症状、缓减疼痛及提高生活质量方面的效果优于单纯使用射频或臭氧治疗。

Objective： To systemically evaluate the effects and safety of using radiofrequency thermocoagulation （RFT）, oxygen-ozone therapy （OOT）, or a combination of RFT with OOT for the treatment of lumbar disc herniation （LDH）. Method： Databases including CBM, CNKI, VIP, Embase and PubMed were searched to identify randomized controlled trials （RCT） involving RFT and/or OOT for treatment of LDH with October 2013 as the deadline. After screening, selection and the methodological quality evaluation, the meta-analysis was performed using RevMan 5.2 software. Results： Seventeen trials involving 2041 patients were included. The meta-analysis showed that the combined therapy was superior to single RFT or OOT with significant difference in good and excellent rates （OR=2.51, 95%CI 1.65 to 3.81, P 〈 0.001/0R=2.48, 95% CI 1.86 to 3.31, P 〈 0.001; 0R=2.18, 95% CI 1.58 to 3.02, P 〈 0.001/ OR=1.69, 95% CI 1.33 to 2.14, P 〈 0.001）. As for pain relief, there was a significant reduction of VAS in combined therapy group compared with RFT or OOT groups （MD=-0.67, 95%CI -1.01 to -0.32, P=0.001/ MD=-0.71, 95%CI -1.03 to -0.39, P 〈 0.001）. Conclusion： Compared with single use of RFT or OOT, the combined treatment might significantly relieve symptoms, alleviate pain and improve the life quality of LDH patients.