小针刀对腰椎间盘突出症治疗效果的Meta分析

Meta-analysis on curative effect of small-needle-knife therapy on lumbar disc herniation

目的：对国内公开发表的小针刀对腰椎间盘突出症治疗疗效相关文献进行Meta分析,探讨针刀疗法对腰椎间盘突出症的临床疗效。方法：全面检索2005年1月-2015年6月中国知网（CNKI）、维普（VIP）、万方等数据库关于小针刀对腰椎间盘突出症治疗疗效的文献进行Meta分析。经筛选,对最终纳入的研究进行方法学质量评价,用Review Manager 5.2.5软件进行统计分析。结果：纳入文献18篇,共2 107例患者。经Meta分析,18项研究具有同质性（χ^2=18.04,df=17,P=0.39〉0.1）,采用固定效应模型进行分析计算、合并效应量。OR合并后经Z检验,Z=9.19（P〈0.00001）,表明针刀组与非针刀组临床疗效差异有统计学意义。进一步亚组分析显示,单纯针刀疗法与针刀联合其他疗法临床疗效差异无统计学意义。结论：小针刀对腰椎间盘突出症治疗疗效优于推拿、牵引、针刺等传统疗法;小针刀联合这些疗法的临床疗效并不优于单一小针刀疗法。但鉴于纳入研究的高质量文献偏少,样本量有限,需要更进一步的设计合理、随机方法正确、大样本、多中心、方法科学的高质量随机对照研究支持针刀疗法的疗效,并形成针刀疗法治疗腰椎间盘突出症的规范化技术。

Objective： To explore the clinical curative effect of small-needle-knife therapy on lumbar disc herniation based on Meta-analysis of related literatures published in China. Methods： The literatures about treating lumbar disc herniation with small-needle-knife therapy in databases as CNKI, VIP, and Wanfang from January 2005 to June 2015 were retrieved. Methodological quality of the included literatures was evaluated and analyzed by using Review Manager 5.2.5. Results： Eighteen literatures with 2 107 patients were included. Homogeneity of the 18 studies was accordance（χ2=18.04, df=17, P=0.390.1）, so fixed effect model and Z test had been chosen, and the results showed that the difference in clinical curative effects between smallneedle-knife therapy group and non-small-needle-knife therapy group has statistical significance Z=9.19（P〈0.00001）. Further subgroup analysis showed that there was no significant statistical difference between single needle-knife therapy and combined needle-knife therapy in clinical curative effect. Conclusion： The curative effect of small-needle-knife therapy on lumbar disc herniation is superior to that of traditional therapy, such as massage, traction, acupuncture and so on, and combined-needle-knifetherapy is not superior to that of single small-needle-knife therapy. However, due to low quality of included studies, limited sample size, randomized controlled, rational design, large sample, multi-center studies are needed to confirm the curative effect of needleknife therapy further, and to form a standardization technology of needle-knife therapy in treating lumbar disc herniation.