中药熏蒸联合牵引治疗腰椎间盘突出症Meta分析

Meta-analysis of Traditional Chinese Medicine Fumigation Combined with Traction in the Treatment of Lumbar Intervertebral Disc Herniation

目的系统评价中药熏蒸联合牵引治疗腰椎间盘突出症的临床疗效。方法全面检索中国知网(CNKI)、万方(Wanfang)、维普(VIP)、中国生物医学文献数据库(CMB)及美国国家医学图书馆期刊文献检索系统(PubMed)、考克兰图书馆(Cochrane Library)中2014—2019年国内外发表的关于中药熏蒸联合牵引治疗腰椎间盘突出症的临床随机对照试验。根据纳入和排除标准筛选文献、资料提取和偏倚风险评估,采用RevMan5.3软件进行数据的Meta分析。结果纳入18篇文献,共2106例患者。Meta分析结果显示:与对照组相比,中药熏蒸联合牵引治疗腰椎间盘突出症可显著提高临床总有效率[OR=4.37,95%CI(3.09,6.19),P<0.00001]和痊愈率[OR=1.94,95%CI(1.54,2.46),P<0.00001],降低视觉模拟评分(VAS)[MD=-0.52,95%CI(-0.91,-0.13),P=0.009<0.01],增加日本骨科协会评估治疗分数(JOA)评分[MD=2.39,95%CI(1.52,3.27),P<0.00001],降低复发率[OR=0.16,95%CI(0.07,0.34),P<0.00001],差异有统计学意义。结论中药熏蒸联合牵引治疗腰椎间盘突出症可显著提高临床总有效率、治愈率,降低疼痛程度,改善临床症状。但鉴于纳入文献质量偏低,样本量有限,今后还需要设计更高质量的多中心、大样本的临床试验进一步验证。

Objective To systematically evaluate the clinical efficacy of traditional Chinese medicine fumigation combined with traction in the treatment of lumbar disc herniation.Methods A randomized controlled trial of Chinese herbal fumigation combined traction in the treatment of lumbar disc herniation was published in 2014—2019 years,including CNKI,WanFang,VIP,Chinese biomedical literature database(CMB),PubMed and Cochrane Library.According to the inclusion and exclusion criteria,literature,data extraction and bias risk assessment were screened,and data meta-analysis was carried out using RevMan 5.3 software.Results A total of 2106 patients were included in 18 literatures.Meta-analysis showed that compared with the control group,fumigation combined with traction could significantly improve the clinical total effective rate[OR=4.37,95%CI(3.09,6.19),P<0.00001]and recovery rate[OR=1.94,95%CI(1.54,2.46),P<0.00001],reduce VAS score[MD=-0.52,95%CI(-0.91,-0.13),P=0.009<0.01],increase JOA score[2.39,95%CI(1.52,3.27),P<0.00001],reduce the recurrence rate[OR=0.16,95%CI(0.07,0.34),P<0.00001],the difference was statistically significant.Conclusion TCM fumigation combined with traction treatment of lumbar disc herniation can significantly improve the clinical total effective rate,cure rate,reduce the degree of pain,improve clinical symptoms.However,in view of the low quality of the included literature and the limited sample size,we need to design higher quality multi-center,large-sample clinical trials to further verify.