系统评价针刺结合关节松动术治疗肩关节周围炎Meta分析

Meta-analysis of Systematic Evaluation of Acupuncture Combined with Joint Mobilization in the Treatment of Scapulohumeral Periarthritis

目的系统评价针刺结合关节松动术治疗肩关节周围炎的有效性和安全性。方法依据Meta分析要求,计算机检索PubMed、CBM、EMbase、The Cochrane Library、中国知网、维普、万方等中英文数据库,计算机检索年限为建库至2019年3月,并辅以手工检索作为补充,手工检索年限为2016—2019年,纳入的文献是以针刺结合关节松动术为干预措施治疗肩关节周围炎的临床随机对照试验,根据纳入以及排除标准筛选文献,文献由两名专业人员独立检索提取,使用RevMan5.3软件进行系统评价分析和文献质量评价。结果共纳入16篇临床随机对照试验,1487例患者。Meta分析结果显示,16篇文献总有效率异质性检验:[Chi2=10.65,P=0.78,I^2=0,OR=4.34,95%CI(2.91,6.47),Z=7.18,P<0.000 01];8篇文献视觉模拟评分(VAS评分)异质性检验:[MD=-1.53,95%CI(-2.37,-0.69),Z=3.56,P<0.000 01];5篇文献报道了肩关节活动度(ROM)5个方面异质性检验的结果分别为前屈[MD=16.55,95%CI(2.14,30.95),Z=2.25,P<0.000 01]、后伸[MD=10.37,95%CI(4.80,15.93),Z=3.65,P<0.000 01]、外展[MD=14.88,95%CI(7.53,22.23),Z=3.97,P<0.000 01]、内旋[MD=12.10,95%CI(10.38,13.83),P<0.000 01]、后旋[MD=12.58,95%CI(10.84,14.32),P<0.000 01]。没有文献报道有不良反应发生。结论针刺结合关节松动术治疗肩关节周围炎疗效明确,可减轻患者疼痛,有一定安全性,中医针刺疗法结合现代康复技术-关节松动术将对肩关节周围炎的实验研究和临床治疗起到一定的指导作用。

Objective To systematically evaluate the effectiveness and safety of acupuncture combined with joint mobilization in treating scapulohumeral periarthritis. Methods According to the requirements of Meta-analysis,Chinese and English databases such as PubMed,CBM,EMbase,The Cochrane Library,CNKI,VIP and WanFang were searched by computer. The computer search period was from March 2019,supplemented by manual search,which lasted from 2016 to 2019. The included literature is a randomized controlled clinical trial of acupuncture combined with joint mobilization as an intervention to treat scapulohumeral periarthritis. According to the inclusion and exclusion criteria,the literature was searched and extracted by two professionals,and Meta-analysis and literature quality evaluation were carried out by RevMan5.3 software. Results A total of 16 clinical randomized controlled trials with 1487 patients were included. Meta-analysis showed that the heterogeneity test of total efficiency of 16 literatures:[Chi^2=10.65,P=0.78,I^2=0,OR=4.34,95%CI(2.91,6.47),Z=7.18,P<0.000 01];Heterogeneity test of VAS scores in 8 papers:[MD=-1.53,95%CI(-2.37,0.69),Z=3.56,P<0.000 01];Five literatures reported ROM,and the results of five heterogeneity tests were flexion [MD=16.55,95%CI(2.14,30.95),Z=2.25,P<0.000 01] and extension [MD=10.37,95%CI(4.80,15.93),Z=3.65,P<0.000 01],abduction [MD=14.88,95%CI(7.53,22.23),Z=3.97,P<0.000 01],internal rotation [MD=12.10,95%CI(10.38,13.83),P<0.000 01],and backward rotation [MD=12.58,95%CI(10.84,14.32),P<0.000 01]. No adverse reactions have been reported in the literature. Conclusion Acupuncture combined with joint mobilization is effective and safe in treating scapulohumeral periarthritis. Acupuncture combined with modern rehabilitation technologyjoint mobilization will play a guiding role in experimental research and clinical treatment of scapulohumeral periarthritis.