推拿治疗膝骨关节炎:随机对照试验系统评价与荟萃分析

Therapeutic massage for knee osteoarthritis:a systematic review and meta-analysis of randomized controlled trials

目的:系统评价推拿治疗膝骨关节炎(KOA)的疗效.方法:共检索了6个中英文数据库,包括中国知网(CNKI)、万方学术期刊全文数据库(Wanfang)、重庆维普数据库(CQVIP)、中国生物医学文献数据库(CBM)、Cochrane图书馆以及PubMed数据库,筛选符合纳入标准的以推拿治疗KOA为研究对象并采用单独口服非甾体药物(NSAIDs)为对照的临床随机对照试验.主要评价指标为总有效率及西安大略与麦克马斯特大学骨关节炎指数(WOMAC)评分.结果:共纳入8篇符合纳入标准的文献,文献质量中等.结果显示,相较于NSAIDs药物,推拿治疗膝骨关节炎有效率更高[RR=1.14,95%CI(1.07,1.21),P<0.0001];在改善疼痛[MD=-2.06,95%CI(-2.75,-1.36),P<0.00001]、僵硬程度[MD=-0.90,95%CI(-1.05,-0.75),P<0.00001]及关节功能[MD=-12.48,95%CI(-13.91,-11.05),P<0.00001]方面,推拿效果更佳.结论:推拿治疗膝骨关节炎比口服非甾体药物更有效;在改善KOA患者膝关节疼痛、僵硬及日常功能方面,推拿手法优于非甾体药物治疗.

Objective:To evaluate the effectiveness of therapeutic massage(tuina)for treating knee osteoarthritis(KOA).Methods:Six English and Chinese databases,including Chinese National Knowledge Infrastructure(CNKI),Wanfang Academic Journal Full-text Database(Wanfang),Chongqing VIP Database(CQV1P),China Biology Medicine Disc(CBM),Cochrane Library and PubMed databases,were independently searched to identify appropriate randomized controlled trials(RCTs)studying therapeutic massage for KOA compared to oral non-steroidal anti-inflammatory drugs(NSAlDs)alone.The main outcome measures were total effectiveness and the Western Ontario and McMaster Universities osteoarthritis index(WOMAC)score.Results:A total of 8 RCTs were included and they were of average quality.The results showed that therapeutic massage was more effective than NSAlDs comparing total effectiveness[risk ratio(RR)=1.14,95%confidence interval(CI)(1.07,1.21),P<0.0001];compared with NSAlDs,therapeutic massage produced more significant improvements in pain[mean difference(MD)=-2.06,95%CI(-2.75,-1.36),P<0.00001],stiffness intensity[MD=-0.90,95%CI(-1.05,-0.75),P<0.00001]and joint function[MD=-12.48/95%CI(-13.91,-11.05),P<0.00001].Con elusion:Therapeutic massage was more effective than oral NSAlDs in treati ng KOA.In relieving pain and stiffness and improving the function of knee joint,therapeutic massage was superior to NSAIDs.