针灸辅助全膝关节置换术后康复有效性的Meta分析

Meta Analysis of Effectiveness on Acupuncture Assisted Rehabilitation after Total Knee Arthroplasty

目的:采用Meta分析评估针灸辅助治疗全膝关节置换术(TKA)术后康复的有效性。方法:通过检索中国期刊全文数据库(CNKI)、万方数据(Wanfang)、维普数据库(VIP)、PubMed、Cochrane Library和Web of Science中针灸辅助TKA术后康复的随机对照试验(RCTs)。纳入文献的筛选和质量评价采用Cochrane偏倚风险评估工具,运用RevMan 5.3及Stata 15.1进行数据分析。结果:共纳入11篇RCTs,共计763例患者。Meta分析显示,与对照组相比,(1)针灸组膝关节术后静息状态疼痛视觉模拟(VAS-R)评分显著降低[术后1 d,MD=-0.65,95%CI(-0.87,-0.42),P<0.00001;术后2 d,MD=-0.35,95%CI(-0.50,-0.21),P<0.00001]。(2)针灸组被动运动状态VAS(VAS-P)评分显著降低[术后1 d,MD=-1.01,95%CI(-1.70,-0.33),P=0.004<0.05;术后2 d,MD=-0.80,95%CI(-1.43,-0.17),P=0.001<0.05;术后3 d,MD=-0.90,95%CI(-1.61,-0.18),P=0.01<0.05;术后7 d,MD=-0.60,95%CI(-0.98,-0.21),P=0.002<0.05;术后14 d,MD=-0.63,95%CI(-1.07,-0.19),P=0.005<0.05]。(3)针灸组关节活动度改善明显[术后3 d,SMD=0.47,95%CI(0.19,0.75),P=0.001<0.05;术后7 d,SMD=0.47,95%CI(0.12,0.83),P=0.009<0.05;术后14 d,SMD=0.26,95%CI(0.00,0.53),P=0.05≤0.05]。(4)针灸组关节功能评分改善更佳[术后7 d,SMD=0.71,95%CI(0.41,1.01),P<0.00001;术后14 d,SMD=0.66,95%CI(0.36,0.96),P<0.0001;研究终末期,SMD=0.69,95%CI(0.21,1.17),P=0.005≤0.05]。(5)针灸组镇痛药不良反应的发生率更低[呕吐,OR=0.11,95%CI(0.06,0.24),P<0.00001;尿潴留,OR=0.26,95%CI(0.11,0.63),P=0.003<0.05]。结论:针灸辅助TKA术后康复的有效性优于单纯常规治疗,因本研究具有一定的局限性,故研究结果需进一步高质量研究验证。

Objective:To evaluate the effectiveness of acupuncture as adjuvant therapy for postoperative rehabilitation after to‐tal knee arthroplasty(TKA).Methods:The randomized controlled trials(RCTs)of acupuncture assisted postoperative rehabilitation studies were searched from China National Knowledge Infrastructure(CNKI),Wanfang,VIP,PubMed,Cochrane Library and Web of Science.The Cochrane bias risk assessment tool was used for screening and quality assessment of the included literature,and Rev‐Man 5.3 and Stata 15.1 were used for data analyses.Results:A total of 11 RCTs with 763 patients were included in final review.Compared with the routine treatment,the meta-analyses indicated that:1)The resting visual analogue scale(VAS-R)score after TKA in the acupuncture group was significantly decreased[postoperatively 1 d,MD=-0.65,95%CI(-0.87,-0.42),P<0.00001;postoperatively 2 d,MD=-0.35,95%CI(-0.50,-0.21),P<0.00001].2)The passive functional exercises visual analogue scale(VAS-P)score in the acupuncture group was significantly decreased after the surgery[postoperatively 1 d,MD=-1.01,95%CI(-1.70,-0.33),P=0.004<0.05;postoperatively 2 d,MD=-0.80,95%CI(-1.43,-0.17),P=0.001<0.05;postoperatively 3 d,MD=-0.90,95%CI(-1.61,-0.18),P=0.01<0.05;postoperatively 7 d,MD=-0.60,95%CI(-0.98,-0.21),P=0.002<0.05;postopera‐tively 14 d,MD=-0.63,95%CI(-1.07,-0.19),P=0.005<0.05].3)The range of motion of the acupuncture group was significantly improved[postoperatively 3 d,SMD=0.47,95%CI(0.19,0.75),P=0.001<0.05;postoperatively 7 d,SMD=0.47,95%CI(0.12,0.83),P=0.009<0.05;postoperatively 14 d,SMD=0.26,95%CI(0.00,0.53),P=0.05≤0.05].4)There was significantly better postoperative improvement in the joint function score of the acupuncture group[postoperatively 7 d,SMD=0.71,95%CI(0.41,1.01),P<0.00001;postoperatively 14 d,SMD=0.66,95%CI(0.36,0.96),P<0.0001;at the end of the study,SMD=0.69,95%CI(0.21,1.17),P=0.005<0.05].5)The incidence of postoperative analgesic adverse reactions was lower in the acupuncture group[vomiting,OR=0.11,95%CI(0.06,0.24),P<0.00001;urinary retention,OR=0.26,95%CI(0.11,0.63),P=0.003<0.05].Conclusion:The effectiveness of acu‐puncture-assisted TKA postoperative rehabilitation is better than that of routine treatment.Due to certain limitations in this study,the research results need to be further verified by more high-quality research.