不同针灸疗法治疗颈型颈椎病的网状Meta分析

Reticular Meta-Analysis of Different Acupuncture and Moxibustion Therapy for Cervical Spondylosis

目的:采取网状Meta分析的方法比较10种针灸相关疗法治疗颈型颈椎病的疗效以及对疼痛的缓解作用,为医师在颈型颈椎病治疗方案的选择上提供参考。方法:依次检索数据库CNKI、WanFang Data、VIP、CBM、PuBMed、Embase or The Cochrane Library中有关针灸相关疗法治疗颈型颈椎病的随机对照临床试验,检索时间均设定为2000年7月1日—2020年7月1日。由2名研究人员分别检索文献并筛选,纳入文献再进行数据提取和文献方法学质量评价,采用NoteExpress进行文献筛选,RevMan5.3软件绘制文献偏倚风险图,ADDIS 1.16.8进行网状Meta分析。结果:共纳入43篇研究共计3399例颈型颈椎病患者。网状Meta分析结果显示,在总有效率方面,排序依次为G(温针)、E(针刀)、A(针刺+推拿)、H(针刺+敷贴)、J(针刺+中药口服)、D(针刺+艾灸)、F(电针)、I(针刺+刺络拔罐)、C(针刺+康复)和B(针刺);在VAS评分方面,排序依次为H(针刺+敷贴)、E(针刀)、I(针刺+刺络拔罐)、A(针刺+推拿)、D(针刺+艾灸)、G(温针)、C(针刺+康复)、J(针刺+中药口服)、B(针刺)和F(电针)。结论:温针疗法、针刀疗法、针刺+推拿和针刺+敷贴均能有效治疗颈型颈椎病,缓解疼痛。但本研究结论仍需更多高质量、大样本研究进行证实。

Objective: To compare the efficacy and pain relief effect of 10 kinds of acupuncture and moxibustion related therapies in the treatment of cervical spondylosis with reticular meta-analysis method, so as to provide reference for the treatment schemes of cervical spondylosis. Methods: Randomized controlled clinical trails on acupuncture and moxibustion related therapies for cervical spondylosis were searched from the databases of CNKI, WanFang Data, VIP, CBM, PubMed, Embase and the Cochrane Library from July 1, 2000 to July 1, 2020. Two researchers searched and screened the literature respectively, and then extracted the data and evaluated the quality of literature methodology. The literature were screened by NoteExpress, the risk map of literature bias was drawn by Revman 5.3 software, and the reticular meta-analysis was conducted by ADDIS 1.16.8. Results: A total of 43 studies, involving 3,399 patients with cervical spondylosis, were included in the study. The results of reticular meta-analysis showed that in terms of total effective rate, the order was G(needle-warming acupuncture), E(acupotomy), A(acupuncture plus Tuina), H(acupuncture plus application), J(acupuncture plus oral Chinese medication), D(acupuncture plus moxibustion), F(electro-acupuncture), I(acupuncture plus blood-letting cupping), C(acupuncture plus rehabilitation) and B(acupuncture);in terms of VAS score, the order was H, E, I, A, D, G, C, J, B and F. Conclusion: Needle-warming acupuncture, acupotomy, acupuncture plus Tuina, as well as acupuncture plus application can effectively relieve pain in the treatment of cervical spondylosis. However, more high quality and large sample studies are needed to verify the conclusion.