中药外用辅助关节镜治疗膝骨关节炎疗效的Meta分析

Meta-analysis of the Efficacy of Arthroscopy Assisted by Traditional Chinese Medicine in the Treatment of Knee Osteoarthritis

目的本研究旨在评价中药外用辅助关节镜治疗膝骨关节炎(knee osteoarthritis,KOA)的疗效。方法通过计算机检索荷兰医学文摘(Excerpta Medica Database,EMBASE)、Cochrane Library、Web of Science、PubMed、中国知网(China National Knowledge Infrastructure,CNKI)、WanFang Data等数据库中有关中药外用辅助关节镜治疗KOA的随机对照试验(randomized controlled trial,RCT),对符合本次研究标准的试验采用Cochrane系统评价方法进行评价并使用Revman 5.4进行文献质量进行评估。主要结局指标:视觉模拟评分法(visual analogue scale,VAS)评分、Lysholm评分、白细胞介素1(interleukin 1,IL-1)、西安大略和麦克马斯特大学骨关节炎指数(Western Ontario and McMaster Universities Osteoarthrtis Index,WOMAC)评分、膝关节周径以及临床有效率。结果共纳入15个RCT,1085名研究对象。Meta分析结果显示,中药外用辅助关节镜治疗KOA的VAS评分(MD=-1.33,95%CI:-2.02~-0.64,P=0.0002)、Lysholm评分(MD=12.74,95%CI:9.49~15.44,P<0.001)、WOMAC评分(MD=-9.05,95%CI:-15.16~-2.94,P=0.004)、膝关节周径(MD=-0.14,95%CI:-0.55~-0.27,P<0.001)、临床有效率(OR=5.29,95%CI:2.78~10.05,P<0.01)的改善均优于单纯使用关节镜组,差异有统计学意义。结论中药外用辅助关节镜治疗KOA相比于单用关节镜能获得更好的短期疗效,可显著减轻患膝关节疼痛,改善患膝关节功能。

Objective To evaluate the efficacy of arthroscopy assisted by traditional Chinese medicine in the treatment of knee osteoarthritis(KOA).Methods The randomized controlled trials(RCT)of traditional Chinese medicine assisted arthroscopy in the treatment of KOA were searched in Excerpta Medica Databas(EMBASE),Cochrane Library,Web of Science,PubMed,China National Knowledge Infrastructure(CNKI),WanFang Data and other databases.The trials that met the criteria of this study were evaluated by Cochrane system evaluation method and the literature quality was evaluated by Revman 5.4.The main outcome measures were visual analogue scale(VAS),Lysholm score,interleukin 1(IL-1),Western Ontario and McMaster Universities Osteoarthrtis Index(WOMAC)score,knee circumference and clinical effective rate.Results A total of 15 RCT with 1085 subjects were included.The results of Meta analysis showed that the improvement of VAS of arthroscopy assisted by traditional Chinese medicine(MD=-1.33,95%CI:-2.02 to-0.64,P=0.0002),Lysholm score(MD=12.74,95%CI:9.49 to 15.44,P<0.001),WOMAC score(MD=-9.05,95%CI:-15.16 to-2.94,P=0.004),knee circumference(MD=-0.14,95%CI:-0.55 to-0.27,P<0.001),clinical effective rate(OR=5.29,95%CI:2.78 to 10.05,P<0.01)were better than those in the arthroscopy group,and the difference was statistically significant.Conclusion This meta analysis confirms that arthroscopy assisted by traditional Chinese medicine can achieve a better short-term effect in the treatment of KOA than arthroscopy alone,which can significantly reduce knee pain and improve knee joint function.