中医疗法联合西药治疗腰椎间盘突出症术后残留症状的Meta分析

Meta-Analysis of Postoperative Residual Symptoms of Lumbar Disc Herniation Treated with Chinese and Western Medicine

目的:系统评价中医疗法(中药内服、针灸、熏蒸)联合西药治疗腰椎间盘突出症患者术后残留症状的临床疗效及安全性。方法:基于中、英文数据库检索中西医结合治疗腰椎间盘突出症患者术后残留症状的临床研究。按Cochrane偏倚风险评价工具对文献进行质量评估,利用RevMan 5.3软件进行分析。结果:纳入21篇文献,meta分析结果提示,观察组总体临床有效率高于对照组[RR=1.23,95%CI(1.15,1.31),P<0.00001],视觉模拟评分显著低于对照组[SMD=-1.03,95%CI(-1.32,-0.74),P<0.00001],日本骨科协会下腰痛评分评分高于对照组[SMD=1.08,95%CI(0.73,1.43),P<0.0001],Oswestry功能障碍指数显著低于对照组[RR=-6.27,95%CI(-8.78,-3.75),P<0.0001],对照组与观察组的不良反应发生情况相比并无差异[RR=1.27,95%CI(0.66,2.42),P=0.47]。结论:中医疗法联合西药能缓解腰椎间盘突出症患者的术后残留症状,减轻疼痛并提高生活质量,且安全性与单纯西药治疗相当。

Objective To systematically evaluate the clinical efficacy and safety of traditional Chinese medicine(internal administration of traditional Chinese medicine,acupuncture,fumigation)combined with western medicine in the treatment of postoperative residual symptoms in patients with lumbar disc herniation.Methods Based on the Chinese and English databases,we searched the clinical research on the treatment of residual symptoms of patients with lumbar disc herniation.The quality of the literature was evaluated according to the Cochrane risk of bias assessment tool,and RevMan 5.3 software was used for analysis.Results Twenty-one articles were included.The results of meta-analysis showed that the clinical effective rate of residual symptoms in the observation group was higher than that in the control group.[RR=1.23,95%CI(1.15,1.31),P<0.00001],and visual analogue scale(VAS)was significantly lower than that in control group[SMD=-1.03,95%CI(-1.32,-0.74),P<0.00001],Janese orthopedic association score(JOA)was higher than control group[SMD=1.08,95%CI(0.73,1.43),P<0.0001],Oswestry disability index(ODI)score was significantly lower than control group[RR=-6.27,95%CI(-8.78,-3.75),P<0.0001].There was no difference in the incidence of adverse reactions between the observation group and the Observation group[RR=1.27,95%CI(0.66,2.42),P=0.47].Conclusion Chinese and Western combined therapy can relieve residual symptoms,relieve pain and improve quality of life in patients with lumbar disc herniation,and its safety is comparable to that of western medicine alone.