推拿及推拿联合其他中医外治法治疗粘连期肩关节周围炎的网状meta分析

Network meta analysis of massage and massage combined with other traditional Chinese medicine external treatment in treating scapulohumeral periarthritis in adhesive period

目的系统评价推拿及推拿联合其他中医外治法治疗粘连期肩关节周围炎(SP)的效果与安全性。方法在中国知网、万方数据库、中国生物医学文献系统、维普网、PubMed、Web of Science、Cochrane图书馆中检索建库至2022年9月的推拿相关疗法治疗粘连期SP的随机对照试验(RCT),对筛选确定纳入的文献进行质量评价和数据提取。以临床有效率、视觉模拟评分法(VAS)评分、不良反应发生情况为结局指标,采用Stata 15.0进行数据分析。结果纳入18项RCTs,涉及1378例患者,包括常规西医治疗、单用推拿、推拿+针刺、推拿+针刀、推拿+温针灸、推拿+中药外用、推拿+浮针7种干预措施。临床有效率的累积排序曲线下面积(SUCRA)排名前3的干预措施为推拿+针刀(87.4%)、推拿+浮针(70.5%)、推拿+温针灸(65.9%)。在降低VAS评分方面,SUCRA排名前3的干预措施为推拿+浮针(83.3%)、推拿+针刀(69.7%)、推拿+中药外用(66.9%)。纳入RCTs中2项研究报道不良反应,对症处理后均消失。结论推拿+针刀、推拿+浮针分别在治疗粘连期SP的临床疗效及改善疼痛方面效果较好,但各疗法的安全性有待进一步研究。

Objective To systematically evaluate the efficacy and safety of massage and massage combined with other traditional Chinese medicine external treatment methods in treating scapulohumeral periarthritis(SP)in adhesive period.Methods Randomized controlled trial(RCT)of massage related therapy in the treatment of SP in adherent period were retrieved from CNKI,Wanfang Data,China Biomedical Literature System,VIP,PubMed,Web of Science,and Cochrane Library from inception to September 2022,quality evaluation and data extraction were carried out for the selected literatures.Clinical effective rate,visual analogue scale(VAS)score,and adverse reactions were used as outcome indexes,and Stata 15.0 was used for data analysis.Results A total of 18 RCTs were included,involving 1378 patients,including seven interventions:conventional western medicine treatment,simple massage,massage+acupuncture,massage+akupotomye,massage+warming needle moxibustion,massage+external use of traditional Chinese medicine,massage+floating acupuncture.The top three interventions in the surface under the cumulative ranking curve(SUCRA)of clinical effective rate were massage+akupotomye(87.4%),massage+floating acupuncture(70.5%),massage+warming needle moxibustion(65.9%).In terms of reducing VAS score,the top three SUCRA interventions were massage+floating acupuncture(83.3%),massage+akupotomye(69.7%),massage+external use of traditional Chinese medicine(66.9%).Two studies included in RCTs reported adverse reactions,which disappeared after symptomatic treatment.Conclusion Massage+akupotomye and massage+floating acupuncture has the better effect on the clinical effective and pain improvement in the treatment of SP in adhesion period,but the safety of each therapy needs to be further compared.