艾灸联合推拿手法治疗腰椎间盘突出症有效性和安全性的Meta分析

Clinical outcomes and safety of moxibustion therapy combined with Tuina(推拿)therapy for treatment of lumbar disc herniation:a meta-analysis

目的:系统评价艾灸联合推拿手法治疗腰椎间盘突出症(lumbar disc herniation,LDH)的有效性和安全性。方法:应用计算机检索PubMed、Cochrane Library、Embase、中国生物医学文献服务系统、中国知网、维普网、万方数据库,筛选艾灸联合推拿手法治疗LDH的随机对照试验,试验组采用艾灸联合推拿手法治疗,对照组采用单纯推拿手法治疗。采用Cochrane偏倚风险评估工具对纳入研究的文献进行质量评估,采用RevMan5.3软件进行Meta分析。结果:共检索到852篇文献,通过逐层筛选最终纳入12篇文献,均为中文文献。Meta分析结果显示,试验组临床总有效率、日本骨科协会腰痛疾患疗效评分均高于对照组[RR=1.18,95%CI(1.10,1.26),P=0.000;MD=3.77,95%CI(2.32,5.22),P=0.000],试验组疼痛视觉模拟量表评分、Oswestry功能障碍指数均低于对照组[MD=-1.53,95%CI(-1.93,-1.13),P=0.000;MD=-2.28,95%CI(-4.40,-0.16),P=0.040],2组不良反应发生率的差异无统计学意义[OR=0.59,95%CI(0.08,4.58),P=0.620]。结论:现有的证据表明,艾灸联合推拿手法治疗LDH具有较好的临床疗效和安全性,疗效优于单纯推拿手法治疗。

Objective:To systematically review the clinical outcomes and safety of moxibustion therapy combined with Tuina(推拿,TN)therapy for treatment of lumbar disc herniation(LDH).Methods:All the randomized controlled trial(RCT)articles about moxibustion therapy combined with TN therapy for treatment of LDH included from database establishing to December 31,2022 were retrieved from the PubMed,Cochrane Library,Embase,Chinese Biomedical Literature Service System,China National Knowledge Internet,Vip Database and Wanfang Database through computer.The patients in experimental group were treated with moxibustion therapy and TN therapy,while the ones in control group with TN therapy alone.The methodological quality of researches in the included articles was evaluated by using Cochrane bias risk assessment tools,and then a Meta-analysis was conducted by using RevMan5.3 software.Results:Eight hundred and fifty-two articles were searched out.After screening,12 Chinese articles(1075 patients)were included in the final analysis,536 patients in experimental group and 539 ones in control group.The results of Meta-analysis revealed that the total clinical effective rate and Japanese Orthopaedic Association(JOA)low back pain efficacy score were higher,while the pain visual analogue scale(VAS)score and Oswestry disability index(ODI)were lower in experimental group compared to control group(RR=1.18,95%CI(1.10,1.26),P=0.000;MD=3.77,95%CI(2.32,5.22),P=0.000;MD=-1.53,95%CI(-1.93,-1.13),P=0.000;MD=-2.28,95%CI(-4.40,-0.16),P=0.040);Furthermore,there was no statistical difference in incidence rate of adverse reactions between the 2 groups(OR=0.59,95%CI(0.08,4.58),P=0.620).Conclusion:Available evidences suggest that moxibustion therapy combined with TN therapy has good clinical outcomes and safety in treatment of LDH,and it surpasses the monotherapy of TN therapy in clinical outcomes.