臭氧疗法治疗腰椎间盘突出症的疗效与安全性:一项基于随机对照的Meta分析和系统综述

Efficacy and safety of ozone therapy for lumbar disc herniation:a meta-analysis based on a randomized control and systematic review

目的 系统评价臭氧注射治疗腰椎间盘突出症(LDH)的疗效与安全性。方法 检索Embase、PubMed、Cochrane library、Web of science数据库中有关臭氧疗法治疗LDH的随机对照研究(RCT)文献,检索日期为建库至2023年2月。由两位研究者独立进行文献检索、筛选、数据提取,采用Cochrane偏倚风险评价工具评估纳入文献的质量,应用Stata 17.0软件进行Meta分析。结果 最终纳入9项RCTs,涉及702例患者。Meta分析结果显示与单纯选择射频热凝、经皮旋切等治疗LDH相比,联合臭氧注射治疗能显著提高Macnab疗效评价的有效率(RR=1.097,95%CI:1.038~1.159,P=0.001)和优良率(RR=1.185,95%CI:1.074~1.309,P=0.001),降低视觉模拟疼痛评分(VAS)(WMD=-0.810~95%CI:-1.205,-0.414,P=0.000)差异具有统计学意义。结论 相较于单纯使用射频热凝、经皮旋切等治疗LDH,联合使用臭氧疗法能显著提高Macnab疗效评价的有效率和优良率,降低VAS评分,安全性高。因受限于纳入原始研究的数量和质量,上述结论有待多中心、大样本、高质量研究进一步予以验证。

Objective To evaluate the efficacy and safety of ozone injection therapy for lumbar disc herniation(LDH).Methods A computerized retrieval of academic papers concerning the randomized controlled trial(RCT)on ozone injection therapy for LDH from the databases of Embase,PubMed,Cochrane library and Web of science was conducted.The retrieval time period was from the establishment of the database to February 2023.The literature retrieval,screening,and data extraction were independently performed by two researchers.Cochrane bias risk assessment tool was used to assess the quality of the included literature.Stata 17.0 software was used to make meta-analysis.Results A total of 9 RCTs including 702 patients were finally included in this study.The results of meta-analysis showed that compared with radiofrequency thermocoagulation,percutaneous rotation and other treatments for LDH,the combination use of ozone injection could significantly improve the effective rate based on Macnab efficacy evaluation criteria(RR=1.097,95%CI:1.038~1.159,P=0.001)and the excellent rate(RR=1.185~95%CI:1.074~1.309,P=0.001),and decrease the visual analog scale(VAS)pain score(WMD=-0.810~95%CI:-1.205~-0.414,P=0.000),and the differences in the above indexes were statistically significant.Conclusion Compared with the simple use of radiofrequency thermocoagulation,percutaneous rotation,and other treatment for LDH,the combination use of ozone injection therapy can significantly improve the effective rate and excellent rate based on Macnab efficacy evaluation criteria,decrease VAS score,with a high clinical safety.Limited by the quantity and quality of the original studies included in this study,the above conclusions need to be further verified by multi-center,large-sample and high-quality studies.