针刺联合康复训练治疗脊髓损伤后运动功能障碍疗效的系统评价与Meta分析

Efficacy of Acupuncture Combined with Rehabilitation in the Treatment of Motor Dysfunction after Spinal Cord Injury: A Systematic Review and Meta-analysis

目的 系统性地评估针刺联合康复训练治疗脊髓损伤后运动功能障碍的疗效,以便为临床实践提供参考依据。方法 通过电子检索万方、维普、中国知网、中国生物医学文献数据库、PubMed、Embase、Web of Science、Cochrane Library。检索从建库至2024年2月29日发表针刺联合康复训练治疗脊髓损伤后运动功能障碍的随机对照试验。结局指标包括:美国脊髓损伤协会运动功能评分、功能独立性评测量表评分、改良Barthel指数评分、直腿抬高角度评分、10米步行速度评分以及临床有效率,由2名评价者依据纳排标准独立筛选文献并提取数据。结果 检索到文献3 434篇,最终纳入16篇。共1 420例患者,试验组710例,对照组710例。Meta分析表明针刺联合康复训练有效改善脊髓损伤患者的临床有效率(OR=4.20,95%CI:3.03~5.84,Z=8.58,P<0.001)、功能独立性评测量表评分(MD=16.41,95%CI:13.62~19.21,Z=11.52,P<0.001)、直腿抬高角度评分(MD=6.90,95%CI:5.40~8.40,P<0.001)、美国脊髓损伤协会运动功能评分(MD=7.22,95%CI:5.43~9.01,Z=7.91,P<0.001)、10米步行速度评分(MD=0.08,95%CI:0.05~0.11,Z=4.50,P<0.001)、改良Barthel指数评分(MD=12.90,95%CI:10.71~15.10,Z=11.51,P<0.001),差异有统计学意义,均优于对照组。结论 针刺联合康复训练疗法可明显改善脊髓损伤后运动功能及日常生活活动能力,其疗效显著可靠,具有广泛推广价值。

Objective To systematically evaluate the efficacy of acupuncture combined with rehabilitation training in the treatment of motor dysfunction after spinal cord injury in order to provide a reference basis for clinical practice. Methods We conducted electronic searches in Wanfang, VIP, CNKI, CBM, PubMed, Embase, Web of Science, and Cochrane Library. The search timeframe was from build to February 29, 2024 for publication of a randomized controlled trial of acupuncture combined with rehabilitation for the treatment of motor dysfunction after spinal cord injury. Outcome measures included the American Spinal Cord Injury Association motor function score, Functional independence measure Scale score, Modified Barthel Index score, Straight Leg Raise Angle Score, 10-meter Walk Speed Score, and Clinical Efficacy Rate. Literature was independently screened and data extracted by 2 evaluators based on inclusion row criteria. Results Literature of 3 434 articles was retrieved and 16 articles were finally included. A total of 1 420 patients were included, 710 in the experimental group and 710 in the control group. Meta-analysis showed that acupuncture combined with rehabilitation training was effective in improving the clinical efficiency rate(OR=4.20, 95%CI:3.03-5.84, Z=8.58, P<0.001), functional independence measure scale scores(MD=16.41,95%CI:13.62-19.21, Z=11.52, P<0.001), Straight Leg Raise Angle Score(MD=6.90, 95%CI:5.40-8.40, P<0.001), American Spinal Cord Injury Association Motor Function Score(MD=7.22,95%CI:5.43-9.01, Z=7.91, P<0.001), and 10-meter Walk Speed Score(MD= 0.08, 95%CI:0.05-0.11, Z=4.50, P<0.001), and modified Barthel Index score(MD=12.90,95%CI:10.71-15.10, Z=11.51, P<0.001), the difference was statistically significant, and all of them were better than the control group.Conclusion Acupuncture combined with rehabilitation training therapy can significantly improve motor function and daily life activities after spinal cord injury, and its efficacy is significant and reliable, with wide popularization value.