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| 扳動類手法治療神經根型頸椎病的有效性和安全性Meta分析及GRADE證據等級評價 |
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王槐旌1, 符碧峰1,2, 丁少杰3, 李遠棟1,2, 楊光1,2, 王平1,2, 馮敏山4
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1.天津中醫藥大學第一附屬醫院, 國家中醫針灸臨床醫學研究中心, 天津 300381;2.天津中醫藥大學第一附屬醫院骨傷科, 國家中醫藥管理局區域中醫骨傷科診療中心, 天津 300381;3.天津市中醫藥研究院附屬醫院針灸一科, 天津 300120;4.中國中醫科學院望京醫院脊柱二科, 北京 100102
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| 摘要: |
| [目的] 系統評價扳動類手法治療神經根型頸椎病的臨床有效性及安全性。[方法] 檢索數據庫自建庫以來至2021年12月中英文獻數據庫（中國知網、萬方數據庫、維普數據庫、中國生物醫學文獻數據庫、Pubmed、EMbase、The Cochrane Library）符合納入排除標準的扳動類手法治療神經根型頸椎病的隨機對照試驗（RCT），并提取文獻數據，用改良Cochrane偏倚風險評估工具對文獻質量進行評價，用RevMan5.3對臨床總有效率、視覺模擬量表（VAS）評分、田中靖久35分積分法、頸椎病治療成績評分改善率、輔助檢查結果、不良反應等結局指標進行Meta分析，并對文獻數目≥10的結局指標作發表偏倚分析，以GRADE標準對結局指標進行證據質量評價。[結果] 納入17項研究，總樣本量1 833例，試驗組927例，對照組906例。Meta分析結果顯示：臨床總有效率[RR=1.25，95%CI（1.20，1.31），P < 0.000 01]，VAS評分[WMD=-1.38，95%CI（-1.90，-0.86），P＜0.000 01]，田中靖久35分積分法[WMD=-2.72，95%CI（-3.29，-2.15），P＜0.000 01]，頸椎病治療成績評分[SMD=1.09，95%CI（0.58，1.61），P＜0.000 1]，輔助檢查結果[SMD=0.74，95%CI（0.20，1.28），P=0.008]，不良反應[RR=，95%CI0.48（0.21，1.09），P=0.08]。在臨床總有效率、VAS評分、田中靖久35分積分法、輔助檢查結果、頸椎病治療成績評分手法組療效優于對照組，不良反應發生數目方面差異無統計學意義。[結論] 扳動類手法可以提高神經根型頸椎病的臨床療效，但不良反應與牽引相比無統計學差異。 |
| 關鍵詞: 扳動類手法 神經根型頸椎病 Meta分析 GRADE評價 |
| DOI：10.11656/j.issn.1672-1519.2023.05.15 |
| 分類號:R274.9 |
| 基金項目:國家中醫藥管理局循證能力建設項目（2019XZZX-GK006）。 |
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| Meta analysis of efficacy and safety of pulling manipulation in the treatment of cervical spondylotic radiculopathy and evaluation of GRADE evidence level |
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WANG Huaijing1, FU Bifeng1,2, DING Shaojie3, LI Yuandong1,2, YANG Guang1,2, WANG Ping1,2, FENG Minshan4
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1.First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300381, China;2.Department of Orthopedics, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Administration of Traditional Chinese Medicine Regional Orthopedics and Traumatology Diagnosis and Treatment Center, Tianjin 300381, China;3.First Department of Acupuncture and Moxibustion, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin 300120, China;4.Second Spine Department, Wangjing Hospital of China Academy of Chinese Medical Science, Beijing 100102, China
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| Abstract: |
| [Objective] To systematically evaluate the clinical efficacy and safety of pulling manipulation in the treatment of cervical spondylotic radiculopathy.[Methods] From the establishment of the database to December 2021, the literature database (CNKI, Wanfang, VIP, CBM, PubMed, EMBASE, the Cochrane Library) was searched, and the literature data were extracted, the literature quality was evaluated with the improved Cochrane bias risk assessment tool, and revman5.3 meta analysis was made on the total clinical effective rate, visual analogue scale (VAS) score, Tanaka Jingjiu 35 point integral method, improvement rate of cervical spondylosis treatment score, auxiliary examination results and adverse reaction outcome indicators, publication bias analysis was made on the outcome indicators with the number of literature ≥10, and the evidence quality of the outcome indicators was evaluated by GRADE standard.[Results] The 17 studies were included, with a total sample size of 1 833, 927 cases in the experimental group and 906 cases in the control group. Meta analysis showed that the total clinical effective rate [RR=1.25, 95%CI(1.20, 1.31), P < 0.000 01], VAS score [WMD=-1.38, 95%CI(-1.90, -0.86), P < 0.000 01], Tanaka Jingjiu 35 point integral method [WMD=-2.72, 95%CI(-3.29, -2.15), P < 0.000 01], cervical spondylosis treatment score [SMD=1.09, 95%CI(0.58, 1.61), P < 0.000 1], auxiliary examination results [SMD=0.74, 95%CI(0.20, 1.28), P=0.008], adverse reactions [RR=0.48, 95%CI(0.21, 1.09), P=0.08]. In the total clinical efficiency, VAS score, Tanaka Jingjiu 35 point integral method, auxiliary examination results and cervical spondylosis treatment score, the curative effect of the manipulation group was better than that of the control group, and there was no significant difference in the number of adverse reactions.[Conclusion] Pulling manipulation can improve the clinical efficacy of cervical spondylotic radiculopathy, but there is no significant statistic difference in adverse reactions compared with traction. |
| Key words: pulling manipulation cervical spondylotic radiculopathy Meta analysis GRADE evaluation |
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