[1]赵继荣,冷向阳,蒋鹏,等.中药汤剂口服联合正骨手法治疗腰椎间盘突出症有效性和安全性的Meta分析[J].中医正骨,2021,33(10):29-35.
　ZHAO Jirong,LENG Xiangyang,JIANG Peng,et al.Clinical efficacy and safety of oral application of traditional Chinese drug decoctions combined with bone setting manipulations for treatment of lumbar disc herniation:a meta-analysis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(10):29-35.
点击复制

中药汤剂口服联合正骨手法治疗腰椎间盘突出症有效性和安全性的Meta分析()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期数:
2021年10期
页码:
29-35
栏目:
文献研究
出版日期:
2021-10-20

文章信息/Info

Title:
Clinical efficacy and safety of oral application of traditional Chinese drug decoctions combined with bone setting manipulations for treatment of lumbar disc herniation:a meta-analysis
作者:
赵继荣1; 冷向阳2; 蒋鹏3; 薛旭1; 陈祁青1; 陈文1; 赵宁1; 马同1; 郭培尧1; 张天龙1
(1.甘肃省中医院,甘肃 兰州 730050; 2.长春中医药大学附属医院,吉林 长春 130021; 3.甘肃中医药大学,甘肃 兰州 730000)
Author(s):
ZHAO Jirong1; LENG Xiangyang2; JIANG Peng3; XUE Xu1; CHEN Qiqing1; CHEN Wen1; ZHAO Ning1; MA Tong1; GUO Peiyao1; ZHANG Tianlong1
1.Gansu Provincial Hospital of TCM,Lanzhou 730050,Gansu,China 2.The Affiliated Hospital of Changchun University of Chinese Medicine,Changchun 130021,Jilin,China 3.Gansu University of Chinese Medicine,Lanzhou 730000,Gansu,China
关键词:
椎间盘移位;  腰椎;  中草药;  煎剂;  正骨手法;  Meta分析;  系统评价
Keywords:
intervertebral disc displacement;  lumbar vertebrae;  drugs; Chinese herbal;  decoction;  bone setting manipulation;  Meta-analysis;  systematic review
摘要:
目的:评价中药汤剂口服联合正骨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:应用计算机检索中国知网、万方数据库、维普网、中国生物医学文献数据库、Pubmed、Cochrane library、Embase、Web of Science,搜集应用中药汤剂口服联合正骨手法治疗LDH的随机对照试验文献,检索时限均为建库至2020年12月1日。试验组干预措施为中药汤剂口服联合正骨手法,对照组干预措施为单纯中药汤剂口服或正骨手法。由2位研究者检索、筛选文献、提取数据并评价纳入研究的偏倚风险后,采用Revman5.3软件对治疗总有效率、腰部疼痛视觉模拟量表(visual analogue scale,VAS)评分、日本骨科学会(Japanese Orthopedic Association,JOA)腰痛疾患评分及并发症发生率进行Meta分析,同时通过改变效应模型进行敏感性分析。结果:共纳入14篇文献。Meta分析结果显示,试验组的治疗总有效率高于对照组[I2=45%,P=0.040; RR=1.20,95%CI(1.15,1.25),P=0.000]; 试验组在治疗开始后20 d以内评价的腰部疼痛VAS评分低于对照组[I2=98%,P=0.000; MD=-2.30,95%CI(-3.87,-0.73),P=0.004],治疗开始后20～30 d评价的腰部疼痛VAS评分低于对照组[I2=92%,P=0.000; MD=-1.18,95%CI(-1.50,-0.86),P=0.000],治疗开始后30 d以上评价的腰部疼痛VAS评分低于对照组[I2=98%,P=0.000; MD=-2.06,95%CI(-3.86,-0.26),P=0.030]; 2组在治疗开始后21 d以内评价的JOA腰痛疾患评分的差异无统计学意义[I2=99%,P=0.000; MD=1.62,95%CI(-8.06,11.30),P=0.740],试验组在治疗开始后21 d评价的JOA腰痛疾患评分高于对照组[I2=0%,P=0.650; MD=4.36,95%CI(3.92,4.80),P=0.000],试验组在治疗开始后21 d以上评价的JOA腰痛疾患评分高于对照组[I2=0%,P=0.630; MD=5.38,95%CI(4.48,6.27),P=0.000]; 仅1项研究报道了治疗后的并发症发生情况,2组均仅发生局部损伤、胃肠道反应、皮肤潮红等轻微并发症,经对症处理后明显缓解。改变效应模型后,各结局指标结果无明显变化,提示本研究Meta分析结果较为稳定。基于治疗总有效率和腰部疼痛VAS评分的漏斗图均显示,各研究点分布不完全对称,提示可能存在发表偏倚。证据质量评价结果显示,4个结局指标的证据质量均为中或低。结论:中药汤剂口服联合正骨手法治疗LDH具有较好的临床疗效和安全性,疗效优于单纯中药汤剂口服或正骨手法治疗。
Abstract:
Objective:To evaluate the clinical curative effects and safety of oral application of Traditional Chinese Drug(TCD)decoctions combined with bone setting manipulations for treatment of lumbar disc herniation(LDH).Methods:All the randomized controlled trial(RCT)articles about oral application of TCD decoctions combined with bone setting manipulations for treatment of LDH included from database establishing to December 1,2020 were retrieved from the China National Knowledge Internet,Wanfang Database,Vip Database,Chinese Biomedical Literature Database,Pubmed,Cochrane library,Embase and Web of Science through computer.The patients in experimental group were treated with oral application of TCD decoctions and bone setting manipulations,while the ones in control group with oral application of TCD decoctions or bone setting manipulations alone.The articles were retrieved and screened and the information was extracted independently by two researchers according to the inclusion and exclusion criteria.The bias risk of the research in the articles was evaluated by using Cochrane bias risk assessment tools and then a Meta-analysis on total effective rate,low back pain visual analogue scale(VAS)score,Japanese Orthopaedic Association(JOA)low back pain score and complication incidence was conducted by using Revman 5.3 software.The sensitivity analysis was conducted by changing the effect models.Results:Fourteen articles were included in the final analysis.The results of Meta-analysis revealed that the total effective rate was higher in experimental group compared to control group(I2=45%,P=0.040; RR=1.20,95%CI(1.15,1.25),P=0.000).The low back pain VAS scores evaluated within 20 days,from the 20th to the 30th day and at over 30 days after the beginning of the treatment were lower in experimental group compared to control group(I2=98%,P=0.000; MD=-2.30,95%CI(-3.87,-0.73),P=0.004; I2=92%,P=0.000; MD=-1.18,95%CI(-1.50,-0.86),P=0.000; I2=98%,P=0.000; MD=-2.06,95%CI(-3.86,-0.26),P=0.030).There was no statistical difference in JOA low back pain scores evaluated within 21 days after the beginning of the treatment between the 2 groups(I2=99%,P=0.000; MD=1.62,95%CI(-8.06,11.30),P=0.740).The JOA low back pain scores evaluated at 21 days and over 21 days after the beginning of the treatment were higher in experimental group compared to control group(I2=0%,P=0.650; MD=4.36,95%CI(3.92,4.80),P=0.000; I2=0%,P=0.630; MD=5.38,95%CI(4.48,6.27),P=0.000).The postoperative complications were reported in one research,only minor complications such as local injury,gastrointestinal reaction and skin flushing were found in the 2 groups,and the symptoms were greatly relieved after symptomatic supportive treatment.After changing the effect models,no evident change was found in the result of each outcome indicator,which suggested the results of Meta-analysis in this study were relatively stable.Funnel plots were drawn based on total effective rate and low back pain VAS scores respectively,and the asymmetrical funnel plots demonstrated that there might be publication bias.The results of evidence quality evaluation showed that the quality of the 4 outcome indicators was medium or poor.Conclusion:Combination of oral application of TCD decoctions with bone setting manipulations has good clinical curative effects and high safety in treatment of LDH,and its curative effect is better than that of monotherapy of oral application of TCD decoctions or bone setting manipulations.

参考文献/References:

[1] WANG J N,ZHAO X J,LIU Z H,et al.Selective phospho-diesterase-2A inhibitor alleviates radicular inflammation and mechanical allodynia in non-compressive lumbar disc herniation rats[J].Eur Spine J,2017,26(7):1961-1968.
[2] 周谋望,岳寿伟,何成奇,等.“腰椎间盘突出症的康复治疗”中国专家共识[J].中国康复医学杂志,2017,32(2):129-135. 中医正骨2021年10月第33卷第10期 J Trad Chin Orthop Trauma,2021,Vol.33,No.10(总755)(总756)中医正骨2021年10月第33卷第10期 J Trad Chin Orthop Trauma,2021,Vol.33,No.10
[3] 中华医学会疼痛学分会脊柱源性疼痛学组.腰椎间盘突出症诊疗中国疼痛专家共识[J].中国疼痛医学杂志,2020,26(1):2-6.
[4] LIU L,XUE H,JIANG L,et al.Comparison of percutaneous transforaminal endoscopic discectomy and microscope-assisted tubular discectomy for lumbar disc herniation[J].Orthop Surg,2021,13(5):1587-1595.
[5] WANG R,LUO H.Regression of lumbar disc herniation with non-surgical treatment:a case report[J].J Int Med Res,2021,49(6):30.
[6] 赵艳,符颖,陈天壮.麻黄附子细辛汤联合腰四味治疗老年性腰腿痛70例[J].中国实验方剂学杂志,2015,21(17):186-189.
[7] 朱立国,韩涛,于杰,等.中医骨伤科旋提手法规范化操作传承模式初探[J].中医杂志,2018,59(11):927-931.
[8] 朱咏梅,张田宁,田千慧,等.中医药治疗腰椎间盘突出症的临床进展[J].中国中医急症,2018,27(1):175-177.
[9] 蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:123-124.
[10] TOYONE T,TAKAHASHI K,KITAHARA H,et al.Visualisation of symptomatic nerve roots.Prospective study of contrast-enhanced MRI in patients with lumbar disc herniation[J].J Bone Joint Surg Br,1993,75(4):529-533.
[11] 陈健.中药汤剂结合中医正骨手法对腰椎间盘突出症患者的临床效果[J].中国农村卫生,2020,12(21):72-73.
[12] 张喜秋.中医骨伤手法联合中药汤剂治疗LDH的有效性分析[J].当代医学,2020,26(24):61-63.
[13] 陈德军,应方光洁.中药结合中医正骨手法治疗腰椎间盘突出症临床观察[J].实用中医药杂志,2020,36(1):9-10.
[14] 李汝任.中医骨伤手法联合中药汤剂治疗腰椎间盘突出症的疗效观察[J].医学食疗与健康,2020,18(1):36-37.
[15] 沈少林.中药汤剂配合中医骨伤手法治疗腰椎间盘突出的效果观察[J].基层医学论坛,2020,24(14):2027-2029.
[16] 彭建周.中医骨伤手法联合中药汤剂治疗腰椎间盘突出症的效果探讨[J].基层医学论坛,2019,23(13):1883-1884.
[17] 苏农.中药汤剂和中医骨伤手法联合治疗腰椎间盘突出的疗效和疼痛评分观察[J].齐齐哈尔医学院学报,2019,40(10):1252- 1253.
[18] 杜中录.中医骨伤手法联合中药汤剂治疗腰椎间盘突出症的临床观察[J].中国民间疗法,2019,27(8):39-40.
[19] 董国顺,王保锁.推拿手法与中药汤剂治疗腰椎间盘突出症疗效[J].中国继续医学教育,2019,11(15):150-152.
[20] 杨阳.中医骨伤手法联合中药治疗腰椎间盘突出症的临床分析[J].临床医学研究与实践,2018,3(4):96-97.
[21] 冯会宾.中医骨伤手法+中药汤剂治疗腰椎间盘突出症的价值分析[J].临床医药文献电子杂志,2017,4(50):9826-9827.
[22] 严学耕.中医骨伤手法联合中药汤剂治疗腰椎间盘突出症48例效果观察[J].深圳中西医结合杂志,2017,27(8):58-59.
[23] 郭华,李刚,李阳,等.中医骨伤手法联合中药汤剂治疗腰椎间盘突出症临床效果观察[J].世界中西医结合杂志,2016,11(8):1123-1125.
[24] 宋德勋,李建军.手法配合中药治疗腰椎间盘突出症50例[J].河南中医,2011,31(2):167-168.
[25] 牟成林,沈向楠,李革飞,等.中医正骨手法联合中药外敷改善腰椎间盘突出症腰椎曲度的疗效观察[J].时珍国医国药,2020,31(5):1179-1183.
[26] 郑旭耀,李哲,黄委委,等.手法治疗腰椎间盘突出症系统评价[J].长春中医药大学学报,2020,36(4):712-718.
[27] 钟起欢.独活寄生汤加减辅治腰椎间盘突出症寒湿证疗效观察[J].实用中医药杂志,2020,36(12):1534-1535.
[28] 杜肖勋,张超,郝延科.基于网络药理学的身痛逐瘀汤治疗腰椎间盘突出症作用机制研究[J].中医药导报,2020,26(15):157-161.
[29] 南晶,张钦.中医骨伤手法加补阳还五汤对腰椎间盘突出症患者的影响[J].实用临床医药杂志,2020,24(13):62-64.

相似文献/References:

[1]邓红军.硫酸钙骨水泥椎体成形联合后路短节段椎弓根螺钉 内固定治疗创伤性胸腰椎骨折[J].中医正骨,2015,27(10):35.
[2]张莉,秦丹霞,张细姣.腹针治疗椎间盘源性腰痛[J].中医正骨,2015,27(10):38.
[3]吴青坡,孙国绍,王林杰.后路椎管减压联合腰椎椎弓根钉动态稳定装置内固定 治疗单节段腰椎退行性疾病[J].中医正骨,2015,27(10):42.
[4]郭小伟,梅伟,潘玉林,等.一期后路病灶清除纳米仿生骨椎体支撑体植骨融合 内固定治疗胸腰椎结核[J].中医正骨,2015,27(07):66.
[5]孙广江,崔海舰.络病理论指导下应用独活寄生汤加减治疗腰椎间盘突出症[J].中医正骨,2015,27(12):37.
　SUN Guangjiang,CUI Haijian.Clinical study on oral application of Duhuo Jisheng Tang Jiajian(独活寄生汤加减)under the guidance of collaterals disease theory for treatment of lumbar disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(10):37.
[6]阮朝阳,曾强华,朱群威.口服消栓口服液和甲钴胺胶囊治疗腰椎间盘突出症 经皮椎间孔镜术后下肢残留神经症状[J].中医正骨,2015,27(12):71.
[7]陈冠军,陈扬,庄汝杰.可灌注骨水泥椎弓根螺钉系统 在老年腰椎疾患手术中的应用[J].中医正骨,2015,27(02):40.
[8]万宏波,马海燕,蒋云霞,等.口服益气化瘀汤联合功能锻炼治疗腰椎退行性疾病 术后残留腰腿痛的临床研究[J].中医正骨,2015,27(06):1.
　WAN Hongbo,MA Haiyan,JIANG Yunxia,et al.Clinical study on oral application of Yiqi Huayu Tang(益气化瘀汤)combined with functional exercise for the treatment of postoperative residual lumbocrural pain in patients with lumbar degenerative disease[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(10):1.
[9]贺振年,康信勇,徐洪伟,等.骨盆矢状位参数对退行性腰椎滑脱症的影响[J].中医正骨,2015,27(06):19.
　HE Zhennian,KANG Xinyong,XU Hongwei,et al.Effect of pelvic parameters in the sagittal plane on degenerative lumbar spondylolisthesis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(10):19.
[10]李鹏,徐世涛,谭磊.椎旁肌间隙入路伤椎单侧植骨内固定治疗 单节段胸腰椎骨折[J].中医正骨,2015,27(06):43.
[11]徐帮杰,杨楠,白伟杰,等.坐位定点旋转整复法治疗腰椎间盘突出症的疗效观察[J].中医正骨,2015,27(11):17.
　XU Bangjie,YANG Nan,BAI Weijie,et al.Observation on the curative effect of fixed-point rotational reduction in sitting position in the treatment of lumbar disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(10):17.
[12]白春晓,贾育松,孙旗,等.中医药在腰椎间盘突出症围手术期应用的研究进展[J].中医正骨,2015,27(11):65.
[13]王少纯,周英杰.郭维淮教授运用活血益气通经汤治疗腰椎间盘突出症的经验[J].中医正骨,2015,27(11):75.
[14]苏洪,张雪林.患侧下肢牵引配合腰椎斜扳法治疗 极外侧型腰椎间盘突出症[J].中医正骨,2015,27(10):40.
[15]谢冬群,黄中梁,叶金丽.加强隔附子饼灸治疗肾阳虚型腰椎间盘突出症的 临床研究[J].中医正骨,2015,27(09):18.
　XIE Dongqun,HUANG Zhongliang,YE Jinli.Clinical study on intensive aconite root cake separated moxibustion in the treatment of kidney-yang-deficiency-type lumbar disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(10):18.
[16]沈海良,钱万锋,周骁栋.针刀松解联合局部封闭与口服中药治疗腰椎间盘突出症[J].中医正骨,2015,27(09):46.
[17]王仁灿,黄炎洪,潘伟江,等.45°肩踝悬吊牵引下撞击腰椎疗法治疗L5S1椎间盘突出症[J].中医正骨,2015,27(08):51.
[18]任博文,杨豪.口服桂葛萆薢汤加减配合功能锻炼治疗 寒湿型腰椎间盘突出症[J].中医正骨,2015,27(08):53.
[19]丁晓医,周子静.射频热凝联合臭氧注射治疗腰椎间盘突出症的护理[J].中医正骨,2015,27(12):81.
[20]仇湘中,蒋盛昶,张信成,等.红外热成像图在腰椎间盘突出症证候疗效评定中的应用[J].中医正骨,2015,27(02):17.
　QIU Xiangzhong,JIANG Shengchang,ZHANG Xincheng,et al.Application of infrared thermal imaging to curative effect evaluation of SYMPTOM COMPLEX for patients with lumbar disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(10):17.

备注/Memo

备注/Memo:
基金项目:国家中医药管理局中医药循证能力建设项目(2019XZZX-GK005)
通讯作者:冷向阳 E-mail:lengxiangy@163.com
更新日期/Last Update: 1900-01-01