[1]王逸松,詹红生,王辉昊.2012—2023年手法治疗颈椎病不良事件的发生与变化情况及防范对策[J].中医正骨,2024,36(11):15-20,57.
　WANG Yisong,ZHAN Hongsheng,WANG Huihao.Occurrence and changes of adverse events in manipulative treatment of cervical spondylosis during 2012—2023 and the prevention countermeasures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2024,36(11):15-20,57.
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2012—2023年手法治疗颈椎病不良事件的发生与变化情况及防范对策()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第36卷
期数:
2024年11期
页码:
15-20,57
栏目:
文献研究
出版日期:
2024-11-20

文章信息/Info

Title:
Occurrence and changes of adverse events in manipulative treatment of cervical spondylosis during 2012—2023 and the prevention countermeasures
作者:
王逸松; 詹红生; 王辉昊
上海中医药大学附属曙光医院,上海 201203
Author(s):
WANG Yisong; ZHAN Hongsheng; WANG Huihao
Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China
关键词:
颈椎病;  肌肉骨骼手法;  不良事件;  文献分析
Keywords:
cervical spondylosis;  musculoskeletal manipulations;  adverse events;  document analysis
摘要:
目的:分析2012—2023年手法治疗颈椎病不良事件的发生与变化情况,并探讨相应的防范对策。方法:应用计算机检索中国生物医学文献服务系统、中国知网、万方数据库、维普网中关于手法治疗颈椎病不良事件的文献,检索时限为2012年1月1日至2023年12月31日。统计分析不良事件的种类、等级、结局及引起不良事件的手法类型等信息,并将统计分析结果与前期文献(1979—2011年)研究所得的结果进行比较分析。结果:①文献检索与筛选结果。共检索到997篇相关文献,经过逐层筛选后最终纳入42篇文献,涉及219例患者和224件不良事件(如果1例患者同时出现头晕、上肢麻木、恶心呕吐,则计为3件不良事件)。②2012—2023年手法治疗颈椎病不良事件发生情况分析结果。不良事件种类位于前3位的依次为头晕(22.32%)、局部疼痛(20.54%)、恶心呕吐(15.63%); 引起不良事件的手法类型为旋转复位法(83例)、按揉穴位法(77例)和拔伸手法(12例),47例未描述引起不良事件的手法类型; 轻度不良事件217件,中度不良事件3件,严重不良事件4件; 35例描述了不良事件的结局且均为恢复或基本恢复,184例未描述不良事件的结局。③2012—2023年手法治疗颈椎病不良事件变化情况分析结果。与12年前(1979—2011年)相比,近12年颈椎病手法治疗不良事件的种类更加多样化,中度、严重不良事件的数量明显下降,头晕仍为占比最高的不良事件; 旋转复位类手法引起的不良事件仍最多,其次为按揉穴位类手法,拔伸类手法引起的不良事件明显增多; 不良事件主要以轻度不良事件为主,中度和严重不良事件占比明显减小; 未描述不良事件结局的病例数大幅增多,且未筛选到死亡病例。结论:与12年前相比,2012—2023年手法治疗颈椎病不良事件,仍多由旋转复位类手法和按揉穴位类手法引起,以轻度不良事件为主且均能恢复,中度、严重不良事件的数量明显减少,但不良事件的种类更加多样化,拔伸类手法引起的不良事件明显增多。通过完善病例资料、规范操作手法、厘清手法机制、严格规范从业人员准入资格、提高医务人员风险意识,以及加强医患之间的积极沟通,可有效防范和减少手法治疗颈椎病不良事件的发生。
Abstract:
Objective:To analyze the occurrence and changes of adverse events in manipulative treatment of cervical spondylosis(CS)during 2012—2023,and to explore the corresponding prevention countermeasures.Methods:All the articles about adverse events in mani-pulative treatment of CS included from January 1,2012 to December 31,2023 were retrieved from the Chinese Biomedical Literature Service System,China National Knowledge Infrastructure,Wanfang Database,and Vip Database through computer,followed by statistics and analysis on the types,grades,and outcomes of adverse events as well as the types of manipulations causing adverse events,and the results were compared with the findings of the articles published during 1979—2011.Results:①Article retrieval and screening results.Nine hundred and ninety-seven articles were searched out.After screening,42 articles were included in the final analysis,involving 219 patients and 224 adverse events(3 adverse events were recorded if one patient experienced dizziness,upper limb numbness,as well as nausea and vomiting simultaneously).②Analysis result of occurrence of adverse events in manipulative treatment of CS during 2012—2023.Among the 224 adverse events in manipulative treatment of CS during 2012—2023,the top three ones were dizziness(22.32%),local pain(20.54%),nausea and vomiting(15.63%)in turn,and the mild,moderate,and severe adverse events were 217,3,and 4,respectively.Among the 219 patients,the adverse events were caused by rotation reduction in 83 cases,acupoint massage in 77 cases,and pulling-stretching manipulation in 12 cases,with 47 cases not specifying the manipulations that led to the adverse events,and the outcomes of adverse events were reported in 35 cases,all of which were recovery or basic recovery,while the outcomes were not reported in 184 cases.③Changes of adverse events in manipulative treatment of CS during 2012—2023.Compared with the period of 1979—2011,the period of 2012—2023 witnessed increased types of adverse events,but decreased number of moderate and severe adverse events in manipulative treatment of CS,with dizziness accounting for the highest proportion in the adverse event.Rotation reduction manipulation led to the most adverse events,followed by acupoint massage,and the adverse events caused by pulling-stretching manipulation increased significantly.In addition,the adverse events were dominant by the mild ones,the proportion of the moderate and severe ones decreased significantly.Besides,the number of cases without reporting the outcomes of adverse events substantially increased,and no death case was identified in the screening process.Conclusion:During 2012—2023,the adverse events in manipulative treatment of CS were still mostly caused by rotation reduction manipulation and acupoint massage,predominantly by mild ones,which can be recoverable.Compared with the period of 1979—2011,the period of 2012—2023 witnessed decreased number of moderate and severe adverse events but increased types of adverse events,with a significant increase in adverse events caused by pulling-stretching manipulation.Efforts should be made to improve case data,standardize the operation of manipulations,decipher the functioning mechanisms of manipulations,strictly regulate the qualifications of practitioners,enhance the risk awareness of medical staff,and strengthen the active communication between doctors and patients,which can effectively prevent and reduce the occurrence of adverse events in manipulative treatment of CS.

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备注/Memo

备注/Memo:
基金项目:国家自然科学基金项目(81973871); 上海市2020年度“科技创新行动计划”医学创新研究专项项目(20MC1920600); 上海中医药大学附属曙光医院第二轮《促进市级医院临床技能与临床创新三年行动计划》重大临床研究项目(SHDC2020CR1051B)
通讯作者:王辉昊 E-mail:huihaowang@126.com
更新日期/Last Update: 1900-01-01