杵针疗法治疗颈椎病的有效性和安全性系统评价
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摘要
目的:系统评价杵针疗法治疗颈椎病的临床有效性及安全性,为其临床推广提供循证医学的证据支持。方法:计算机检索PubMed、EMBase、Cochrane Library、Web of Science等外文数据库以及中国生物医学文献数据库(CBM)、中国知网(CNKI)、维普网(VIP)和万方网(WanFang)等中文数据库,配合补充检索手段,收集所有杵针治疗颈椎病的随机对照试验(Randomized Controlled Trial,RCT)。文献筛选后对纳入文献进行资料提取及方法学质量评价,然后实施定性或定量分析。结果:共纳入8篇RCT(640例患者)。(1)定性分析的结果证实杵针疗法治疗颈椎病的临床疗效肯定,具备良好的有效性及安全性。(2)定量分析的结果显示杵针疗法能显著提高颈椎病患者临床症状的痊愈率(P <0. 05)。杵针因素的痊愈率与针刺因素或口服西药因素相比,其组间差异无统计学意义(P> 0. 05)。结论:杵针疗法治疗颈椎病安全有效,有助于提高颈椎病患者临床症状的痊愈率,应在临床中大力推广。
Objective: To systematically evaluate the efficacy and safety of pestle needle therapy for cervical spondylosis,and to provide the reference of evidence-based medicine for its clinical expansion. Methods: A computer-based retrieval was performed in foreign databases as Pub Med,EMbase,Cochrane Library,Web of Science and Chinese ones as CBM,CNKI,VIP and Wan Fang,and supplementary retrieval was also performed with other sources. All relevant randomized controlled trials( RCTs) were collected to systematically research pestle needle therapy for cervical spondylosis. After literature screening,we carried out data extraction and methodologic quality evaluation of the included studies. Finally,qualitative or quantitative analyses were performed according to actual circumstances. Results: A total of 8 RCTs were included,comprising 640 patients.(1)The results of qualitative analysis confirmed the superior effectiveness of pestle needle therapy in the treatment of cervical spondylosis,with good clinical efficacy and safety.(2)The results of quantitative analysis showed that pestle needle therapy could significantly improve the recovery rate of clinical symptoms in patients with cervical spondylosis( P < 0. 05). There were no statistically significant differences of recovery rate between Chunzhen factor and acupuncture factor or oral western medicine factor( P > 0. 05). Conclusion: The pestle needle therapy is secure and effective in the treatment of cervical spondylosis,which can help patients with cervical spondylosis improve the recovery rate of clinical symptoms and should be widely promoted in clinical practice.
Objective: To systematically evaluate the efficacy and safety of pestle needle therapy for cervical spondylosis,and to provide the reference of evidence-based medicine for its clinical expansion. Methods: A computer-based retrieval was performed in foreign databases as Pub Med,EMbase,Cochrane Library,Web of Science and Chinese ones as CBM,CNKI,VIP and Wan Fang,and supplementary retrieval was also performed with other sources. All relevant randomized controlled trials( RCTs) were collected to systematically research pestle needle therapy for cervical spondylosis. After literature screening,we carried out data extraction and methodologic quality evaluation of the included studies. Finally,qualitative or quantitative analyses were performed according to actual circumstances. Results: A total of 8 RCTs were included,comprising 640 patients.(1)The results of qualitative analysis confirmed the superior effectiveness of pestle needle therapy in the treatment of cervical spondylosis,with good clinical efficacy and safety.(2)The results of quantitative analysis showed that pestle needle therapy could significantly improve the recovery rate of clinical symptoms in patients with cervical spondylosis( P < 0. 05). There were no statistically significant differences of recovery rate between Chunzhen factor and acupuncture factor or oral western medicine factor( P > 0. 05). Conclusion: The pestle needle therapy is secure and effective in the treatment of cervical spondylosis,which can help patients with cervical spondylosis improve the recovery rate of clinical symptoms and should be widely promoted in clinical practice.
引文
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[6]周海华,郭少英.颈椎病的中医外治法研究进展[J].现代中西医结合杂志,2014,23(4):449-451.
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[10] STRINE TW,HOOTMAN JM. US national prevalence and correlates of low back and neck pain among adults[J]. Arthritis Rheum,2007,57(4):656-665.
[11]张尚省,樊成虎.中医治疗青少年颈椎病研究进展[J].亚太传统医药,2016,12(19):66-68.
[12]马明,张世民.青年颈椎病的研究进展[J].中国骨伤,2014,27(9):792-795.
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[14]洪小萍,李世斌,连艺杰.中医药治疗颈椎病的现状分析[J].福建医药杂志,2016,38(4):138-139.
[15]王浩然,贾红玲,张永臣.颈椎病针刺机制研究进展[J].山东中医药大学学报,2015,39(6):576-578.
[16] WANG MY,TSAI PS,LEE PH,et al. Systematic review and meta-analysis of the efficacy of tuina for cervical spondylosis[J]. J Clin Nurs,2008,17(19):2531-2538.
[17]申治富,余思奕,胡幼平.杵针疗法的理论及临床运用[J].上海针灸杂志,2015,34(6):575-578.
[18]刘栩豪,余洋,钟磊,等.杵针腰阳关八阵、河车命强段治疗腰痹病31例[J].中国针灸,2016,36(3):295-298.
[19]刘全让,钟枢才.李仲愚主任医师杵针疗法经验[J].成都中医药大学学报,1996,19(3):6-7.
[20]钟枢才,刘全让.李仲愚老先生的杵针疗法浅析[J].中医教育,1994,13(6):43,45.
[21] HU Y,LI Z,MI DH,et al. Chemoradiation combined with regional hyperthermia for advanced oesophageal cancer:a systematic review and meta-analysis[J]. J Clin Pharm Ther,2017,42(2):155-164.
[22] LI Z,YANG KH,MI DH,et al. The research about guidance of systematic review for clinical study[J]. Cochrane Database Syst Rev,2012:107.
[23]钟枢才.杵针学[M].北京:中国中医药出版社,2006,1-136.
[24]李仲愚.杵针治疗学[M].钟枢才,李淑仁整理.成都:四川科学技术出版社,1990,1-349.
[25] LI Z,MI DH,YANG KH,et al. Comparison between Autocad and Draftsight in data extraction[J]. Cochrane Database Syst Rev,2013:56.
[26] LI Z,YANG KH,MI DH,et al. The method of exracting data from figure with software[J]. Cochrane Database Syst Rev,2012:104.
[27]胡月,李征,曲雁,等.胸腔化疗联合热疗治疗癌性胸腔积液有效性和安全性的Meta分析[J].中国全科医学,2017,20(32):4034-4041.
[28]胡月,李征,曲雁,等.热疗综合疗法治疗原发性鼻咽癌的系统评价[J].循证医学,2015,15(2):96-101,107.
[29]蒋振亚,李常度.杵针大椎八阵穴为主治疗颈椎病的临床观察[J].中国针灸,2001,21(2):94-96.
[30]李少华.杵针“大椎八阵”穴治疗神经根型颈椎病的临床研究[D].成都:成都中医药大学,2009.
[31]苏敏.杵针疗法治疗椎动脉型颈椎病的临床疗效观察[C]//第二届全国民间中医药开发工程大会论文集.中山:出版者不详,2014:158-160.
[32]刘泽恩.杵针结合蜡疗治疗混合型颈椎病疗效观察[J].实用中医药杂志,2015,31(2):130.
[33]董远蔚,杨斐,钟磊.杵针配合牵引治疗颈性眩晕[J].吉林中医药,2016,36(4):417-418.
[34]杜越,杨斐,董远蔚,等.杵针治疗颈性眩晕临床疗效观察[J].医学信息,2016,29(12):286-287.
[35] WANG YZ,ZHONG L,WU ZJ,et al. Efficacy study on pestle needle combined with Chinese herbal fumigation for cervical spondylosis[J]. J Acupunct Tuina Sci,2016,14(4):284-289.
[36]税毅冬,尹玲,刘健佳,等.杵针对缓解神经根型颈椎病疼痛的效果观察[J].四川中医,2017,35(3):189-190.
[37]李淑仁,钟枢才,周信华,等.李仲愚杵针疗法治疗胃脘痛65例临床观察[J].成都中医药大学学报,1996,19(3):16-17,56.
[38]沈音丽,郭鸿,王洁莹,等.杵针疗法联合膀胱功能训练干预神经源性膀胱的临床研究[J].四川中医,2017,35(9):175-177.
[39]刘晓玲,梁凡,王欣欣,等.杵针疗法的临床研究进展[J].四川中医,2015,33(7):190-191.
[40]刘栩豪,余洋,钟磊,等.应用TTM评价杵针治疗寒湿型腰腿痛的临床疗效研究[J].针灸临床杂志,2016,32(9):54-57.
[41]晋松,孙剑峰,郭鸿,等.杵针疗法调理背俞穴治疗外感发热[J].四川中医,2016,34(8):38-40.
[2]周健,吕强,张宏.主动运动疗法对颈椎病的干预现状[J].中国医药导报,2016,13(4):49-52.
[3]王庆甫.中医筋伤学[J].北京:中国中医药出版社,2014,319.
[4]卢志明,唐占英,叶秀兰,等.颈椎病的发病机理及传统手法治疗研究进展[J].中国中医骨伤科杂志,2011,19(1):61-64.
[5]张丽美,师彬.颈椎病中医辨证分型及中药治疗研究进展[J].中成药,2013,35(7):1522-1525.
[6]周海华,郭少英.颈椎病的中医外治法研究进展[J].现代中西医结合杂志,2014,23(4):449-451.
[7]张亚敏,孙华.颈椎病针灸干预临床研究进展[J].针灸临床杂志,2013,29(9):62-64.
[8] WANG C,TIAN F,ZHOU Y,et al. The incidence of cervical spondylosis decreases with aging in the elderly,and increases with aging in the young and adult population:a hospital-based clinical analysis[J]. Clin Interv Aging,2016,11:47-53.
[9] QUE Q,YE X,SU Q,et al. Effectiveness of acupuncture intervention for neck pain caused by cervical spondylosis:study protocol for a randomized controlled trial[J].Trials,2013,14:186.
[10] STRINE TW,HOOTMAN JM. US national prevalence and correlates of low back and neck pain among adults[J]. Arthritis Rheum,2007,57(4):656-665.
[11]张尚省,樊成虎.中医治疗青少年颈椎病研究进展[J].亚太传统医药,2016,12(19):66-68.
[12]马明,张世民.青年颈椎病的研究进展[J].中国骨伤,2014,27(9):792-795.
[13]柯尊华,王静怡.颈椎病流行病学及发病机理研究进展[J].颈腰痛杂志,2014,35(1):62-64.
[14]洪小萍,李世斌,连艺杰.中医药治疗颈椎病的现状分析[J].福建医药杂志,2016,38(4):138-139.
[15]王浩然,贾红玲,张永臣.颈椎病针刺机制研究进展[J].山东中医药大学学报,2015,39(6):576-578.
[16] WANG MY,TSAI PS,LEE PH,et al. Systematic review and meta-analysis of the efficacy of tuina for cervical spondylosis[J]. J Clin Nurs,2008,17(19):2531-2538.
[17]申治富,余思奕,胡幼平.杵针疗法的理论及临床运用[J].上海针灸杂志,2015,34(6):575-578.
[18]刘栩豪,余洋,钟磊,等.杵针腰阳关八阵、河车命强段治疗腰痹病31例[J].中国针灸,2016,36(3):295-298.
[19]刘全让,钟枢才.李仲愚主任医师杵针疗法经验[J].成都中医药大学学报,1996,19(3):6-7.
[20]钟枢才,刘全让.李仲愚老先生的杵针疗法浅析[J].中医教育,1994,13(6):43,45.
[21] HU Y,LI Z,MI DH,et al. Chemoradiation combined with regional hyperthermia for advanced oesophageal cancer:a systematic review and meta-analysis[J]. J Clin Pharm Ther,2017,42(2):155-164.
[22] LI Z,YANG KH,MI DH,et al. The research about guidance of systematic review for clinical study[J]. Cochrane Database Syst Rev,2012:107.
[23]钟枢才.杵针学[M].北京:中国中医药出版社,2006,1-136.
[24]李仲愚.杵针治疗学[M].钟枢才,李淑仁整理.成都:四川科学技术出版社,1990,1-349.
[25] LI Z,MI DH,YANG KH,et al. Comparison between Autocad and Draftsight in data extraction[J]. Cochrane Database Syst Rev,2013:56.
[26] LI Z,YANG KH,MI DH,et al. The method of exracting data from figure with software[J]. Cochrane Database Syst Rev,2012:104.
[27]胡月,李征,曲雁,等.胸腔化疗联合热疗治疗癌性胸腔积液有效性和安全性的Meta分析[J].中国全科医学,2017,20(32):4034-4041.
[28]胡月,李征,曲雁,等.热疗综合疗法治疗原发性鼻咽癌的系统评价[J].循证医学,2015,15(2):96-101,107.
[29]蒋振亚,李常度.杵针大椎八阵穴为主治疗颈椎病的临床观察[J].中国针灸,2001,21(2):94-96.
[30]李少华.杵针“大椎八阵”穴治疗神经根型颈椎病的临床研究[D].成都:成都中医药大学,2009.
[31]苏敏.杵针疗法治疗椎动脉型颈椎病的临床疗效观察[C]//第二届全国民间中医药开发工程大会论文集.中山:出版者不详,2014:158-160.
[32]刘泽恩.杵针结合蜡疗治疗混合型颈椎病疗效观察[J].实用中医药杂志,2015,31(2):130.
[33]董远蔚,杨斐,钟磊.杵针配合牵引治疗颈性眩晕[J].吉林中医药,2016,36(4):417-418.
[34]杜越,杨斐,董远蔚,等.杵针治疗颈性眩晕临床疗效观察[J].医学信息,2016,29(12):286-287.
[35] WANG YZ,ZHONG L,WU ZJ,et al. Efficacy study on pestle needle combined with Chinese herbal fumigation for cervical spondylosis[J]. J Acupunct Tuina Sci,2016,14(4):284-289.
[36]税毅冬,尹玲,刘健佳,等.杵针对缓解神经根型颈椎病疼痛的效果观察[J].四川中医,2017,35(3):189-190.
[37]李淑仁,钟枢才,周信华,等.李仲愚杵针疗法治疗胃脘痛65例临床观察[J].成都中医药大学学报,1996,19(3):16-17,56.
[38]沈音丽,郭鸿,王洁莹,等.杵针疗法联合膀胱功能训练干预神经源性膀胱的临床研究[J].四川中医,2017,35(9):175-177.
[39]刘晓玲,梁凡,王欣欣,等.杵针疗法的临床研究进展[J].四川中医,2015,33(7):190-191.
[40]刘栩豪,余洋,钟磊,等.应用TTM评价杵针治疗寒湿型腰腿痛的临床疗效研究[J].针灸临床杂志,2016,32(9):54-57.
[41]晋松,孙剑峰,郭鸿,等.杵针疗法调理背俞穴治疗外感发热[J].四川中医,2016,34(8):38-40.