神经根病患者治疗策略的疗效:网络荟萃分析。

The effectiveness of therapeutic strategies for patients with radiculopathy: A network meta-analysis.

机构信息

1 Department of General Rehabilitation, Capital Medical University School of Rehabilitation Medicine, China Rehabilitation Research Center, Beijing Boai Hospital, Beijing, China.

2 Community Chronic Disease Research Center, Institute of Chinese Basic Clinical Medicine, 71046 China Academy of Chinese Medical Sciences , Beijing, China.

出版信息

Mol Pain. 2018 Jan-Dec;14:1744806918768972. doi: 10.1177/1744806918768972.

Abstract

Objectives The aim of this network meta-analysis is to assess the effectiveness of therapeutic strategies for patients with radiculopathy, including physical, medical, surgical, and other therapies. Methods We electronically searched electronic databases including PubMed and Embase for randomized controlled trials. The response rate and visual analog scale of pain change were considered as primary outcomes. The outcomes were measured by odds ratio (OR) value and corresponding 95% credible intervals (CrIs) or standardized mean difference (MD) with 95% CrIs. Besides, surface under cumulative ranking curve (SUCRA) were performed to rank efficacy and safety of treatments on each end points. Results A total of 16 eligible studies with 1071 subjects were included in this analysis. Our results showed that corticosteroid was significantly more effective than control regarding the response rate (OR = 3.86, 95% CrI: 1.16, 12.55). Surgery had a better performance in pain change compared with control (MD = -1.92, 95% CrI: -3.58, -0.15). According to the SUCRA results, corticosteroid, collar, and physiotherapy ranked the highest concerning response rate (SUCRA = 0.656, 0.652, and 0.610, respectively). Surgery, traction, and corticosteroid were superior to others in pain change (SUCRA = 0.866, 0.748, and 0.589, respectively). Conclusion According to the network meta-analysis result, we recommended surgery as the optimal treatment for radiculopathy patients; traction and corticosteroids were also recommended for their beneficial interventions.

摘要

目的

本网状荟萃分析旨在评估神经根病患者的治疗策略的有效性,包括物理、医学、手术和其他治疗方法。

方法

我们电子检索了包括 PubMed 和 Embase 在内的电子数据库,以寻找随机对照试验。反应率和疼痛变化视觉模拟量表被视为主要结局。通过比值比(OR)值和相应的 95%可信区间(CrI)或标准化均数差(MD)和 95%CrI 来衡量结果。此外,还进行了累积排序曲线下面积(SUCRA)分析,以对每种治疗方法的疗效和安全性进行排名。

结果

共有 16 项符合纳入标准的研究,共纳入 1071 例患者。我们的结果表明,皮质类固醇在反应率方面明显优于对照组(OR=3.86,95%CrI:1.16,12.55)。手术在疼痛变化方面的表现优于对照组(MD=-1.92,95%CrI:-3.58,-0.15)。根据 SUCRA 结果,皮质类固醇、颈托和物理治疗在反应率方面排名最高(SUCRA=0.656、0.652 和 0.610)。手术、牵引和皮质类固醇在疼痛变化方面优于其他治疗方法(SUCRA=0.866、0.748 和 0.589)。

结论

根据网络荟萃分析结果,我们推荐手术作为神经根病患者的最佳治疗方法;牵引和皮质类固醇也因其有益的干预而被推荐。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eacc/5900815/e0f575986510/10.1177_1744806918768972-fig1.jpg

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