Department of Acupotomy Chiropractors, The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang 330006, China.
Jiangxi Normal University, Nanchang 330022, China.
J Tradit Chin Med. 2020 Jun;40(3):355-364. doi: 10.19852/j.cnki.jtcm.2020.03.002.
To evaluate the clinical efficacy and safety of acupotomy in treatment of knee osteoarthritis (OA).
Extensive literature searches were carried out in PubMed, EMBASE, Cochrane Library (Issue 5, 2017), Chinese Biomedical Literature Database, China National Knowledge Infrastructure Database, China Science and Technology Journal Database and Wanfang Database. All databases were retrieved from their inception until May 31, 2017. Randomized controlled trials incorporating acupotomy versus intra-articular sodium hyaluronate for knee osteoarthritis were included. According to Cochrane Reviews' Handbook (5.2), two reviewers screened each article and extracted data independently and were blinded to the findings of each reviewer. Meta-analysis was performed by the Cochrane Collaboration's RevMan 5.3 software.
We identified 12 studies involving 1150 patients aged between 40 and 78 years old. The pooled analysis indicated that acupotomy showed a significant improvement for short-term effect [cure rate: odds ratio (OR) = 2.04, 95% confidence interval (CI) (1.46, 2.85), P < 0.01; total effective rate: OR = 2.25, 95% CI (1.55, 3.28), P < 0.01; pain score: standard mean difference (SMD) = －1.02; 95% CI (－1.72, －0.31); P = 0.005; Western Ontario and McMaster Universities Questionnaire (WOMAC) score: SMD = －0.74; 95% CI (－1.11, －0.37); P < 0.01]; and also for long-term effect [total effective rate: OR = 2.99, 95%CI (1.88, 4.76), Z = 4.64, P < 0.01; pain score: SMD = －1.68; 95% CI (－2.14, －1.22); P < 0.001; WOMAC score: SMD = －0.91; 95% CI (－1.40, －0.41); P < 0.001]. In addition, there was no obvious difference between acupotomy group and control group in adverse events [OR = 2.13, 95%CI (0.14, 32.28), P = 0.58].
Acupotomy is a safe and effective treatment for KOA. However, due to the methodological deficiency of the included studies, well-designed randomized controlled trials are required to further confirm the findings.
评价针刀治疗膝骨关节炎（OA）的临床疗效和安全性。
在 PubMed、EMBASE、Cochrane 图书馆（2017 年第 5 期）、中国生物医学文献数据库、中国知网数据库、中国科技期刊数据库和万方数据库中进行广泛的文献检索。所有数据库均从其建立到 2017 年 5 月 31 日进行检索。纳入针刀与关节内透明质酸钠治疗膝骨关节炎的随机对照试验。根据 Cochrane 系统评价手册（5.2），两名评审员独立筛选每篇文章并提取数据，对每篇评审员的发现均保持盲态。采用 Cochrane 协作网 RevMan 5.3 软件进行荟萃分析。
我们共确定了 12 项研究，涉及 1150 名年龄在 40 至 78 岁之间的患者。荟萃分析表明，针刀治疗在短期疗效[治愈率：比值比（OR）=2.04，95%置信区间（CI）（1.46，2.85），P<0.01；总有效率：OR=2.25，95%CI（1.55，3.28），P<0.01；疼痛评分：标准化均数差（SMD）=-1.02；95%CI（-1.72，-0.31）；P=0.005；西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分：SMD=-0.74；95%CI（-1.11，-0.37）；P<0.01]和长期疗效[总有效率：OR=2.99，95%CI（1.88，4.76），Z=4.64，P<0.01；疼痛评分：SMD=-1.68；95%CI（-2.14，-1.22）；P<0.001；WOMAC 评分：SMD=-0.91；95%CI（-1.40，-0.41）；P<0.001]方面均具有显著优势。此外，针刀组与对照组在不良事件方面无明显差异[OR=2.13，95%CI（0.14，32.28），P=0.58]。
针刀治疗膝骨关节炎安全有效。但是，由于纳入研究的方法学缺陷，需要进行精心设计的随机对照试验来进一步证实这些发现。
