Sun Jigao, Zhao Yan, Zhu Ruizheng, Chen Qianglong, Song Mengge, Xue Zhipeng, Wang Rongtian, Chen Weiheng
The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China.
Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
Evid Based Complement Alternat Med. 2020 Oct 31;2020:2168283. doi: 10.1155/2020/2168283. eCollection 2020.
We performed a comprehensive search on PubMed, the Cochrane Library, EMBASE, and four Chinese databases for articles published prior to June 2020. We included only randomized controlled trials (RCTs) that used acupotomy therapy as the major intervention in adults with knee OA, were published in either Chinese and English, included more than 20 subjects in each group, and included pain and function in the outcome measures. Knee OA was defined by the American College of Rheumatology or Chinese Orthopedic Association criteria in all studies. We extracted the visual analogue scale (VAS) pain score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score, the total effectiveness rate, the modified Japanese Orthopedic Association (JOA) activities of daily living score, and Lysholm's score. We calculated the mean difference (MD) or risk ratio (RR) for all relevant outcomes. Meta-analyses were conducted using random-effects models when appropriate.
We identified 1317 potentially relevant studies, thirty-two of which met the eligibility criteria and were conducted in China between 2007 and 2020. A total of 3021 knee OA patients (62.96% female, median age: 57 years, and median disease duration: 33 months) were included. The treatment duration ranged from 1 week to 5 weeks (median: 3 weeks). The typical acupotomy treatment involved releasing soft tissue adhesions and was performed once a week for 1-5 weeks until the pain was relieved. The control group treatments included acupuncture (8 studies), electroacupuncture (10 studies), sodium hyaluronate (8 studies), radiofrequency electrotherapy (1 study), and nonsteroidal anti-inflammatory drugs (NSAIDs, 5 studies). The results from the meta-analysis showed that acupotomy led to superior improvements in the VAS pain score (MD = -1.11; 95% confidence interval (CI), -1.51 to -0.71; < 0.00001) and WOMAC pain score (MD = -2.32; 95% CI, -2.94 to -1.69; < 0.00001), a higher total effectiveness rate (RR = 1.15; 95% CI, 1.09-1.21; < 0.00001), and superior improvements in the JOA score (MD = 6.39; 95% CI, 4.11-9.76; < 0.00001) and Lysholm's score (MD = 12.75; 95% CI, 2.61-22.89; = 0.01) for overall pain and function. No serious adverse events were reported.
Chinese acupotomy therapy may relieve pain and improve function in patients with knee OA. Furthermore, rigorously designed and well-controlled RCTs are warranted.
我们在PubMed、Cochrane图书馆、EMBASE以及四个中文数据库中进行了全面检索，以查找2020年6月之前发表的文章。我们仅纳入了以针刀疗法作为主要干预措施的随机对照试验（RCT），这些试验针对的是成年膝骨关节炎患者，发表语言为中文或英文，每组受试者超过20例，且结局指标包括疼痛和功能。所有研究中膝骨关节炎均根据美国风湿病学会或中国骨科协会的标准进行定义。我们提取了视觉模拟评分法（VAS）疼痛评分、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）疼痛评分、总有效率、改良日本骨科协会（JOA）日常生活活动评分以及Lysholm评分。我们计算了所有相关结局的平均差（MD）或风险比（RR）。在适当情况下，使用随机效应模型进行荟萃分析。
我们识别出1317项可能相关的研究，其中32项符合纳入标准，这些研究于2007年至2020年在中国开展。共纳入3021例膝骨关节炎患者（女性占62.96%，中位年龄：57岁，中位病程：33个月）。治疗持续时间为1周至5周（中位值：3周）。典型的针刀治疗包括松解软组织粘连，每周进行1次，共进行1 - 5周，直至疼痛缓解。对照组治疗包括针灸（8项研究）、电针（10项研究）、透明质酸钠（8项研究）、射频电疗（1项研究）以及非甾体抗炎药（NSAIDs，5项研究）。荟萃分析结果显示，针刀疗法在VAS疼痛评分（MD = -1.11；95%置信区间（CI），-1.51至-0.71；P < 0.00001）和WOMAC疼痛评分（MD = -2.32；95% CI，-2.94至-1.69；P < 0.00001）方面有更显著的改善，总有效率更高（RR = 1.15；95% CI，1.09 - 1.21；P < 0.00001），并且在JOA评分（MD = 6.39；95% CI，4.11至9.76；P < 0.00001）和Lysholm评分（MD = 12.75；95% CI，2.61至22.89；P = 0.01）方面，在总体疼痛和功能改善上更优。未报告严重不良事件。
中医针刀疗法可能缓解膝骨关节炎患者的疼痛并改善其功能。此外，需要开展设计严谨且控制良好的随机对照试验。
