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成年人半月板损伤引起的疼痛的比较效果:系统评价和网络荟萃分析。

Comparative effects on pain arising from injury to the knee meniscus in adults: A systematic review and network meta-analysis.

机构信息

Shanghai Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, P.R. China.

Sichuan Provincial Hospital for Women and Children, Chengdu, P.R. China.

出版信息

Clin Rehabil. 2021 Jun;35(6):801-811. doi: 10.1177/0269215520976649. Epub 2020 Nov 30.

Abstract

OBJECTIVE

To identify the most effective pain management method for meniscus injuries by comparing pain relief observed with several common interventions including combined different combinations of surgery and exercise, surgery alone, supervised exercise alone and home exercise alone.

METHODS

PubMed, Embase, CINAHL, Cochrane Library, Web of Science, SportDiscus, and PEDro were searched from database inception through October 15, 2020. Randomized controlled trials investigating the effect of surgery and exercise for meniscus injuries by using the visual analogue scale (VAS) assessment were eligible for inclusion. Primary outcome was mean change in VAS score from baseline. Comparisons between interventions were made through use of random-effects network meta-analysis over the short-term (three months) and mid-term (12 months). Relative ranking of therapies was assessed by the surface-under-the-cumulative ranking possibilities. All reference lists of included studies were hand-searched.

RESULTS

We investigated six RCTs (total  = 796 patients). No significant difference was found between different treatments of pain control in three months and 12 months. The surface under the cumulative ranking curves suggested that supervised exercise combined with surgery was considered most likely to overshadow other treatments in reducing short-term pain (surface under cumulative ranking curve (SUCRA) values: 98.1; mean ranks: 1.1) and mid-term pain (SUCRA values: 97.2; mean rank: 1.1).

CONCLUSION

There is not sufficient evidence to identify any preferred or more effective surgical and/or exercise-based treatment program.

摘要

目的

通过比较几种常见干预措施(包括手术和运动的不同组合、单纯手术、监督运动和家庭运动)的缓解疼痛效果,确定治疗半月板损伤最有效的疼痛管理方法。

方法

从数据库建立到 2020 年 10 月 15 日,在 PubMed、Embase、CINAHL、Cochrane 图书馆、Web of Science、SportDiscus 和 PEDro 上进行检索。纳入研究使用视觉模拟评分(VAS)评估半月板损伤手术和运动效果的随机对照试验。主要结局为 VAS 评分从基线的平均变化。通过使用短期(3 个月)和中期(12 个月)的随机效应网络荟萃分析,对干预措施进行比较。通过累积排序概率曲线下面积评估治疗方法的相对排名。纳入研究的所有参考文献均进行手工检索。

结果

我们调查了六项 RCT(总计 796 名患者)。在 3 个月和 12 个月时,不同疼痛控制治疗方法之间没有发现显著差异。累积排序概率曲线下面积表明,监督运动与手术相结合在减轻短期疼痛方面最有可能优于其他治疗方法(累积排序概率曲线下面积值:98.1;平均秩:1.1)和中期疼痛(累积排序概率曲线下面积值:97.2;平均秩:1.1)。

结论

没有足够的证据表明任何手术和/或基于运动的治疗方案更具优势或更有效。

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