比较温针灸与其他物理疗法治疗腰椎间盘突出症的疗效：一项荟萃分析。
Comparison of Needle-Warming Moxibustion and Other Physical Therapies for Lumbar Disc Herniation: A Meta-analysis.
机构信息
Department of Surgery, Haikou Hospital of Traditional Chinese Medicine, Haikou 570216, China.
Nursing Department, Haikou Hospital of Traditional Chinese Medicine, Haikou 570216, China.
出版信息
Comput Math Methods Med. 2022 Jul 28;2022:2986223. doi: 10.1155/2022/2986223. eCollection 2022.
BACKGROUND
Needle-warming moxibustion (NWM) demonstrates a controversial effect on lumbar disc herniation (LDH). This study is aimed at comparing the efficacy of NWM and conventional acupuncture or other physical therapies on LDH through a meta-analysis.
METHODS
Potentially eligible literatures were retrieved and screened from electronic databases. The subject of the literature was a comparison of NWM and conventional acupuncture or other physical therapies for LDH. The methodological quality was evaluated by the Jadad scale. The chi-square test was used for the heterogeneity test. Subgroup analysis was used to explore the source of heterogeneity. Risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI) was used to describe the effect size. The publication bias was evaluated by Egger's test.
RESULTS
The effective rate of NWM in the treatment of LDH was significantly higher than that of conventional acupuncture (RR = 1.27, 95%CI [1.18, 1.36], < 0.00001) and lumbar traction (RR = 1.12, 95%CI [1.06, 1.18], < 0.0001) There was no significant difference in the effective rate between NWM and electric acupuncture for LDH (RR = 1.06, 95%CI [0.98, 1.14], = 0.17). VAS of LDH patients treated with NWM was lower than conventional acupuncture (MD = -1.51, 95%CI [-1.70, -1.31], < 0.00001) and lumbar traction (MD = -2.64, 95%CI [-2.79, -2.49], < 0.00001) but statistically insignificant with electric acupuncture (MD = -0.31, 95%CI [-0.72, 0.09], = 0.13). JOA scores of LDH patients treated with NWM were higher than those with conventional acupuncture (MD = 2.24, 95%CI [1.04, 3.45], = 0.0003) and lumbar traction (MD = 10.76, 95%CI [10.45, 11.07], < 0.00001) but statistically insignificant with electric acupuncture (MD = 0.25, 95%CI [-0.95, 1.45], = 0.69). The long-term effective rate of NWM on LDH was higher than that of conventional acupuncture (MD = 3.13, 95%CI[2.12, 4.61], < 0.00001). In this study, no heterogeneity ( > 0.10, < 50%) and publication bias ( > 0.05) among the literature were noted.
CONCLUSION
The effect of NWM on LDH was superior to traction therapy and conventional acupuncture therapy, but similar to electric acupuncture for LDH. High-quality randomized controlled trials were still needed to confirm the results.
背景
温针灸治疗腰椎间盘突出症（LDH）的效果存在争议。本研究旨在通过荟萃分析比较温针灸与常规针刺或其他物理疗法治疗 LDH 的疗效。
方法
从电子数据库中检索并筛选出潜在符合条件的文献。文献的主题是比较温针灸与常规针刺或其他物理疗法治疗 LDH 的疗效。采用 Jadad 量表评价方法学质量。采用卡方检验进行异质性检验。采用亚组分析探讨异质性的来源。采用风险比（RR）或均数差（MD）及其 95%置信区间（CI）表示效应量。采用 Egger 检验评估发表偏倚。
结果
温针灸治疗 LDH 的有效率明显高于常规针刺（RR=1.27，95%CI[1.18，1.36]， < 0.00001）和腰椎牵引（RR=1.12，95%CI[1.06，1.18]， < 0.0001），但与电针治疗 LDH 的有效率差异无统计学意义（RR=1.06，95%CI[0.98，1.14]， = 0.17）。温针灸治疗 LDH 患者的视觉模拟评分（VAS）低于常规针刺（MD=-1.51，95%CI[1.70，-1.31]， < 0.00001）和腰椎牵引（MD=-2.64，95%CI[2.79，-2.49]， < 0.00001），但与电针差异无统计学意义（MD=-0.31，95%CI[0.72，0.09]， = 0.13）。温针灸治疗 LDH 患者的日本骨科协会评估治疗分数（JOA）高于常规针刺（MD=2.24，95%CI[1.04，3.45]， = 0.0003）和腰椎牵引（MD=10.76，95%CI[10.45，11.07]， < 0.00001），但与电针差异无统计学意义（MD=0.25，95%CI[-0.95，1.45]， = 0.69）。温针灸治疗 LDH 的远期有效率高于常规针刺（MD=3.13，95%CI[2.12，4.61]， < 0.00001）。本研究中，文献无明显异质性（ > 0.10， < 50%）和发表偏倚（ > 0.05）。
结论
温针灸治疗 LDH 的效果优于牵引疗法和常规针刺疗法，但与电针治疗 LDH 的效果相似。仍需要高质量的随机对照试验来证实这些结果。
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