扳动类手法治疗神经根型颈椎病的有效性和安全性Meta分析及GRADE证据等级评价

Meta analysis of efficacy and safety of pulling manipulation in the treatment of cervical spondylotic radiculopathy and evaluation of GRADE evidence level

关键词:  扳动类手法  神经根型颈椎病  Meta分析  GRADE评价

Key words:  pulling manipulation  cervical spondylotic radiculopathy  Meta analysis  GRADE evaluation

摘要:

[目的] 系统评价扳动类手法治疗神经根型颈椎病的临床有效性及安全性。[方法] 检索数据库自建库以来至2021年12月中英文献数据库（中国知网、万方数据库、维普数据库、中国生物医学文献数据库、Pubmed、EMbase、The Cochrane Library）符合纳入排除标准的扳动类手法治疗神经根型颈椎病的随机对照试验（RCT），并提取文献数据，用改良Cochrane偏倚风险评估工具对文献质量进行评价，用RevMan5.3对临床总有效率、视觉模拟量表（VAS）评分、田中靖久35分积分法、颈椎病治疗成绩评分改善率、辅助检查结果、不良反应等结局指标进行Meta分析，并对文献数目≥10的结局指标作发表偏倚分析，以GRADE标准对结局指标进行证据质量评价。[结果] 纳入17项研究，总样本量1 833例，试验组927例，对照组906例。Meta分析结果显示：临床总有效率[RR=1.25，95%CI（1.20，1.31），P < 0.000 01]，VAS评分[WMD=-1.38，95%CI（-1.90，-0.86），P＜0.000 01]，田中靖久35分积分法[WMD=-2.72，95%CI（-3.29，-2.15），P＜0.000 01]，颈椎病治疗成绩评分[SMD=1.09，95%CI（0.58，1.61），P＜0.000 1]，辅助检查结果[SMD=0.74，95%CI（0.20，1.28），P=0.008]，不良反应[RR=，95%CI0.48（0.21，1.09），P=0.08]。在临床总有效率、VAS评分、田中靖久35分积分法、辅助检查结果、颈椎病治疗成绩评分手法组疗效优于对照组，不良反应发生数目方面差异无统计学意义。[结论] 扳动类手法可以提高神经根型颈椎病的临床疗效，但不良反应与牵引相比无统计学差异。

Abstract:

[Objective] To systematically evaluate the clinical efficacy and safety of pulling manipulation in the treatment of cervical spondylotic radiculopathy.[Methods] From the establishment of the database to December 2021, the literature database (CNKI, Wanfang, VIP, CBM, PubMed, EMBASE, the Cochrane Library) was searched, and the literature data were extracted, the literature quality was evaluated with the improved Cochrane bias risk assessment tool, and revman5.3 meta analysis was made on the total clinical effective rate, visual analogue scale (VAS) score, Tanaka Jingjiu 35 point integral method, improvement rate of cervical spondylosis treatment score, auxiliary examination results and adverse reaction outcome indicators, publication bias analysis was made on the outcome indicators with the number of literature ≥10, and the evidence quality of the outcome indicators was evaluated by GRADE standard.[Results] The 17 studies were included, with a total sample size of 1 833, 927 cases in the experimental group and 906 cases in the control group. Meta analysis showed that the total clinical effective rate [RR=1.25, 95%CI(1.20, 1.31), P < 0.000 01], VAS score [WMD=-1.38, 95%CI(-1.90, -0.86), P < 0.000 01], Tanaka Jingjiu 35 point integral method [WMD=-2.72, 95%CI(-3.29, -2.15), P < 0.000 01], cervical spondylosis treatment score [SMD=1.09, 95%CI(0.58, 1.61), P < 0.000 1], auxiliary examination results [SMD=0.74, 95%CI(0.20, 1.28), P=0.008], adverse reactions [RR=0.48, 95%CI(0.21, 1.09), P=0.08]. In the total clinical efficiency, VAS score, Tanaka Jingjiu 35 point integral method, auxiliary examination results and cervical spondylosis treatment score, the curative effect of the manipulation group was better than that of the control group, and there was no significant difference in the number of adverse reactions.[Conclusion] Pulling manipulation can improve the clinical efficacy of cervical spondylotic radiculopathy, but there is no significant statistic difference in adverse reactions compared with traction.