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Meta analysis of efficacy and safety of pulling manipulation in the treatment of cervical spondylotic radiculopathy and evaluation of GRADE evidence level
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DOI   10.11656/j.issn.1672-1519.2023.05.15
Key Words   pulling manipulation;cervical spondylotic radiculopathy;Meta analysis;GRADE evaluation
Author NameAffiliationE-mail
WANG Huaijing First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300381, China  
FU Bifeng First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300381, China
Department of Orthopedics, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Administration of Traditional Chinese Medicine Regional Orthopedics and Traumatology Diagnosis and Treatment Center, Tianjin 300381, China 
 
DING Shaojie First Department of Acupuncture and Moxibustion, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin 300120, China  
LI Yuandong First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300381, China
Department of Orthopedics, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Administration of Traditional Chinese Medicine Regional Orthopedics and Traumatology Diagnosis and Treatment Center, Tianjin 300381, China 
 
YANG Guang First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300381, China
Department of Orthopedics, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Administration of Traditional Chinese Medicine Regional Orthopedics and Traumatology Diagnosis and Treatment Center, Tianjin 300381, China 
 
WANG Ping First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300381, China
Department of Orthopedics, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Administration of Traditional Chinese Medicine Regional Orthopedics and Traumatology Diagnosis and Treatment Center, Tianjin 300381, China 
yfywangping@sina.com 
FENG Minshan Second Spine Department, Wangjing Hospital of China Academy of Chinese Medical Science, Beijing 100102, China  
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.

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