1. 同济大学附属上海市第四人民医院中医科,上海,200081
2. 上海中医药大学附属龙华医院脊柱病研究所,上海,200032
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陈柯村, 施杞, 朱穆朗玛, 等. 旋转牵伸类手法治疗冻结肩的系统评价与Meta分析[J]. 上海中医药杂志, 2019,53(8):15-21.
CHEN Kecun, SHI Qi, ZHU Mulangma, et al. Rotary drawing manipulation in treatment of frozen shoulder:ameta-analysis and systematic evaluation[J]. Shanghai Journal of Traditional Chinese Medicine, 2019,53(8):15-21.
陈柯村, 施杞, 朱穆朗玛, 等. 旋转牵伸类手法治疗冻结肩的系统评价与Meta分析[J]. 上海中医药杂志, 2019,53(8):15-21. DOI: 10.16305/j.1007-1334.2019.08.004.
CHEN Kecun, SHI Qi, ZHU Mulangma, et al. Rotary drawing manipulation in treatment of frozen shoulder:ameta-analysis and systematic evaluation[J]. Shanghai Journal of Traditional Chinese Medicine, 2019,53(8):15-21. DOI: 10.16305/j.1007-1334.2019.08.004.
目的:系统评价旋转牵伸类手法治疗冻结肩的有效性及安全性。 方法:计算机检索2007年至2017年期间Pubmed、Cochrane library、Embase、CBM、CNKI、VIP、万方等国内外数据库收录的有关旋转牵伸类手法治疗冻结肩的临床随机对照试验(RCT)文献,并按照纳入标准与排除标准人工筛选出最终文献,提取有效数据,采用Cochrane系统评价方法对纳入的研究进行质量评价,并采用RevMan5.3软件进行数据的Meta分析。 结果:①最终纳入10篇RCT文献,共涉及1 084例冻结肩患者。②纳入的10个研究中,大多数对方法学中的分配隐藏、盲法、失访与退出标准描述不清楚或未描述,总体文献的质量较低。③Meta分析结果显示,治疗组(旋转牵伸类手法治疗)在提高总有效率[RR=1.19,95%CI为(1.10,1.29),P<0.000 1]、痊愈率及改善VAS评分[手法vs针灸:WMD=-0.73,95%CI(-1.08,-0.39),P<0.000 1;手法vs封闭:WMD=-1.50,95%CI(-1.88,-1.12);Z=7.79,P<0.000 01]方面,优于对照组(其他非药物疗法)。 结论:旋转牵伸类手法可以显著改善冻结肩患者的临床症状,疗效优于其他非药物疗法。但由于纳入文献的方法学质量不高,且研究之间自身也有不小的差异,故本研究结论未来仍需开展更多设计更严格的大样本、多中心的临床随机对照试验进一步验证。
Objective:To systematically evaluate the effectiveness and safety of rotary drawing manipulation in the treatment of frozen shoulder. MethodsLiteratures about clinical randomized controlled trials (RCTs) on rotary drawing manipulation for frozen shoulder were electronically searched from Pubmed, Cochrane library, Embase, CBM, CNKI, VIP, WANGFANG and other databases at home and abroad from 2007 to 2017, and final literatures were manually selected based on inclusion and exclusion criteria to extract valid data. Quality evaluation was performed on the included studies by the Cochrane systematic evaluation method, and meta-analysis was conducted on data using the RevMan 5.3 software. Results:①Ten RCT literatures involving 1084 patients with frozen shoulder were included. ②Most of the 10 studies included did not describe or were not clear about the criteria of assignment masking, blinding, being lost to follow-up or withdrawal, and the overall quality of literatures was low. ③Meta-analysis showed that the treatment group (rotary drawing manipulation therapy) was superior to the control group (other non-drug therapy) in increasing the total effective rate [RR=1.19,5% CI (1.10,1.29), P<0.000 1], the curative rate [RR=1.42,5% CI (1.05,1.92), P=0.02] and improving the VAS score [manipulation vs acupuncture and moxibustion:WMD=-0.73,5% CI (-1.08, -0.39), P<0.000 1; manipulation vs block:WMD=-1.50,5% CI (-1.88, -1.12); Z=7.79, P<0.000 01]. Conclusion:Rotary drawing manipulation therapy improves the symptoms of frozen shoulder, with efficacy superior to the other non-drug therapies. However, more multi-center randomized controlled trials with a larger sample size are needed to further confirm the conclusion due to the poor quality of methodology for including the literatures and the differences among the studies included.
手法治疗推拿肩关节周围炎系统评价Meta分析
manipulation therapymassagefrozen shouldersystematic evaluationMeta-analysis
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