[1]许 辉,肖涟波△,康冰心,等.推拿手法治疗膝骨性关节炎临床疗效及安全性Meta分析*[J].陕西中医,2019,(12):1807-1813.
　XU Hui,XIAO Lianbo,KANG Bingxin,et al.Clinical efficacy and safety of Chinese Tuina in treating knee osteoarthritis Metaanalysis[J].,2019,(12):1807-1813.
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推拿手法治疗膝骨性关节炎临床疗效及安全性Meta分析*
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《陕西中医》[ISSN:1000-7369/CN:61-1281/TN]

卷:
期数:
2019年12期
页码:
1807-1813
栏目:
Meta 分析
出版日期:
2019-12-05

文章信息/Info

Title:
Clinical efficacy and safety of Chinese Tuina in treating knee osteoarthritis Metaanalysis
文章编号:
DOI:10.3969/j.issn.10007369.2019.12.041
作者:
许 辉1; 肖涟波2△; 康冰心1; 徐喜瑞1; 钟 声1; 邱国伟1; 施 杞3; 4
1.上海中医药大学附属光华医院(上海200050)；2.上海市光华中西医结合医院(上海 200050)；3.上海中医药大学附属龙华医院(上海200003)；4.上海中医药大学脊柱病研究所(上海 200003)
Author(s):
XU Hui; XIAO Lianbo; KANG Bingxin; et al.
Guanghua Hospital，Shanghai University of Chinese Medicine (Shanghai 200050)
关键词:
膝骨性关节炎; 针刺; 推拿; 手法; Meta分析; 随机对照试验
Keywords:
Key words Knee osteoarthritis; Acupuncture; Tuina; Manipulation; Metaanalysis; Randomized controlled trial
分类号:
R684
文献标志码:
A
摘要:
摘 要 目的：应用Meta分析方法评价推拿手法治疗膝骨性关节炎(KOA)的临床疗效及安全性。方法：检索国内外大型文献数据库中关于推拿手法治疗KOA的随机对照试验(RCT)文献，采用Cochrane系统评价的方法，以RevMan5.3软件对数据进行分析，GRADE系统对所得文献进行证据质量评价。结果：最终纳入17篇文献，共计1387例。Meta分析结果表明推拿手法治疗组和西药对照组在治疗KOA的VAS评分、不良反应方面无统计学差异(P＞005)。与西药对照组、针刺对照组和中药对照组相比，推拿手法治疗组的有效率较高\[(MD=2.30，95% CI (1.65，3.22)，P＜0.0001\]。与西药对照组相比，推拿手法治疗组的WOMAC评分改善更为明显\[MD=9.04，95% CI（16.71，1.36），P=0.02\]。GRADE证据质量评价系统显示文献总体质量偏低。结论：推拿手法治疗KOA有一定临床疗效，推拿手法与西药相比，在VAS评分、不良反应方面疗效相当，但在改善WOMAC评分方面疗效优于西药，在提高有效率方面推拿手法治疗组优于各对照组。同时研究表明推拿手法存在一定的不良反应，临床应用时应注意。
Abstract:
Abstract Objective：To evaluate the clinical efficacy and safety of Chinese Tuina in treating knee osteoarthritis(KOA) by Metaanalysis. Methods：Largescale literature database at home and abroad were searched to collect data of randomized controlled trial(RCT) with respect to Chinese Tuina for KOA according to Cochrane systematic review，and data analyses were performed by Revman 5.3 software and grading of evidence quality were assessed with the GRADE system. Results：A total of 17 RCTs involving 1387 cases were identified. Metaanalysis indicated that no statistically significant differences were found in both Chinese Tuina treatment group and western medicine control group regarding to VAS score and adverse reactions(P＞005).The effective rate of Chinese Tuina group was higher than that of western medicine control group，acupuncture control group and traditional Chinese medicine control group \[MD=2.30，95% CI （1.65，3.22），P＜0.0001\]. Compared with western medicine control group，the improvement of WOMAC score in Chinese Tuina group was more obvious \[MD=9.04，95% CI （16.71，1.36），P=0.02\]. GRADE evidence quality evaluation system shows that the overall quality of the results of this study is on the low side. Conclusion：Chinese Tuina is effective in treating KOA. Compared with western medicine，both groups show equivalent effects on VAS score and adverse reactions，and Chinese Tuina was better than western medicine in improving WOMAC score. Chinese Tuina was better than the control group in improving the effective rate. At the same time，the study shows that there are some adverse events in Chinese Tuina，which should be paid attention to in clinical use.

参考文献/References:

[1] Felson DT，Lawrence RC，Dieppe PA，et al. Osteoarthritis：new insights. Part 1：the disease and its risk factors[J].Annals of Internal Medicine,2000,133(8):635646.
[2] Price CC，Tanner JJ，Schmalfuss I，et al. A pliot study evaluating presurgery neumanan tomical hiomarjers for postoperative cognitive decline after total knee arthroplasty in older adults[J].Anesthesiology,2014,120(3):601613.
[3] Branco JC，Rodrigues AM，Gouveia N，et al. Prevalence of rheumatic and musculoskeletal diseases and their impact on healthrelated quality of life，physical function and mental health in Portugal：results from EpiReumaPta national health survey[J].RMD Open,2016,2(1):e166.
[4] Cross M，Smith E，Hoy D，et al.The global burden of hip and knee osteoarthritis：estimates from the global burden of disease 2010 study[J].Ann Rheum Dis,2014,73(7):13231330.
[5] 帖小佳,郑如庚,赵 梦,等.中国中老年人膝关节骨关节炎患病率的Meta分析[J].中国组织工程研究,2018,22(4):650656.
[6] Malfait AM. Osteoarthritis year in review 2015：biology[J].Osteoarthritis & Cartilage,2016,24(1):2126.
[7] Liu BR，Terkeltaub R. Emerging regulators of the inflammatory process in osteoarthritis[J].Nature Reviews Rheumatology,2015,11(1):3544.
[8] Vos T,Flaxman AD,Naghavi M,et al. Years lived withdisability(YLDs) for 1160 sequelae of 289 diseases and injuries19902010[J].Journal of the Faculty of Culture and Education,Saga University,2016,2(3):143181.
[9] Goldring SR，Goldring MB. Clinical aspects，pathology and pathophysiology of osteoarthritis[J].Journal of Musculoskeletal and Neuronal Interactions,2006,6(4):376378.
[10] Sofat N，Robertson SD，Wait R. Fibronectin III 1314 domains induce joint damage via Tolllike receptor 4 activation and synergize with interleukin1 and tumour necrosis factor[J].J Innate Immun,2012,4(1):6979.
[11] Hunter D，Arden N，Bannuru RR，et al. OARSI guidelines for the nonsurgical management of knee osteoarthritis[J].Osteoarthritis Cartilage,2014,22(3):363388.
[12] 秦宇航,林法财,王建珠,等.温补肝肾手法治疗膝骨性关节炎的临床观察[J].中国全科医学,2017,20(S3):386388.
[13] 张 超,王 平,张君涛,等.过伸过屈牵拉手法治疗早期膝关节骨性关节炎的效果及其机制[J].山东医药,2018,58(32):5860.
[14] 赵明宇,鲍铁周,赵 启,等.基于平乐正骨“筋滞骨错”理论推拿治疗膝关节骨性关节炎疗效评价[J].中华中医药杂志,2017,32(3):13721374.
[15] Higgins PT，Altman DG，Gotzscbe PC，et al. The cochrane collaboration’s tool for assessing risk of bias in randomised trials[J].BMJ,2011,343:d5928.
[16] Jadad AR，Moore RA，Carroll D，et al. Assessing the quality of reports of randomized clinical trials:is blinding necessary[J].Control Clin Trials,1996,17(1):112.
[17] Moher D，Liberati A，Tetzlaff J，et al. Preferred reporting items for systematic reviews and Meta  analyses：the prisma statement[J].PLoS Med,2009,6(7)：e1000097.
[18] 何 伟,方苏亭,王胜利,等.松凝分筋手法治疗膝关节骨性关节炎的临床研究[J].中国中医骨伤科杂志,2010,18(2):3031.
[19] 樊远志,龚 利,严隽陶,等.推拿治疗对膝骨关节炎患者股四头肌功能的影响[J].上海中医药杂志,2010,44(10):5760.
[20] 樊远志,房 敏,严隽陶,等.推拿手法对膝骨关节炎患者股四头肌肌力影响的临床研究[J].中医学报,2010,25(5):10071010.
[21] 廖康兴,王明杰.韦氏整治手法治疗老年膝骨性关节炎的临床研究[J].广州中医药大学学报,2010,27(6):572575.
[22] 冯学烽,韩清民,陈 宇.经筋手法治疗阳明经筋病膝骨性关节炎31例[J].河南中医,2011,31(4):404405.
[23] 王建国,何丽娟.推拿整复治疗膝骨关节炎疗效观察[J].中国医药指南,2012,10(3):231232.
[24] 杨志伟,孟 伟,张 弛.温经通络手法治疗膝关节骨性关节炎50例观察[J].实用中医药杂志，2014,30(4):320321.
[25] 刘顺超,汪崇淼,吴耀持.推拿改善退行性膝骨关节炎患者膝关节功能的临床研究[J].上海中医药杂志,2014,48(10):6263.
[26] 金成辉.夹胫推肘牵膝推拿法治疗膝骨关节炎临床研究[J].辽宁中医药大学学报,2015,17(2):170171.
[27] 吉海春,郑 肖,李庆兵,等.峨眉伤科推拿手法治疗膝关节骨性关节炎疗效观察[J].实用中医药杂志,2015,31(5):446.
[28] 陈 高.一指禅推法结合拔伸法对膝骨性关节炎疗效研究[D].广州：广州中医药大学,2015.
[29] 陈云建.针灸和手法治疗膝关节骨性关节炎的疗效比较[J].按摩与康复医学,2016,12(32):223224.
[30] 段长伟.理筋手法治疗膝关节骨性关节炎的临床研究[D].长春：长春中医药大学,2017.
[31] 刘志泓.推拿治疗肝肾亏虚型膝痹(膝骨性关节炎)的临床研究[D].广州：广州中医药大学,2017.
[32] Jin LL，Ma BT，Liu XL，et al. A randomized clinical trial assessment of nonsteroidal antiinflammatory drugs and Chinese bone setting manipulation therapy in knee osteoarthritis[J]. International Journal of Clinical and Experimental Medicine,2017,10(3):51065115.
[33] 袁 培,司井夫.基于“整体观念”推拿治疗膝骨关节炎的随机、阳性药平行对照临床研究[J].上海中医药杂志,2018,52(10):6066.
[34] 姚志城,吴奕豪.基于以筋代骨理论推拿治疗膝关节骨性关节炎临床观察[J].新中医,2018,50(5):101104.
[35] Gauchard GC，Vancon G，Meyer P，et al. On the role of knee joint in balance control and postural strategies：effects of total knee replacement in elderly subjects with knee osteoarthritis[J].Gait & Posture,2010,32(2):155160.
[36] Smith TO，Higson E，Pearson M，et al. Is there an increased risk of falls and fractures in people with early diagnosed hip and knee osteoarthritis? Data from the osteoarthritis initiative[J].Int J Rheum Dis,2018,21:11931201.
[37] Roos EM，Arden NK. Strategies for the prevention of knee osteoarthritis[J].Nature Reviews Rheumatology,2016,12(2):92102.
[38] Sharma L，Song J，Dunlop D，et al. Varus and valgus alignment and incident and progressive knee osteoarthritis[J].Arthritis＆Rheumatology,2017,69(11):19401945.
[39] Duymus TM，Mutlu S，Dernek B，et al. Choice of intraarticular injection in treatment of knee osteoarthritis：platelet  rich plasma，hyaluronic acid or ozone options[J].Knee Surg Sports Traumatol Arthrosc,2017,25(2):485492.
[40] 中华医学会骨科学分会关节外科学组.骨关节炎诊疗指南(2018年版)[J].中华骨科杂志,2018,38(12):705715.
[41] 蒲晓东,杨艳梅.膝骨关节炎中医病名再辨识[J].时珍国医国药,2017,28(12):29722973.
[42] 邓 健,刘 渊,杨力强.痧脊经筋疗法治疗膝骨关节炎的临床研究[J].时珍国医国药,2017,28(5):11301132.
[43] 钟露斌,曹学伟,李 俊,等.岭南骨伤名家黄宪章治疗膝骨关节炎经验总结[J].时珍国医国药,2017,28(4):946948.
[44] 黄露露,苏友新.国内膝关节骨性关节炎社区康复的研究现状[J].中国康复医学杂志,2018,33(9):11221128.
[45] PeultierCelli L，Lion A，CharyValckenaere I，et al. Comparison of highfrequency intensive balneotherapy with lowfrequency balneotherapy combined with landbased exercise on postural control in symptomatic knee osteoarthritis：a randomized clinical trial[J].Int J Biometeorol,2019.

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备注/Memo

备注/Memo:
*上海市科学技术委员会中医引导项目(17401932900) 上海市卫计委中西医结合康复诊疗能力提升项目\[ZY (20182020)FWTX6023\] 上海市科学技术委员会中医引导项目(18401904800) 上海市卫计委中医临床优势培育项目(ZYBZ2017017)
更新日期/Last Update: 2019-12-19