针刺治疗膝骨关节炎临床疗效Meta分析

发布时间：2018-04-29 15:10

本文选题：膝骨关节炎 + 针刺　；参考：《辽宁中医药大学》2017年硕士论文

【摘要】：目的:探究针刺治疗膝骨关节炎(KOA)的临床疗效。方法:提取检索关键词,设计科学有效的文献检索策略,利用计算机检索中国知网数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数据库(WF)、维普数据库(VIP),各数据库检索时间均截止到2016年12月。共纳入40个随机对照试验,包括4031例受试者,其中试验组2012例,对照组2019例。采用Rev Man 5.3软件进行数据分析。文献质量采用Cochrane协作网提供的质量评价工具进行评价。主要评价指标包括临床有效率、疼痛效果、僵硬效果、日常活动度效果。所得出的计数资料采用比值比(OR),计量资料采用标准化均数差(SMD)及它们的95%置信区间(CI)表示。结果:1.针刺治疗KOA总临床有效率试验组高于对照组[OR=3.20,95%CI(2.63,3.90)];总疼痛效果试验组低于对照组[SMD=-0.52,95%CI(-0.90,-0.15)];总僵硬效果两组间无显著性差异[SMD=-0.22,95%CI(-0.52,0.08)];总日常活动度效果两组间无显著性差异[SMD=-0.14,95%CI(-0.29,0.01)];漏斗图均左右基本对称。2.三种不同针刺方法治疗KOA临床有效率:OR(温针灸)OR(普通针刺)OR(电针);疼痛效果:SMD(温针灸)SMD(电针)SMD(普通针刺);僵硬效果:SMD(电针)SMD(温针灸)SMD(普通针刺);日常活动度效果:SMD(温针灸)SMD(电针)SMD(普通针刺)。3.针刺对比中药、推拿和西药治疗KOA临床有效率:OR(对比西药组)OR(对比中药组)OR(对比推拿组);疼痛效果:SMD(对比西药组)SMD(对比中药组)SMD(对比推拿组);僵硬效果:SMD(对比西药组)SMD(对比中药组)SMD(对比推拿组);日常活动度效果:SMD(对比西药组)SMD(对比中药组)SMD(对比推拿组)。4.不同结局时间针刺治疗KOA临床有效率:OR(30d以上)OR(22d~30d)OR(1d~21d);疼痛效果:SMD(30d以上)SMD(1d~21d)SMD(22d~30d);僵硬效果:SMD(30d以上)SMD(22d~30d)SMD(1d~21d);日常活动度效果:SMD(30d以上)SMD(1d~21d)SMD(22d~30d)。5.针刺配合理疗对比单独理疗治疗KOA临床有效率:试验组高于对照组[OR=2.50,95%CI(1.28,4.88)];配合推拿对比单独推拿治疗KOA临床有效率:试验组高于对照组[OR=4.77,95%CI(2.85,7.98)];配合中药对比单独中药治疗KOA临床有效率:试验组高于对照组[OR=5.05,95%CI(2.55,9.98)]。结论:1.针刺治疗KOA临床有效率高于其它疗法,止痛效果优于其它疗法。2.三种不同针刺方法治疗KOA,温针灸疗法临床有效率最高,温针灸疗法止痛效果最优,电针疗法改善僵硬效果最优,温针灸疗法改善日常活动度效果最优。3.针刺对比中药、推拿和西药治疗KOA,临床有效率对比西药组最高,止痛效果、改善僵硬效果、改善日常活动度效果均对比西药组最优。4.不同结局时间针刺治疗KOA,临床有效率疗程30天以上最高,止痛效果、改善僵硬效果、改善日常活动度效果均疗程30天以上最优。5.治疗KOA临床有效率,针刺配合理疗高于单独理疗,配合推拿高于单独推拿,配合中药高于单独中药治疗。
[Abstract]:Objective: to explore the clinical effect of acupuncture on knee osteoarthritis. Methods: the key words were extracted, and scientific and effective literature retrieval strategies were designed. Using computer to search CNKI, CBM, WFN, VIPB, all the databases were searched as of December, 2016. The retrieval time of each database is as of December 2016, and the search time of each database is as of December 2016. The search time of each database is as follows: (1) the Chinese biomedical literature database (CBM); A total of 40 randomized controlled trials were conducted, including 4031 subjects, including 2012 in the trial group and 2019 in the control group. The data were analyzed by Rev Man 5.3 software. The literature quality is evaluated by the quality evaluation tool provided by Cochrane Cooperative Network. The main evaluation measures include clinical efficacy, pain effect, stiffness effect and daily activity effect. The calculated data are expressed by the ratio ratio and the standard mean difference (SMD) and their 95% confidence interval (CI). The result is 1: 1. The total clinical effective rate of acupuncture treatment for KOA was higher in the experimental group than in the control group [OR3.20995 CI 2.633.90]; the total pain effect in the experimental group was lower than that in the control group [SMD-0.5295CI-0.90 CI-0.15]; there was no significant difference in the total stiffness effect between the two groups [SMD-0.2295CI-0.520.08]; there was no significant difference in the total daily activity between the two groups [SMD-0.1495CI-0.290.01]; and the funnel graph showed no significant difference between the two groups (SMD-0.2295CI-0.520.08); the total daily activity effect had no significant difference between the two groups [SMD-0.1495CI-0.290.01]. Average left and right basic symmetry. 2. Effective rate of three different Acupuncture methods for KOA Clinical effectiveness: (warm Acupuncture or Orr; pain effect: SMD); effect of warming Acupuncture and moxibustion on SMD (General Acupuncture); rigid effect of SMD (warm Acupuncture SMD; effect of Daily activity) SMD (Acupuncture and moxibustion SMD). Acupuncture contrast traditional Chinese medicine, The effective rate of massage and western medicine in treating KOA is: (1) the clinical effective rate of KOA is compared with that of traditional Chinese medicine group (control group); the effect of pain is compared with that of western medicine group (SMD group); the effect of pain is compared with that of traditional Chinese medicine group (SMD group); the effect of inflexibility is compared with that of traditional Chinese medicine group (SMD group). The effect of daily activity was as follows: 1. The effective rate of acupuncture in the treatment of KOA at different outcome times was more than 22 days, 30 days and more than 22 days and 21 days, the pain effect was more than 30 days, the pain effect was more than 22 days, the stiffness effect was more than 30 days, and the stiffness effect was more than 22 days and 30 days, and the effect of daily activity was more than 30 days, and the effect of daily activity was more than one day, thirty days, and five days, the effect of stiffness was more than 30 days and more than 30 days, and the effect of daily activity was more than 30 days and more than one day, and the effect of daily activity was more than one day, one day and thirty days. The clinical effective rate of acupuncture combined with physiotherapy alone in the treatment of KOA was higher in the experimental group than in the control group [ORA 2.50 ~ 95 ~ 1.28 ~ 4.88]; in the experimental group, the clinical effective rate of massage alone was higher than that in the control group [ORF 4.775 ~ 95CII 2.85 ~ 7.98]; and in comparison with traditional Chinese medicine alone, the clinical effective rate was higher in the experimental group than in the control group. The clinical effective rate of KOA in the trial group was higher than that in the control group. Conclusion 1. The clinical effective rate of acupuncture for KOA is higher than that of other therapies, and the analgesic effect is better than that of other therapies. Among the three different acupuncture methods, the clinical effective rate of warming acupuncture therapy is the highest, the effect of warming acupuncture therapy is the best, the effect of electroacupuncture therapy is the best, and the effect of warming acupuncture therapy is the best. 3. Acupuncture compared with traditional Chinese medicine, massage and western medicine treatment of KOA. the clinical effective rate of western medicine group is the highest, analgesic effect, improve stiffness effect, improve the effect of daily activities compared with the western medicine group is the best. 4. 4. In the treatment of KOAat with different outcome time, the clinical effective rate was the highest in more than 30 days, the analgesic effect was the highest, the stiffness effect was improved, and the average course of treatment was more than 30 days. 5. The effective rate of acupuncture combined with physiotherapy was higher than that of physical therapy alone, and that of combined massage was higher than that of massage alone, and that of traditional Chinese medicine was higher than that of traditional Chinese medicine alone.
【学位授予单位】：辽宁中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.9

【参考文献】