手法治疗椎动脉型颈椎病临床随机对照试验的系统评价

目的:评价手法治疗椎动脉型颈椎病的安全性、有效性,分析目前临床治疗现状。方法:检索PubMed、OVID、Cochrane图书馆、CBM、CNKI、VIP等数据库以及手工检索,共收集手法治疗椎动脉型颈椎病的文献265篇,中文文献251篇,英文文献14篇,其中5篇符合纳入研究标准,全部为中文文献;Cochrane系统评价手册进行质量评价,并对5篇文献采用RevMan 4.2进行Meta分析。结果:纳入的5篇文献共736例患者。5篇文献的治愈率汇总合并OR为2.93,95%CI为[2.10,4.08];有效率汇总合并OR为3.99,95%CI为[2.47,6.44];手法对椎动脉型颈椎病的治愈率、有效率均明显优于其他疗法(除手法之外的治疗方法,如牵引、药物等)(P<0.01)。结论:目前所纳入研究结果显示手法治疗椎动脉型颈椎病安全、有效,手法对椎动脉型颈椎病的治愈率、有效率明显优于其他疗法;但由于纳入文献的数量有限且质量不是很高,结论尚不确定,因此需要多中心的临床随机对照且长时间随访的试验,进一步验证。

Systematic review of clinical randomized controlled trials on manipulation treatment for vertebral artery type of cervical spondylosis

Objective:To evaluate the safety and efficacy of the manipulation treatment for vertebral artery type of cervical spondylosis and analyze the current status of clinical study. Methods:To retrievie the PubMed,OVID,Cochrane library,CBM-disc database,CNKI database,VIP database,265 literatures of the manipulation treatment of vertebral artery type of cervical spondylosis were collected,including 251 literatures Chinese and 14 literatures English. Among the literatures,5 studies of Chinese literatures accorded with inclusion criteria. Cochrane systematic review was used to quality evaluation;and 5 studies were used RevMan 4.2 for Meta analysis of literature. Results:Five documents included a total of 736 patients. Summary of the literature combined OR for the cure rate was 2.93,95% CI was [2.10,4.08]. Summary OR for the combined efficiency was 3.99,95% CI was [2.47,6.44]. Manipulation group’s cure rate of vertebral artery type of cervical spondylosis was efficient and clearly superior to the other therapies. Expect of the manipulation,the traction and the drugs,hereinafter referred to as "other therapies"(P<0.01). Conclusion:At present,documents included in this study have shown that manipulation treatment on vertebral artery type of cervical spondylosis is safe,both cure rate and the effective rate are much better than other therapies;but the incorporation of a limited number of documents and the quality is not very high,the conclusion is still uncertain,high-quality evidence should be needed to be further validated.