小针刀联合中药治疗膝骨关节炎疗效的网状Meta分析

目的:目前针对膝骨关节炎的中西医治疗方法很多,但尚无特效的疗法。近年来有较多临床研究证实了小针刀联合中药内服对于膝骨关节炎的有效性,但尚缺乏相关的系统评价来提供循证证据支持。系统评价小针刀联合各种中药治疗膝骨关节炎的临床疗效,为治疗膝骨关节炎的临床决策提供循证参考。方法:计算机检索国内外各文献数据库,搜索小针刀联合内服中药对比其他疗法治疗膝骨关节炎的临床随机对照试验;主要结局指标为总有效率,次要结局指标包括膝关节指数评分、目测类比评分及Lysholm膝关节功能评分,其中总有效率的统计量指标类型为二分类变量,其他指标为连续型变量。逐层筛选纳入文献后,使用Cochrane系统评价员手册5.1.0版随机对照试验偏倚风险评估工具对文献进行质量评价。提取数据后,采用Stata 15.0软件进行网状Meta分析。结果:①共纳入26个随机对照试验,包括2940例患者,涉及到小针刀加中药治疗、小针刀、中药、针刺加中药治疗、针刺治疗、西药共6种干预措施,Jadad评分显示纳入文献的质量均偏低;②网状Meta分析结果显示:与西药、中药、针刺、针刺加中药、小针刀相比,小针刀加中药能显著提高总有效率(P<0.05);与西药、针刺、针刺加中药相比,小针刀加中药能显著降低膝关节指数评分(P<0.05);与西药、中药、小针刀相比,小针刀加中药治疗能显著降低目测类比评分(P<0.05),显著提高Lysholm膝关节功能评分(P<0.05);③曲线下面积(SUCAR)检测结果显示,小针刀加中药治疗在提高有效率、降低膝关节指数评分、降低目测类比评分及提高Lysholm膝关节功能评分方面,在文章所涉及的6种干预措施中效果最佳的可能性最大。结论:小针刀联合内服中药在文章所涉及的6种膝骨关节炎干预措施中为疗效最优,在缓解疼痛和改善膝关节功能方面明显均优于西药、中药、小针刀。文章结果为临床治疗膝骨关节炎提供了一定的循证医学证据,但由于纳入文献质量偏低,未来仍需更多高质量的临床研究加以验证。

Clinical efficacy of small needle knife combined with traditional Chinese medicine in the treatment of knee osteoarthritis:a network Meta-analysis

OBJECTIVE: There are many treatments for knee osteoarthritis, but there is no specific treatment. In recent years, increasing clinical studies have confirmedthe effectiveness of small needle knife combined with Chinese medicine for knee osteoarthritis. However, there is still a lack of systematic evaluation to provide evidence-based support. In this paper, we aimed to systematically evaluate the clinical efficacy of small needle knife combined with traditional Chinesemedicine in the treatment of knee osteoarthritis, so as to provide evidence-based reference for clinical decision-making in the treatment of knee osteoarthritis.METHODS: The randomized controlled trials of small needle knife combined with traditional Chinese medicine in the treatment of knee osteoarthritis weresearched by computer. The total effective rate was the main outcome, and the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index,Visual Analogue Scale (VAS) and Lysholm scores were the secondary outcomes. Among them, the total effective rate was expressed as a binary variable, andthe other indicators were expressed as continuous variables. The quality evaluation and data extraction were carried out using Cochrane Hand Book 5.1.0 afterthe included literatures were screened layer by layer, and the data were processed by Stata15.0 software followed by a network Meta-analysis.RESULTS: A total of 26 randomized controlled trials involving 2 940 patients were included. The Jadad score showed that the quality of the included literaturewas low. The results showed that: Compared with small needle knife, traditional Chinese medicine, acupuncture plus Chinese medicine treatment, acupuncturetreatment, and western medicine, small needle knife plus traditional Chinese medicine could significantly improve the total effective rate (P < 0.05);comparedwith western medicine, acupuncture, acupuncture plus traditional Chinese medicine, small needle knife plus traditional Chinese medicine could significantlyreduce the WOMAC score;compared with small needle knife, traditional Chinese medicine and western medicine, small needle knife plus traditional Chinesemedicine could significantly reduce the VAS score (P < 0.05) and significantly improve Lysholm knee joint function score (P < 0.05). The area under curve resultsshowed that small needle knife plus traditional Chinese medicine had the best effect in improving the effective rate, reducing WOMAC score, reducing VASscore and improving Lysholm knee function score in the included six methods.CONCLUSION: Small needle knife combined with traditional Chinese medicine has significant clinical efficacy in the treatment of knee osteoarthritis, and thiscombined treatment is significantly superior to western medicine, traditional Chinese medicine, and small needle knife alone in alleviating pain and improvingknee joint function. The conclusion of this study provides certain evidence-based reference for the clinical treatment of knee osteoarthritis, but further highqualityclinical application research is required.