| 袁林,姜佳慧,毕鸿雁.非手术脊柱减压系统对腰椎间盘突出症治疗效果的Meta分析[J].中国康复,2024,39(3):168-176 |
| 非手术脊柱减压系统对腰椎间盘突出症治疗效果的Meta分析 |
| Meta-analysis of non-surgical spinal decompression system for the treatment of lumbar disc herniation |
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| DOI： |
| 中文关键词: 腰椎间盘突出症 非手术脊柱减压 牵引 Meta分析 |
| 英文关键词: lumbar disc herniation non-surgical spinal decompression traction Meta-analysis |
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| 中文摘要: |
| 目的：明确非手术脊柱减压系统（SDS)对腰椎间盘突出症(LDH)的干预效果。方法：检索PubMed、Cochrane Library、Embase、Web of Science、中国知网CNKI、万方数据库(Wanfang Database)、中国生物医学文献数据库(CBM)、维普中文科技期刊数据库(VIP)等有关于SDS干预LDH的随机对照研究，建库时限自建库以来至2023年8月21日。由至少2名研究者进行文献筛选、提取资料，利用Cochrane系统评价手册5.1.0和Jadad量表对纳入文献进行质量评价，使用revman5.4软件进行Meta结果分析，stata14.0进行偏倚风险评价。结果：纳入16篇文献，总计965例患者。结果显示，在疼痛改善方面，SDS干预能明显降低患者疼痛评分（95%CI［-1.05~-0.75］；SMD=-0.90，P<0.001）；在腰椎功能改善方面，SDS干预能增加患者竖脊肌平均肌电值（95%CI［6.49~19.51］;MD=13.00;P<0.001）、多裂肌平均肌电（95%CI［6.62~19.97］;MD=13.30;P<0.001）、竖脊肌平均功率频率斜率（95%CI［0.05~0.09］;MD=0.07;P<0.001）、多裂肌平均功率频率斜率(95%CI［0.05~0.10］;MD=0.07;P<0.001），降低患者ODI评分（95%CI［-1.27~-0.71］;SMD=-0.99;P<0.001）；在椎间盘突出程度改善上，SDS干预能明显降低椎间盘突出指数（95%CI［-2.87~-0.77］;SMD=-1.82;P<0.001），椎体后缘至突出物顶点的距离（95%CI［-1.11~-0.79］;MD=-0.95;P<0.001），但在椎间盘高度干预效果不显著（95%CI［-0.38~1.19］;MD=0.41;P=0.31）；在有效率方面，SDS干预能显著提高患者治疗效果（95%CI［1.16~1.42］;RR=1.28;P<0.001）。结论：SDS或联合治疗能够减轻LDH患者的疼痛程度、改善腰椎功能障碍、提高椎旁肌肌肉功能、缓解椎间盘突出程度、提高治疗效果，但在改善椎间盘高度上的效果并不明显。 |
| 英文摘要: |
| Objective: To determine the intervention effect of non-surgical spinal decompression system (SDS) on lumbar disc herniation (LDH). Methods: PubMed, Cochrane Library, Embase, Web of Science, CNKI, Wanfang Database, Chinese Biomedical Literature Database (CBM), and VIP Database which had published randomized controlled trials on SDS intervention of LDH were searched. The search time limit was from the establishment of the database to August 21, 2023. At least 2 researchers screened the literature and extracted the data. Cochrane Handbook 5.1.0 and the Jadad scale were used to evaluate the quality of the included studies. Revman5.4 software was used to analyze the results of the Meta-analysis, and stata14.0 software was used to assess the risk of bias. Results: A total of 16 studies involving 965 patients were included. The results showed that SDS intervention could significantly reduce the score of patients with pain (95% CI ［-1.05~-0.75］; SMD=-0.90, P<0.001). In terms of lumbar function improvement, SDS intervention could increase AEMG of erector spinae (95% CI ［6.49~19.51］; MD=13.00; P<0.001), AEMG of the multifidus (95% CI ［6.62~19.97］; MD=13.30; P<0.001), mean MPFs of erector spinae (95% CI ［0.05~0.09］; MD=0.07; P<0.001), mean MPFs of the multifidus (95% CI ［0.05~0.10］; MD=0.07; P<0.001), reduced ODI score (95% CI ［-1.27~-0.71］; SMD=0.99; P<0.001). SDS intervention could significantly reduce the intervertebral disc herniation index (95% CI ［-2.87~-0.07］; SMD=-1.82; P<0.001), from the posterior margin of the vertebral body to the apex of the protrusion (95% CI［-1.11~-0.79］; MD=-0.95; P<0.001), but the intervention effect was not significant in disc height (95% CI［-0.38~1.19］; MD=0.41; P=0.31). In terms of effective rate, SDS intervention could significantly improve the treatment effect of patients (95% CI ［1.16~1.42］; RR=1.28; P<0.001). Conclusion:SDS or combined therapy can relieve the pain, improve the lumbar dysfunction, improve the function of paraspinal muscles, relieve the degree of intervertebral disc herniation, and improve the therapeutic effect of LDH patients, but the effect on improving the height of intervertebral disc is not obvious. |
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