摘要
为系统评价经皮激光椎间盘减压术(PLDD)联合臭氧注射治疗腰椎间盘突出症(LDH)的疗效和安全性,采用计算机检索PubMed、EMbase、The Cochrane Library、Web of Science、CBM、Wan Fang Data、VIP和CNKI数据库,搜集PLDD联合臭氧注射治疗LDH有效性和安全性的随机对照试验(RCT),检索时限自建库日期至2021年3月1日。由两位研究者独立进行文献检索、筛选、数据提取,并对文献质量、研究的偏倚风险进行评价后,采用RevMan5.3软件进行Meta分析。最终纳入18个RCT,包括3069例患者。Meta分析结果显示:与单纯使用PLDD或者臭氧注射治疗LDH相比,PLDD联合臭氧注射可显著提高改良Macnab疗效评价标准的优良率[OR=3.76,95%CI(2.89,4.90),P<0.00001],降低视觉模拟疼痛评分(VAS)[MD=-0.85,95%CI(-1.32,-0.38),P=0.0004],提高日本骨科协会评估治疗分数评分(JOA)的优良率[OR=4.28,95%CI(3.39,5.41),P<0.00001],差异有统计学意义。现有证据表明,相比于单纯使用PLDD或者臭氧注射治疗LDH,PLDD联合臭氧注射作为治疗LDH的一种介入疗法,能提高改良Macnab疗效评价标准的优良率、日本骨科协会评估治疗分数评分(JOA)的优良率,降低视觉模拟疼痛评分(VAS),安全性高。受限于纳入研究的数量和质量,上述结论有待于大量多中心、大样本、高质量研究进一步予以验证。
Objective To systematically review the efficacy and safety of percutaneous laser disc decompression(PLDD)combined with ozone injection in the treatment of lumbar disc herniation(LDH).Methods We searched PubMed,Embase,the Chochrane library,Web of Science,CBM,Wanfang Data,VIP and CNKI databases,Randomized controlled trials(RCTs)on the efficacy and safety of PLDD combined with ozone injection in the treatment of LDH were collected,and the retrieval time is from the establishment date to March 1,2021.The two researchers independently conducted literature retrieval,screening,data extraction,literature quality and risk of bias evaluation.Meta-analysis was conducted by using RevMan 5.3software.Results Eighteen RCTs,including 3069patients,were eventually included.Meta-analysis results showed that:compared with use PLDD or ozone injection individually in the treatment of LDH,PLDD combined with ozone injection can significantly increase the curative effect of modified MacNab evaluation standard[the OR=3.76,95%CI(2.89,4.90),P<0.00001],reduce the Visual Analogue Scales(VAS)[MD=-0.85,95%CI(-1.32,-0.38),P=0.0004],improve the excellent rate of Japanese Orthopaedic Association scores,(JOA)[OR=4.28,95%CI(3.39,5.41),P<0.00001],the difference was statistically significant.Conclusion the existing evidence showed that,compared with the PLDD or ozone injection be used alone in the treatment of LDH,PLDD combined with ozone injection,as a kind of interventional therapy in the treatment of LDH,can improve the curative effect of modified Macnab evaluation standard,the excellent rate of Japanese Orthopaedic Association scores(JOA),reduce the Visual Analogue Scales(VAS),high security.Owing to the limitation of the quantity and quality of the included studies,the above conclusions need to be further verified by a large number of multi-center,large-sample and high-quality studies.
作者
蒋鹏
赵继荣
陈文
张娜
王兴盛
赵宁
马同
薛旭
杨文通
史凡凡
Jiang Peng;Zhao Jirong;Chen Wen;Zhang Na;Wang Xingsheng;Zhao Ning;Ma Tong;Xue Xu;Yang Wentong;Shi Fanfan(Clinical College of Traditional Chinese Medicine,Gansu University of Traditional Chinese Medicine,Lanzhou,Gansu730030,China;Department of Spine and Orthopedics,Gansu Provincial Hospital of Traditional Chinese Medicine,Lanzhou,Gansu730050,China;Evidence-based Medicine Center of Lanzhou University,Lanzhou,Gansu730030,China;Key Laboratory of Evidence-Based Medicine and Clinical Transformation in Gansu Province,Lanzhou,Gansu730030,China)
出处
《应用激光》
CSCD
北大核心
2022年第5期178-188,共11页
Applied Laser
基金
中医药循证能力建设项目(2019xzzx-gk005)
国家自然科学基金项目(81760877)
卫生部医药卫生科技发展研究中心科研基金项目(W2014ZT210)
国家中医药管理局国家中医临床研究基地业务建设科研专项课题(JDZX2015039)
兰州市创新人才项目(2018-RC-99)
兰州市创新人才项目(2018-RC-94)
甘肃省自然科学基金项目(17JR5RA051)
甘肃省科技厅重点研发计划-社会发展类项目(20YF3FA016)。
