针灸结合推拿治疗急性踝关节扭伤的Meta分析

A Meta-Analysis of Acupuncture Combined with Tuina in the Treatment of Acute Ankle Sprains

摘要: 目的：通过对现有文献进行meta分析，探讨针灸结合推拿治疗急性踝关节扭伤的临床疗效，为中医治疗急性踝关节扭伤提供参考。方法：计算机检索中国知网、万方、维普、CBM、PubMed数据库，收集自建库至2021年12月内关于针灸结合推拿治疗急性踝关节扭伤的随机对照试验，2名研究人员独立进行文献的检索、筛选及数据提取，按Cochrane提供的工具对纳入的文献进行质量评价及风险评估，并且同时采用改良Jadad量表进行文献质量评估，最后使用Revman5.4对数据进行meta分析。结果：最终纳入13个随机对照试验结果，共有1116例患者，试验组581例患者主要干预措施为针灸结合推拿，对照组535例患者为非针灸结合推拿的其他干预措施。meta分析结果显示：① 针灸结合推拿组的总有效率高于其他治疗组[RR = 1.21, 95%CI: 1.14~1.28, P < 0.00001]；② 针灸结合推拿组的VAS评分低于其他治疗组[MD = −1.08, 95%CI: −1.37~−0.78, P < 0.00001]；③ 针灸结合推拿组的肿胀程度低于其他治疗组[SMD = −1.06，95%CI: −1.56~−0.55, P < 0.00001]；④ 针灸结合推拿组的踝关节功能优于其他治疗组[SMD = 1.13, 95%CI: 0.83~1.42, P < 0.00001]；⑤ 针灸结合推拿组的疼痛消失时间优于其他治疗组[MD = −5.10, 95%CI = −5.45~−4.74, P < 0.00001]；⑥ 针灸结合推拿组的恢复正常行走的时间快于其他治疗组[MD = −5.61, 95%CI: −7.21~−4.10, P < 0.00001]。结论：针灸结合推拿治疗急性踝关节扭伤在缓解踝关节疼痛、减轻踝关节肿胀程度、改善踝关节功能及提高患者生活质量方面明显优于其他治疗方式，但由于此次纳入文献样本较少且质量较低，可能存在一定偏倚因素，未来仍需更多高质量文献来证实。

Abstract: Objective: To investigate the clinical efficacy of acupuncture combined with tuina in the treatment of acute ankle sprains by meta-analysis of the existing literature, and to provide a reference for the treatment of acute ankle sprains by traditional Chinese medicine. Methods: Computer retrieved CNKI, Wanfang, Weipu, CBM, PubMed databases, collected randomized controlled trials on acupuncture combined with tuina for the treatment of acute ankle sprains from the establishment of the library to December 2021, and independently conducted literature retrieval, screening and data extraction, and conducted quality evaluation and risk assessment of the included literature according to the tools provided by Cochrane, and at the same time used the modified jaded scale for literature quality assessment. Finally, the data was meta-analyzed using Revman5.4. Results: The results of 13 randomized controlled trials were included, with a total of 1116 patients, the main intervention of 581 patients in the experimental group was acupuncture combined with tuina, and 535 patients in the control group were other interventions other interventions other than acupuncture combined tuina. The results of the meta-analysis showed that the total effective rate of acupuncture combined with tuina was higher than that of other treatment groups [RR = 1.21, 95%CI: 1.14~1.28, P < 0.00001]; the VAS score of the acupuncture combined tuina group was lower than that of other treatment groups [MD = −1.08, 95%CI: −1.37~−0.78, P < 0.00001]; the degree of swelling in the acupuncture combined tuina group was lower than that in other treatment groups [SMD = −1.06, 95%CI: −1.56~−0.55, P < 0.00001]; the ankle function of the acupuncture combined tuina group was better than that of other treatment groups [SMD = 1.13, 95%CI: 0.83~1.42, P < 0.00001]; the pain disappearance time in the acupuncture combined Tuina group was better than that in other treatment groups [MD = −5.10, 95%CI = −5.45~−4.74, P < 0.00001]; the acupuncture combined tuina group took faster time to return to normal walking than in other treatment groups [MD = −5.61, 95%CI: −7.21~−4.10, P < 0.00001]. Conclusion: Acupuncture combined with tuina for the treatment of acute ankle sprains is significantly better than other treatment methods in relieving ankle pain, reducing ankle swelling, improving ankle function and improving the quality of life of patients, but due to the small and low quality of the literature included in this paper, there may be some bias factors, and more high-quality literature is still needed to confirm it in the future.