不同针刺方法治疗第三腰椎横突综合征的网状Meta分析

Network Meta-Analysis of Different Acupuncture Methods for the Treatment of Third Lumbar Transverse Process Syndrome

摘要: 目的：采用网状Meta分析系统评价不同针刺方法治疗第三腰椎横突综合征的临床疗效。方法：计算机检索中国知网、维普、万方、sinomed、Pub Med、Embase、Cochrane Library和Web of Science中针刺方法治疗第三腰椎横突综合征的随机对照试验，检索范围是从各数据库建立之初直至2024年12月。接着由2位研究人员分别进行文献检索、筛选、数据提取，并纳入符合标准的文献。采用Stata16.0软件对纳入的文献数据进行网状Meta分析。结果：最终纳入24篇随机对照试验，干预措施涉及11种针刺疗法。温刃针、毫火针、火针、刃针、针刀的临床有效率均显著高于针刺与电针。刃针、温针、浮针、针刀的临床有效率明显低于温刃针。温刃针、毫火针、针刀、火针、浮针、温针的VAS评分低于针刺。温刃针、毫火针、针刀、温针的VAS评分低于电针。温刃针、毫火针、针刀的VAS评分低于温针与刃针。火留针的VAS评分高于毫火针与针刀。提高临床有效率的SUCRA概率排序：温刃针(95.1%) > 毫火针(73.4%) > 火针(63.7%)为前三。降低VAS评分的SUCRA概率排序：温刃针(85.2%) > 毫火针(81.4%) > 针刀(73.2%)为前三。漏斗图显示临床有效率的点大多聚集在上部，并且分布呈现出良好的对称性，表示本研究可能具有较小的发表偏倚风险。相比之下，VAS评分的散点分布显示出较大的偏倚风险。结论：温刃针在提高临床有效率和改善VAS评分方面具有明显优势，但仍需要大样本、高质量的临床试验给予验证。

Abstract: Objective: Using a network meta-analysis system to evaluate the clinical efficacy of different acupuncture methods in treating third lumbar transverse process syndrome. Methods: A computer search was performed on CNKI, VIP.com, Wanfang Data Knowledge Service Platform, Chinese Biomedical Literature Service System Database, Pub Med, Embase, Cochrane Library and Web of Science for reports on acupuncture treatment of third lumbar transverse process syndrome. For randomized controlled trials, the search time limit is from the establishment of each database to December 2024. Two researchers independently searched, screened literature, extracted data, and included literature that met the criteria. Finally, Stata 16.0 software was used to perform network meta-analysis on the included literature data. Results: 24 randomized controlled trials were finally included, involving a total of 11 types of acupuncture therapies. The clinical effectiveness of warm-bladed acupuncture, milli-fire acupuncture, fire acupuncture, bladed acupuncture, and acupuncture are significantly higher than acupuncture and electro-acupuncture. The clinical effectiveness of bladed acupuncture, warm acupuncture, floating acupuncture, and acupuncture was significantly lower than that of warm-edged acupuncture. The VAS scores of warm-blade acupuncture, milli-fire acupuncture, needle-knife acupuncture, fire acupuncture, floating acupuncture, and warm acupuncture are lower than those of acupuncture. The VAS scores of warm-bladed acupuncture, millifire acupuncture, acupotomy, and warm acupuncture are lower than those of electro-acupuncture. The VAS scores of warm-bladed acupuncture, milli-fire acupuncture, and needle-knife were lower than those of warm-bladed acupuncture and bladed acupuncture. The VAS score of fire-retaining acupuncture was higher than that of milli-fire acupuncture and needle-knife. The ranking of SUCRA probability of improving clinical effectiveness is: warm-edged acupuncture (95.1%) > milli-fire acupuncture (73.4%) > fire acupuncture (63.7%). The ranking of SUCRA probability of reducing VAS score is: warm blade needle (85.2%) > millifire needle (81.4%) > needle knife (73.2%). The scatter points of clinical effectiveness are all located in the inverted funnel plot and the left and right distributions are roughly symmetrical, indicating that the risk of publication bias is small, while the risk of bias in the VAS score scale is greater. Conclusion: Warm-edge acupuncture has obvious advantages in improving clinical efficacy and VAS scores, but it still needs large-sample, high-quality clinical trials for verification.