摘要
背景 确立手法治疗中医骨伤科领域的优势病种,将对推动手法技术和骨伤科优势专科的发展起到促进作用,但目前其评价和筛选尚缺乏基于循证医学证据的量化评价过程.目的 应用证据图方法,系统梳理手法治疗中医骨伤科领域疾病的系统评价,探索手法治疗中医骨伤科领域的优势病种.方法 计算机检索PubMed、Embase、Cochrane Library、Web of Science、中国生物医学文献服务系统、中国知网、维普网和万方数据知识服务平台,搜集手法治疗中医骨伤科领域疾病的系统评价,检索时限均为建库至 2023-03-05,运用图表结合文字的方式呈现证据分布特点.结果 纳入的 126 篇系统评价发表年限为 2003-2023 年,国内外相关研究数量总体呈增长趋势.方法 学质量评价结果显示 13 篇为中等质量、64 篇为低质量、49 篇为极低质量.证据图显示,手法治疗中医骨伤科领域研究证据主要分布于 18 个临床病种包括颈椎病、腰痛、膝关节炎、腰椎间盘突出症、踝关节扭伤、肩周炎、颈源性头痛、寰枢关节半脱位、桡骨远端骨折、肱骨外上髁炎、腕管综合征、腰扭伤、脊柱侧弯、髋关节炎、纤维肌痛综合征、肌筋膜疼痛综合征、肩袖损伤、肱骨髁上骨折,呈现出有益或可能有益的效应.结论 手法治疗在中医骨伤科的临床应用广泛,但由于方法学质量存在不足,并且缺乏安全性和经济性的研究证据,未来仍需多层级机构间联动合作,建立健全评价标准和体系,提高研究质量,更新研究证据,进一步探索手法在中医骨伤科领域中的优势所在.
Abstract
Background Establishing the advantageous diseases in the field of traditional Chinese orthopedics treated with manual therapy will promote the development of manual techniques and dominant discipline.However,the current evaluation and selection lack a quantitative evaluation process based on evidence-based medicine.Objective To systematically review systematic reviews of diseases in the field of traditional Chinese orthopedics treated with manual therapy using evidence mapping methodology and explore the advantageous diseases in this field.Methods Computerized searches were conducted in PubMed,Embase,Cochrane Library,Web of Science,SinoMed,China National Knowledge Infrastructure,Wanfang Data,and VIP database to collect systematic reviews of diseases in the field of traditional Chinese orthopedics treated with manual therapy from inception to March 5,2023.The evidence distribution characteristics were presented using a combination of charts and text.Results A total of 126 systematic reviews published from 2003 to 2023 were included,showing an overall increasing trend in the quantity of relevant studies both domestically and internationally.Methodological quality assessment results indicated that 13 reviews were of moderate quality,64 were of low quality,and 49 were of very low quality.The evidence map showed that the research evidence in the field of traditional Chinese orthopedics treated with manual therapy mainly focused on 18 clinical diseases,including cervical spondylosis,low back pain,knee osteoarthritis,lumbar disc herniation,ankle sprain,adhesive capsulitis of the shoulder,cervicogenic headache,atlantoaxial subluxation,distal radius fracture,lateral epicondylitis of the humerus,carpal tunnel syndrome,lumbar sprain,scoliosis,hip osteoarthritis,fibromyalgia syndrome,myofascial pain syndrome,rotator cuff injury,and supracondylar fracture of the humerus,demonstrating beneficial or potentially beneficial effects.Conclusion Manual therapy is widely used in the clinical practice of traditional Chinese orthopedics.However,due to methodological shortcomings and a lack of research evidence on safety and cost-effectiveness,future efforts should focus on multi-level inter-agency cooperation to establish sound evaluation standards and systems,improve research quality,update research evidence,and further explore the advantages of manual therapy in the field of traditional Chinese orthopedics.
基金项目
国家重点研发计划项目(2021YFC1712800)
北京市科技新星计划交叉合作项目(20220484228)
中国中医科学院中医药循证能力提升建设项目(ZZ13-024-7)
中国中医科学院望京医院高水平中医医院建设项目(WJYY-XZKT-2023-05)
维普
万方数据