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中华老年骨科与康复电子杂志 ›› 2023, Vol. 09 ›› Issue (05) : 307 -314. doi: 10.3877/cma.j.issn.2096-0263.2023.05.009

Meta分析

体外冲击波治疗非特异性腰痛疗效的系统评价和Meta分析
徐红莉, 杨钰琳, 薛清, 张茜, 马丽虹, 邱振刚†()   
  1. 250355　济南，山东中医药大学康复医学院
    250355　济南，山东中医药大学康复医学院；250300　济南，山东中医药大学附属医院大学城医院康复科
  • 收稿日期:2023-04-24 出版日期:2023-10-05
  • 通信作者: 邱振刚
  • 基金资助:
    山东省教育厅（省部级项目，名称：中国特色的作业治疗专业人才培养模式创新研究）

Efficacy of extracorporeal shock wave for non-specific low back pain: a systematic review and Meta-analysis

Hongli Xu, Yulin Yang, Qing Xue, Qian Zhang, Lihong Ma, Zhengang Qiu†()   

  1. Department of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan 250355, China
    Department of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan 250355, China; Department of Rehabilitation, Affiliated Hospital of Shandong University of Traditional Chinese Medicine University Town Hospital, Jinan 250300, China
  • Received:2023-04-24 Published:2023-10-05
  • Corresponding author: Zhengang Qiu
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引用本文：

徐红莉, 杨钰琳, 薛清, 张茜, 马丽虹, 邱振刚. 体外冲击波治疗非特异性腰痛疗效的系统评价和Meta分析[J]. 中华老年骨科与康复电子杂志, 2023, 09(05): 307-314.

Hongli Xu, Yulin Yang, Qing Xue, Qian Zhang, Lihong Ma, Zhengang Qiu. Efficacy of extracorporeal shock wave for non-specific low back pain: a systematic review and Meta-analysis[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2023, 09(05): 307-314.

目的

文章通过Meta分析研究体外冲击波治疗非特异性腰痛的临床效果，以期为临床治疗提供循证证据。

方法

计算机检索PubMed、Web of science、Embase、Cochrane Library及中国知网、维普和万方数据库，收集体外冲击波治疗腰痛的随机对照试验，检索时间范围为自各数据库建库至2023年3月12日，使用Cochrane偏倚风险工具和Jadad量表对纳入的文献进行质量评价，运用Revman 5.4软件进行Meta分析。

结果

纳入14篇符合条件的随机对照试验，共涉及642例患者，其中干预组324例，对照组318例。Meta分析结果显示，与对照组相比，体外冲击波可以显著改善腰痛患者的疼痛程度（SMD=-0.90，95% CI：-1.07，-0.74，P<0.001）、Oswestry功能障碍指数（MD=-6.61，95% CI：-9.19，-4.03，P<0.001）、Beck抑郁量表评分（MD=-3.84，95% CI：-5.37，-1.97，P<0.001）和36条目简明健康调查量表评分（MD=8.51，95% CI：7.82，9.20，P<0.001），但不能显著改善患者的指地距离（MD=-2.65，95% CI：-7.57，2.26，P=0.29）。

结论

体外冲击波可以改善腰痛患者的疼痛程度、功能障碍程度、抑郁程度和生活质量，但是对于腰部柔韧性的改善作用还需进一步研究证明。

关键词: 体外冲击波, 腰痛, 疗效, Meta分析
Objective

The article investigates the clinical effectiveness of extracorporeal shock wave treatment for non-specific low back pain through Meta-analysis, with a view to providing evidence-based evidence for clinical treatment.

Methods

Computer searches of PubMed, Web of science, Embase, Cochrane Library and China Knowledge Network, Vipshop and Wanfang databases were conducted to collect randomized controlled trials of extracorporeal shock wave for low back pain, and the search time frame was from the establishment of each database to March 12, 2023, and the Cochrane Risk of Bias Tool and Jadad were used to The quality of the included literature was evaluated using the Cochrane Risk of Bias Tool and Jadad scale, and Meta-analysis was performed using Revman 5.4 software.

Results

14 eligible randomized controlled trials involving 642 patients were included, including 324 in the intervention group and 318 in the control group. Meta-analysis results showed that compared with the control group, extracorporeal shock wave significantly improved pain levels in patients with low back pain (SMD=-0.90, 95% CI: -1.07, -0.74, P<0.001), the Oswestry Dysfunction Index (MD=-6.61, 95% CI: -9.19, -4.03, P<0.001), Beck Depression Scale score (MD=-3.84, 95% CI: -5.37, -1.97, P<0.001) and 36-item Brief Health Survey scale score (MD=8.51, 95% CI: 7.82, 9.20, P<0.001), but did not significantly improve patients' finger-ground distance (MD= -2.65, 95% CI: -7.57, 2.26, P=0.29).

Conclusions

Extracorporeal shock waves can improve the level of pain, dysfunction, depression and quality of life in patients with low back pain, but further studies are needed to prove the improvement effect on low back flexibility.

Key words: Extracorporeal shock wave, Low back pain, Therapeutic effect, Meta-analysis
图1 文献筛选流程图
表1 纳入文献的基本特征
纳入文献 样本量 年龄（岁） 性别（男/女，例）
干预组/对照组 干预组 对照组 干预组 对照组
Kiziltas[30]，2022 36/34 47.4±14.3 45.3±12.2 23/13 14/20
Rajfur[31]，2022 20/20 42.3±13.1 45.4±14 10/10 10/10
Taheri[32]，2021 17/15 42.5±10.1 37.1±11.8 6/11 9/6
Elgendy[33]，2020 15/15 32.73±6.73 33.26±5.48 10/5 10/5
Eftekharsadat[34]，2020 27/27 44.74±9.34 45.04±11.86 7/20 10/17
Çelik[35]，2020 25/20 40.76±10.68 40.25±10.26 15/10 8/12
Walewicz[36]，2019 20/20 51.1±8.4 55.8±9.3 6/14 5/15
Schneider[37]，2018 15/15 - - - -
Han[43]，2015 15/15 49.7±8.3 46.0±8.9 - -
Lee[38]，2014 13/15 53.92±10.38 54.33±13.16 - -
李祖虹[39]，2019 32/32 59.5±9.5 58.8±9.6 19/13 17/15
王宁[40]，2019 30/30 49.7±8.3 46.0±8.9 14/16 16/14
杨杰华[41]，2015 27/29 33.27±10.12 33.27±9.63 2/27 3/26
郑志新[42]，2013 32/31 45.84±11.85 47.39±12.69 18/14 16/15
纳入文献 干预措施 ESWT治疗参数 结局指标
干预组 对照组
Kiziltas[30]，2022 ESWT，每周2次，共5次 常规康复 剂量2600次，频率10Hz，压强2.8bar ①②③④
Rajfur[31]，2022 ESWT，每周2次，共10次 常规康复 剂量1000次，频率4Hz，能量0.15mJ/mm2 ①②
Taheri[32]，2021 ESWT，每周1次，共4次 假治疗 剂量1500次，频率4Hz，能量0.15mJ/mm2 ①②
Elgendy[33]，2020 ESWT，每周2次，共12次 常规康复 剂量2000次，频率5Hz，能量0.1mJ/mm2 ①
Eftekharsadat[34]，2020 ESWT，每周1次，共5次 类固醇注射 剂量1500次，频率10-16Hz，能量0.1mJ/mm2 ①②⑤
Çelik[35]，2020 ESWT，每周2次，共12次 安慰剂 剂量1500次，频率2.5Hz，能量0.12mJ/mm2 ①②
Walewicz[36]，2019 ESWT，每周2次，共10次 假治疗 剂量2000次，频率5Hz，能量0.1mJ/mm2 ①②
Schneider[37]，2018 ESWT，每周2次，共6次 常规康复 频率15-42Hz ①
Han[43]，2015 ESWT，每周2次，共12次 常规康复 剂量1000次，频率2.5Hz，能量0.01-0.16mJ/mm2 ①②③
Lee[38]，2014 ESWT，每周2次，共12次 常规康复 剂量2000次，频率5Hz，能量0.1mJ/mm2 ①
李祖虹[39]，2019 ESWT，每周2次，共4次 常规康复 剂量1500-2500次，频率5-15Hz，压强1.2-2.0kPa ①⑤
王宁[40]，2019 ESWT，每周1次，共4次 常规康复 剂量1000次，频率2.5Hz，能量0.01-0.16mJ/mm2 ①②③
杨杰华[41]，2015 ESWT，每周2次，共6次 常规康复 剂量1800-2500次，频率90次/min，根据耐受度选择能量强度 ①
郑志新[42]，2013 ESWT，每周2次，共4次 常规康复 剂量2000次，频率8-12Hz，压强1.6-3.0bar ①④
图3 纳入文献的偏倚风险总结图
表2 纳入文献的Jaded量表评分
纳入文献 随机序列产生 隐藏分配 盲法 退出与失访 总分 质量
Kiziltas[30]，2022 1 2 1 1 5 高
Rajfur[31]，2022 2 2 1 1 6 高
Taheri[32]，2021 2 2 1 1 6 高
Elgendy[33]，2020 2 1 1 1 5 高
Eftekharsadat[34]，2020 2 2 1 1 6 高
Çelik[35]，2020 2 2 2 1 7 高
Walewicz[36]，2019 2 1 1 1 5 高
Schneider[37]，2018 2 1 1 1 5 高
Han[43]，2015 1 1 1 1 4 高
Lee[38]，2014 1 1 1 1 4 高
李祖虹[39]，2019 1 1 1 1 4 高
王宁[40]，2019 2 2 1 1 6 高
杨杰华[41]，2015 1 1 1 1 4 高
郑志新[42]，2013 2 2 1 1 6 高
图6 ESWT对腰痛患者BDI评分影响的Meta分析森林图
图10 ODI指标的发表偏倚漏斗图
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