中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (6): 957-963.doi: 10.3969/j.issn.2095-4344.4004

• 骨与关节循证医学 evidence-based medicine of the bone and joint • 上一篇    下一篇

电针干预全膝关节置换后疼痛的Meta分析

李  琰1，2，3，王  佩 1，2，3，邓东焕4，严  伟1，2，3，李  磊1，2，3，姜红江1，2，3   

  1. 1山东省文登整骨医院，山东省威海市   264400；2山东省骨伤研究院，山东省威海市   264400；3威海市骨科临床研究中心，山东省威海市264400；4威海市文登区妇女儿童医院，山东省威海市   264400
  • 出版日期:2021-02-28 发布日期:2020-12-05
  • 通讯作者: 姜红江，博士，主任医师，山东省文登整骨医院骨关节科，山东省威海市 264400
  • 作者简介:李琰，男，1991年生，山东省平原县人，汉族，2018年山东中医药大学毕业，硕士，医师，主要从事骨与关节损伤、骨质疏松症的基础和临床研究。
  • 基金资助:
    基本中医药循证能力建设项目[国中医药科技中医便函[2019]130号]；2018年国家中医药管理局全国名老中医药专家孙文学传承工作室建设项目[国中医药人教函[2018]134号]；威海市第四批中医重点专科建设项目(骨关节科)[威卫办[2019]87号]

Electroacupuncture for pain control after total knee arthroplasty: a meta-analysis

Li Yan1, 2, 3, Wang Pei1, 2, 3, Deng Donghuan4, Yan Wei1, 2, 3, Li Lei1, 2, 3, Jiang Hongjiang1, 2, 3   

  1. 1Shandong Wendeng Orthopedic Hospital, Weihai 264400, Shandong Province, China; 2Shandong Institute of Orthopedics and Traumatology, Weihai 264400, Shandong Province, China; 3Weihai Orthopedic Clinical Research Center, Weihai 264400, Shandong Province, China; 4Weihai Wendeng Women’s and Children’s Hospital, Weihai 264400, Shandong Province, China
  • Online:2021-02-28 Published:2020-12-05
  • Contact: Jiang Hongjiang, MD, Chief physician, Shandong Wendeng Orthopedic Hospital, Weihai 264400, Shandong Province, China; Shandong Institute of Orthopedics and Traumatology, Weihai 264400, Shandong Province, China; Weihai Orthopedic Clinical Research Center, Weihai 264400, Shandong Province, China
  • About author:Li Yan, Master, Physician, Shandong Wendeng Orthopedic Hospital, Weihai 264400, Shandong Province, China; Shandong Institute of Orthopedics and Traumatology, Weihai 264400, Shandong Province, China; Weihai Orthopedic Clinical Research Center, Weihai 264400, Shandong Province, China
  • Supported by:
    the Evidence-Based Capacity Building Project for Basic Chinese Medicine, No. [2019]130; the Sun Wenxue Inheritance Studio Construction Project of National Famous and Traditional Chinese Medicine Experts of State Administration of Chinese Medicine in 2018, No. [2018]134 ; the Fourth Batch of Key Traditional Chinese Medicine Specialty Construction Project in Weihai (Orthopedics), No. [2019]87

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摘要：

文题释义：
电针镇痛：是指首先通过毫针刺入腧穴后，再用电针仪通过毫针输入电流而达到镇痛的目的。
全膝关节置换后疼痛：是全膝关节置换术后最常见的症状，具体表现为术后患者出现持续的膝关节残余痛，原因是多方面的，与手术创伤相关，早期属于急性疼痛，后期可逐渐转变为慢性疼痛，可持续数月或数年，容易导致患者手术满意度下降及膝关节功能不良，严重影响患者日常生活和社交活动。

目的：应用电针来缓解全膝关节置换后疼痛在临床上得到广泛应用，但是对于其疗效和安全性仍然存在争议。系统评价电针治疗全膝关节置换后疼痛的有效性与安全性。
方法：计算机检索公开发表在PubMed、Embase、Cochrane Library、SinoMed、CNKI、VIP和Wanfang等数据库中有关电针治疗全膝关节置换后疼痛的随机对照试验，检索时间均设定为从建库至2019-12-31。2位研究员独立筛选文献，提取资料并评价纳入研究的偏倚风险后，采用RevMan 5.3软件进行Meta分析。
结果：①最终纳入6项研究，共304例患者；②Meta分析结果显示，试验组术后3 d[MD=-0.67，95%CI(-1.01，-0.33)，P < 0.001]、7 d[MD= -0.60，95%CI(-0.88，-0.33)， P < 0.001]、14 d [MD=-0.97，95%CI(-1.74，-0.21)， P < 0.05]和临床试验终点时[MD=-0.67，95%CI(-1.04， -0.30)，P < 0.001]的疼痛目测类比评分均显著低于对照组，差异有显著性意义；试验组术后1 d 目测类比评分与对照组相比差异无显著性意义[MD=-0.12，95%CI(-0.64，0.40)，P > 0.05]；③试验组术后眩晕的发生率低于对照组，差异有显著性意义[OR=0.28，95%CI(0.10，0.78)，P < 0.05]；④而术后呕吐的发生率与对照组相比差异无显著性意义 [OR=0.83，95%CI(0.37，1.87)，P > 0.05]。
结论：电针治疗全膝关节置换后疼痛有明显优势，可以显著缓解患者术后3，7，14 d和研究终末期的疼痛反应，同时能降低术后眩晕的风险，但对于患者术后第1天的疼痛反应与术后呕吐发生率方面没有显著效果。受纳入研究数量和质量限制，上述结论有待更多高质量研究予以验证。
https://orcid.org/0000-0002-4677-8075 (李琰) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 骨, 关节, 膝关节置换, 电针, 术后疼痛, 眩晕, Meta分析

Abstract: OBJECTIVE: Electroacupuncture has been commonly used in clinical practice for pain after total knee arthroplasty, but its effects and safety remain controversial. The efficacy and safety of electroacupuncture in the treatment of pain after total knee arthroplasty were systematically evaluated.
METHODS: PubMed, Embase, Cochrane Library, SinoMed, CNKI, VIP and Wanfang databases were searched to collect randomized controlled trials on electroacupuncture in the treatment of pain after total knee arthroplasty from inception to December 31, 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was performed by RevMan 5.3 software. 
RESULTS: (1) A total of six studies involving 304 patients were included. (2) The results of meta-analysis showed that compared with control group, the experimental group had significantly lower visual analogue scale scores at 3 days [MD=-0.67, 95%CI(-1.01 to -0.33), P < 0.001], 7 days [MD=-0.60, 95%CI (-0.88 to -0.33), P < 0.001), 14 days [MD=-0.97, 95%CI(-1.74 to -0.21), P < 0.05) and end point of clinical trial (MD=-0.67, 95%CI(-1.04 to -0.30), P < 0.001), respectively, after total knee arthroplasty. There were no significant differences in visual analogue scale scores at 1 day after total knee arthroplasty [MD=-0.12, 95%CI(-0.64, 0.40), P > 0.05). (3) The incidence of postoperative vertigo was significantly lower in the trial group than that in the control group [OR=0.28, 95%CI(0.10, 0.78), P < 0.05]. (4) The incidence of postoperative vomiting was not significantly different between the trial and control groups [OR=0.83, 95%CI(0.37, 1.87), P > 0.05].
CONCLUSION: Electroacupuncture has obvious advantages in the treatment of pain after total knee arthroplasty, which can significantly relieve the pain reaction of patients at 3, 7, 14 days and the end point of clinical trial, and can reduce the incidence of postoperative vertigo, but it cannot reduce the incidence of postoperative vomiting and pain at 1 day after total knee arthroplasty. Due to the limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions. 

Key words: bone, joint, knee arthroplasty, electroacupuncture, postoperative pain, vertigo, meta-analysis

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