Clinical efficacy of small needle knife combined with traditional Chinese medicine in the treatment of knee osteoarthritis: a network Meta-analysis

doi:10.12307/2021.231

Abstract

Abstract: OBJECTIVE: There are many treatments for knee osteoarthritis, but there is no specific treatment. In recent years, increasing clinical studies have confirmed the effectiveness of small needle knife combined with Chinese medicine for knee osteoarthritis. However, there is still a lack of systematic evaluation to provide evidence-based support. In this paper, we aimed to systematically evaluate the clinical efficacy of small needle knife combined with traditional Chinese medicine in the treatment of knee osteoarthritis, so as to provide evidence-based reference for clinical decision-making in the treatment of knee osteoarthritis.
METHODS: The randomized controlled trials of small needle knife combined with traditional Chinese medicine in the treatment of knee osteoarthritis were searched by computer. The total effective rate was the main outcome, and the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, Visual Analogue Scale (VAS) and Lysholm scores were the secondary outcomes. Among them, the total effective rate was expressed as a binary variable, and the other indicators were expressed as continuous variables. The quality evaluation and data extraction were carried out using Cochrane Hand Book 5.1.0 after the included literatures were screened layer by layer, and the data were processed by Stata15.0 software followed by a network Meta-analysis.
RESULTS: A total of 26 randomized controlled trials involving 2 940 patients were included. The Jadad score showed that the quality of the included literature was low. The results showed that: Compared with small needle knife, traditional Chinese medicine, acupuncture plus Chinese medicine treatment, acupuncture treatment, and western medicine, small needle knife plus traditional Chinese medicine could significantly improve the total effective rate (P < 0.05); compared with western medicine, acupuncture, acupuncture plus traditional Chinese medicine, small needle knife plus traditional Chinese medicine could significantly reduce the WOMAC score; compared with small needle knife, traditional Chinese medicine and western medicine, small needle knife plus traditional Chinese medicine could significantly reduce the VAS score (P < 0.05) and significantly improve Lysholm knee joint function score (P < 0.05). The area under curve results showed that small needle knife plus traditional Chinese medicine had the best effect in improving the effective rate, reducing WOMAC score, reducing VAS score and improving Lysholm knee function score in the included six methods.
CONCLUSION: Small needle knife combined with traditional Chinese medicine has significant clinical efficacy in the treatment of knee osteoarthritis, and this combined treatment is significantly superior to western medicine, traditional Chinese medicine, and small needle knife alone in alleviating pain and improving knee joint function. The conclusion of this study provides certain evidence-based reference for the clinical treatment of knee osteoarthritis, but further high-quality clinical application research is required.

Key words: bone, knee, osteoarthritis, small needle knife, traditional Chinese medicine, pain, knee joint function, randomized controlled trial, network Meta-analysis

CLC Number:

Huang Cihui, Liu Jiayue, Huang Yingjie, Zhuang Zeqin, Lin Yunxin, Li Dan, Zheng Liang. Clinical efficacy of small needle knife combined with traditional Chinese medicine in the treatment of knee osteoarthritis: a network Meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(32): 5240-5248.

Figures/Tables 24

2.8 敏感性分析结果见图18，以总有效率为疗效指标，各个研究无明显异质性，对其进行敏感性分析，结果显示临床疗效的Meta分析稳定性较高。以WOMAC评分变化为疗效指标，各个研究有显著的异质性，对其进行敏感性分析，显示WOMAC评分的Meta分析结果不稳定，推测异质性可能来源于2个研究[15， 21]。将该研究剔除后，再次分析异质性，发现异质性仍然较大(I2=96.2%，P < 0.001)，分析原因，可能与涉及该指标的文献数量过少有关，因此应谨慎对待WOMAC评分这一指标的分析结果。以目测类比评分变化为疗效指标，各个研究有显著的异质性，对其进行敏感性分析，显示目测类比评分的Meta分析结果不稳定，异质性可能来源于2个研究[25，31]。将这2个研究剔除后，重新进行分析，发现异质性仍然较大(I2=96.9%，P < 0.001)，其原因可能是报道该指标的文献数量过少，提示目测类比评分的结果不稳定，需谨慎解读。以Lysholm评分为疗效指标，各个研究有中等异质性，对其进行敏感性分析，显示Lysholm评分的Meta分析结果欠稳定，异质性可能来源于2个研究[11，30]，造成异质性的原因可能是这2个研究与其他研究疗程的差异。剔除此2个研究后，发现其他研究无明显的异质性(I2=0，P=0.437)，用固定效应模型对剔除此2个研究后的其他研究进行分析，结果显示，与单用中药(SMD=0.85，95%CI：1.16-0.54)、单用西药(SMD=1.06，95%CI：1.45-0.68)相比，小针刀加中药能显著提升Lysholm膝关节功能评分(P < 0.05)，与单用中药相比，单用西药改善Lysholm膝关节功能评分的疗效无显著差异(P < 0.05)；概率排序结果显示，改善Lysholm膝关节功能评分的疗效由优到劣的排序为小针刀加中药>中药>西药。 "

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