非药物干预腰椎间盘突出症内镜术后残余症状患者的网状Meta分析*

作者：王美君，杜丽梅，胡文珍，孙凤歧

单位：甘肃省中医院，甘肃 兰州 730050

引用：引用：王美君，杜丽梅，胡文珍，孙凤歧.非药物干预腰椎间盘突出症内镜术后残余症状患者的网状Meta分析[J].中医药导报,2026,32(5):188-196,219.

DOI：10.13862/j.cn43-1446/r.2026.05.030

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摘要：

目的：比较不同的非药物疗法对腰椎间盘突出症（LDH）内镜术后残余症状患者的疗效。方法：检索中国知网（CNKI）、万方数据知识服务平台（Wanfang Data）、维普中文期刊服务平台（CSTJ）、PubMed、Embase和Web of Science数据库中应用非药物疗法治疗LDH内镜术后残余症状的随机对照试验（RCT），检索时间均为建库至2024年12月。2名研究员独立筛选文献、提取资料并评价所纳入研究的偏倚风险后，采用Stata 16.0软件对数据进行分析。结果：共纳入了33项RCT，包括2 635例LDH内镜术后残余症状患者和11种非药物疗法（推拿、八段锦、冲击波、正骨、温针灸、艾灸、电针、经皮穴位电刺激、针刀、针刺和核心肌群训练）。不同干预措施在改善VAS评分方面的SUCRA排序结果为经皮穴位电刺激（75.6%）>核心肌群训练（69.4%）>针刺（66.3%）>冲击波（59.4%）>针刀（58.8%）>温针灸（58.2%）>艾灸（57.2%）>八段锦（51.3%）>麦肯基运动（42.1%）>电针（41.8%）>推拿（40.6%）>常规治疗（15.5%）>正骨（13.9%）。不同干预措施在改善ODI评分方面的SUCRA排序结果为艾灸（82.7%）>针刺（77.0%）>推拿（73.3%）>正骨（72.9%）>经皮穴位电刺激（49.0%）>核心肌群训练（47.0%）>电针（39.7%）>麦肯基运动（28.4%）>冲击波（23.1%）>常规治疗（6.9%）。不同干预措施在改善JOA评分方面的SUCRA排序结果为针刺（84.3%）>麦肯基运动（70.8%）>冲击波（67.5%）>电针（59%）>艾灸（53.4%）>核心肌群训练（51.5%）>八段锦（34.7%）>温针灸（18.1%）>常规治疗（10.7%）。不同干预措施在优良率方面的SUCRA排序结果为核心肌群训练（94.4%）>针刺（59.0%）>针刀（58.7%）>艾灸（56.0%）>八段锦（54.3%）>冲击波（50.5%）>电针（14.4%）>常规治疗（12.6%）。结论：针刺可能是治疗LDH内镜术后残余症状疗效最好的非药物疗法，核心肌群训练与艾灸则分别为长期稳定性维持与炎症控制的重要补充。

关键词：腰椎间盘突出症；非药物疗法；脊柱内镜；针刺；核心肌群训练；艾灸；网状Meta分析

Abstract：

Objective: To compare the efficacy of different non-pharmacological therapies for residual symptoms in patients after endoscopic surgery for lumbar disc herniation (LDH). Methods: Randomized controlled trials (RCTs) on non-pharmacological therapies for residual symptoms after LDH endoscopic surgery were retrieved from China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform (Wanfang Data), China Science and Technology Journal Database (CSTJ), PubMed, Embase and Web of Science databases from the establishment of the databases to December 2024. Two researchers independently screened the literature, extracted data and assessed the risk of bias of included studies. Data analysis was performed using Stata 16.0 software. Results: A total of 33 RCTs were included, involving 2,635 patients with residual symptoms after LDH endoscopic surgery and 11 non-pharmacological interventions (tuina, Baduanjin, shock wave, bone setting, warm acupuncture, moxibustion, electroacupuncture, transcutaneous electrical acupoint stimulation, acupotomy, acupuncture, and core muscle training). The SUCRA ranking of different interventions in improving VAS score was as follows: transcutaneous electrical acupoint stimulation (75.6%) > core muscle training (69.4%) > acupuncture (66.3%) > shock wave (59.4%) > acupotomy (58.8%) > warm acupuncture (58.2%) > moxibustion (57.2%) > Baduanjin (51.3%) > McKenzie exercise (42.1%) > electroacupuncture (41.8%) > tuina (40.6%) > conventional treatment (15.5%) > bone setting (13.9%). The SUCRA ranking for ODI score improvement was: moxibustion (82.7%) > acupuncture (77.0%) > tuina (73.3%) > bone setting (72.9%) > transcutaneous electrical acupoint stimulation (49.0%) > core muscle training (47.0%) > electroacupuncture (39.7%) > McKenzie exercise (28.4%) > shock wave (23.1%) > conventional treatment (6.9%). The SUCRA ranking for JOA score improvement was: acupuncture (84.3%) > McKenzie exercise (70.8%) > shock wave (67.5%) > electroacupuncture (59%) > moxibustion (53.4%) > core muscle training (51.5%) > Baduanjin (34.7%) > warm acupuncture (18.1%) > conventional treatment (10.7%). The SUCRA ranking for excellent and good rate was: core muscle training (94.4%) > acupuncture (59.0%) > acupotomy (58.7%) > moxibustion (56.0%) > Baduanjin (54.3%) > shock wave (50.5%) > electroacupuncture (14.4%) > conventional treatment (12.6%). Conclusion: Acupuncture may be the most effective non-pharmacological therapy for residual symptoms after LDH endoscopic surgery. Core muscle training and moxibustion serve as important supplements for long-term stability maintenance and inflammation control, respectively.

Key words：lumbar disc herniation; non-pharmacological therapy; spinal endoscopy; acupuncture; core muscle training; moxibustion; network Meta-analysis

发布时间：2026-05-24

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