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中国全科医学

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手法治疗中医骨伤科领域临床优势病种的证据图谱研究

冯天笑1，2，王旭2，卜寒梅2，秦晓宽2，肖想玉2，3，魏戌4，5*，朱立国2，5*   

  1. 1.100029 北京市，北京中医药大学研究生院；2.100102 北京市，中国中医科学院望京医院脊柱二科；3.250000 山东省济南市，山东中医药大学第一临床医学院；4.100102 北京市，中国中医科学院望京医院学术发展处；5.100102 北京市，中医正骨技术北京市重点实验室
  • 收稿日期:2023-12-15 接受日期:2024-01-16
  • 通讯作者: 魏戌，研究员 / 博士生导师； 朱立国，主任医师 / 博士生导师
  • 基金资助:
    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“中医药临床循证研究专项”（WJYY-XZKT-2023-05）

Study on the Evidence Map of Manual Therapy of Clinical Advantageous Diseases in Traditional Chinese Orthopedics

FENG Tianxiao1，2，WANG Xu2，BU Hanmei2，QIN Xiaokuan2，XIAO Xiangyu2，3，WEI Xu4，5*，ZHU Liguo2，5*   

  1. 1.Graduate School，Beijing University of Chinese Medicine，Beijing 100029，China；2.Department of Spine Ⅱ，Wangjing Hospital of China Academy of Chinese Medical Sciences，Beijing 100102，China；3.The First Clinical Medical College，Shandong University of Traditional Chinese Medicine，Jinan 250000，China；4.Academic Development Office，Wangjing Hospital of China Academy of Chinese Medical Sciences，Beijing 100102，China；5.Beijing Key Laboratory of Orthopedics of Traditional Chinese Medicine，Beijing 100102，China
  • Received:2023-12-15 Accepted:2024-01-16
  • Contact: WEI Xu，Professor/Doctoral supervisor； ZHU Liguo，Professor of medicine/Doctoral supervisor

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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、The 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。

关键词: 手法, 骨科；中医骨伤科学；优势病种；证据图；系统评价；Meta 分析

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，The 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.

Key words: Manipulation, orthopedic；Orthopedics traumatology（TCM）；Predominance disease；Evidence map；Systematic review；Meta-analysis

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