| Objective:To evaluate the efficacy and safety of acupuncture and moxibustion in the treatment of sciatica by using systems review and meta-analysis.Methods:1.Search methods:We searched CBM(1978-2017.07),VIP(1989-2017.07),CNKI(1979-2017.07),wanfang database(1997-2017.07),PubMed(1996-2-2017.07),EMBASE(1980-2017.07).At the same time combine manual search and supplementary search.2.Include and exclusion criteria: acupuncture treatment for sciatica,adopt acupuncture or give priority to with acupuncture combination therapy with other treatment methods,and the blank control,sham acupuncture,a placebo,western medicine,traction,closed treatment control.The study type was a randomized controlled trial.Eliminate duplicate publications.3.Data extraction and quality evaluation: independent data extraction and bias risk assessment by two researchers.The data extraction table was used to extract data,and the "bias risk assessment" tool recommended by the Cochrane handbook 5.1.0 was used to assess the quality of the included literature.4.Data analysis: the data were statistically analyzed with RevMan5.3 software.The two classification variables used Relative Risk(RR),and the continuous variables were weighted mean difference(WMD).Meta-analysis was used when data homogeneity was better.5.Grading of evidence quality: the grading system is used to assess the statistical analysis results of RCTs.Results:33 trials were included,4955 patients,the main interventions are acupuncture,acupuncture combined with western medicine,acupuncture and moxibustion combined with infrared irradiation,acupuncture combined with massage,acupuncture and moxibustion combined with western medicine,acupuncture combined with traction kerotherapy closed.1.Acupuncture treatment of primary sciatica : compared with western medicine,acupuncture and moxibustion treatment can significantly reduce the number of invalid [RR= 0.22,95% CI(0.09,0.55)],lower leg pain VAS score [WMD =-0.87,95% CI(-1.67,-0.07)],increase the pain threshold [WMD = 1.23,95% CI(1.02,1.44)],GRADE rating:low level.2.Acupuncture treatment for sciatica due to lumbar disc:(1)compared with western medicine,acupuncture,acupuncture combined with traction kerotherapy western medicine treatment can significantly reduce the number of invalid [RR = 0.27,95% CI(0.14,0.14);RR = 0.22,95% CI(0.08,0.62)],GRADE ratings are: lower and lower.(2)compared with western medicine,acupuncture,acupuncture combined with western medicine,acupuncture and moxibustion combined with western medicine,acupuncture combined with traction kerotherapy infrared irradiation can significantly reduce the leg pain VAS score more[WMD =-6.98,95% CI(-10.78,-3.13);the WMD =-2.05,95% CI(-2.49,-1.61);the WMD =-1.59,95% CI(-2.23,-0.95);the WMD =-3.69,95% CI(-3.98,-3.40)],GRADE ratings are: extremely lower,lower,lower and lower.(3)Compared with traction,acupuncture combined with infrared irradiation can significantly reduce the number of invalid patients [RR = 0.13,95% CI =(0.03,0.57)],GRADE rating: low level.3.Acupuncture treatment of sciatica caused by piriformis syndrome:(1)compared with western medicine,acupuncture,acupuncture combined with massage can more significantly reduce the number of invalid [RR = 0.06,95% CI(0.01,0.01);RR = 0.11,95% CI(0.05,0.23)],acupuncture can significantly reduce the leg pain VAS score [WMD =-0.26,95% CI(-0.51,-0.01)],GRADE rating: lower and lower.(2)compared with the closed,needle knife,acupuncture and moxibustion combined with closed,acupuncture combined with massage more significantly reduce the number of invalid [RR = 0.13,95% CI(0.03,0.03);RR = 0.09,95% CI(0.02,0.02);RR = 0.18,95% CI(0.04,0.04),P = 0.02),GRADE ratings are respectively: low-level,low-level,extremely low;The combination of acupuncture and moxibustion can lower the rate of leg pain VAS score [WMD =-2.30,95% CI(-3.52,-1.08)],GRADE rating: low level.4.It was reported that acupuncture treatment of sciatica was less than that of acupuncture,which was mainly caused by subcutaneous hemorrhage after acupuncture and injection.Conclusion:1.Acupuncture treatment of primary sciatica: compared with western medicine,acupuncture is more effective in reducing the number of patients with primary sciatica,improving the pain threshold and alleviating leg pain.Future research is likely to have a significant impact on the assessment of existing outcomes,and the likelihood of a change in the reliability of the assessment results is greater.2.Acupuncture treatment for sciatica due to lumbar disc:(1)compared with western medicine,acupuncture,acupuncture combined with traction kerotherapy western medicine can effectively reduce sciatica due to lumbar disc treatment is invalid,the number of acupuncture and moxibustion,acupuncture combined with western medicine,acupuncture and moxibustion combined with western medicine,acupuncture combined with traction kerotherapy infrared irradiation can more effectively reduce leg hurts,future research is likely to have important effects on existing curative effect evaluation,change the credibility of evaluation results.(2)compared with traction,acupuncture and moxibustion combined with infrared irradiation can effectively reduce sciatica due to lumbar disc treatment is invalid,the number of future research is likely to have important effects on existing curative effect evaluation,change the credibility of evaluation results.3.The acupuncture treatment of sciatica caused by piriformis syndrome:(1)compared with western medicine,acupuncture,acupuncture combined with massage can effectively reduce sciatica caused by piriformis syndrome treatment is invalid,the number of acupuncture and moxibustion can effectively relieve leg hurts more,the future research is likely to have important effects on existing curative effect evaluation,change the credibility of evaluation results.(2)compared with the closed treatment,needle knife,acupuncture combined with closed more effectively reduce the sciatic nerve pains piriformis syndrome caused by treatment is invalid,the number of acupuncture combined with closed can effectively relieve leg hurts more,the future research is likely to have important effects on existing curative effect evaluation,change the credibility of evaluation results.The effect of acupuncture combined with massage to reduce the number of patients with sciatic neuralgia caused by piriformis syndrome is very uncertain.4.There is less adverse reaction and higher safety in acupuncture treatment of sciatica. |
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