| 摘要: |
| [目的] 运用网状 Meta 分析（NMA）的方法，评价不同的中医外治法对指屈肌腱狭窄性腱鞘炎（FTST）的临床疗效。[方法] 运用 PubMed、Embase、The Cochrane Library、中国知网（CNKI）、维普数据库（VIP）、万方知识服务平台检索中医外治法治疗指屈肌腱狭窄性腱鞘炎的随机对照试验。检索时间为建库至 2025 年 10 月 24 日。制定检索词和检索策略检索文献，并根据纳排标准，进行初筛和全文筛选。对文献进行质量评价和资料提取，采用 Review Manager5.4 和 Stata15.1 进行统计分析。[结果] 经筛选纳入 49 项研究，共计 5 379 例患者入选，共涉及 9 种干预措施，包括 8 种中医外治法（针刀、温针灸、中药外洗、膏药贴敷、艾灸、推拿、火针、针刺）和封闭治疗作为对照。在临床有效率方面，相较于封闭治疗，针刀、温针灸、艾灸、针刺、火针这 5 种中医外治手段疗效更佳。而在中医外治法之间的间接比较中，温针灸的疗效优于针刀和中药外洗；艾灸优于针刺；火针优于推拿。在视觉模拟评分（VAS）评分方面，与封闭治疗相比，针刀和温针灸的疗效更为显著。而在中医外治法之间的间接比较中，温针灸的疗效优于中药外洗、针刺、针刀，针刀的疗效优于中药外洗，火针的疗效优于中药外洗。累积排名概率曲线下面积（SUCRA）显示：在有效率方面，9 种干预措施概率排名前 3 为温针灸、针刀、艾灸。在改善 VAS 评分方面，6 种干预措施概率排序前 3为温针灸、针刀、针刺。同时亚组分析显示，对于病程小于 6 个月的患者，温针灸在治疗有效率方面具有一定优势。[结论] 中医外治法可有效治疗指屈肌腱狭窄性腱鞘炎，改善 VAS 评分。在临床治疗中可根据指屈肌腱狭窄性腱鞘炎不同分期结合患者病情，选择适宜的中医外治方案。根据 SUCRA 结果排序，温针灸在临床有效率、VAS 评分改善及病程<6 个月患者的治疗中排序相对靠前，呈现出一定的治疗优势，但受限于纳入文献的质量与数量以及证据的质量，临床应用时应结合患者实际情况审慎选择。上述结论仍需通过多中心、大样本的随机对照试验进一步验证，以期为临床实践提供更高质量的证据支持。 |
| 关键词: 网状Meta分析 指屈肌腱狭窄性腱鞘炎 中医外治法 |
| DOI：10.11656/j.issn.1672-1519.2026.10.06 |
| 分类号:R686.1 |
| 基金项目:中国中医科学院望京医院第一批院级专家学术经验继承项目（WJSC-202307）；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（WJYYXZKT-2023-27）；北京中医药大学教育科学研究课题（XJL XS009）。 |
|
| Efficacy of traditional Chinese medicine external treatment for flexor tendon stenosing tenovaginitis： A network Meta-analysis |
|
WANG Xinyue1,2, YU Ximing1, CHEN Yanbai1, HE Mingjiang1,2
|
|
1.Beijing University of Chinese Medicine, Beijing 100102, China;2.Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100029, China
|
| Abstract: |
| [Objective] To evaluate the clinical efficacy of different traditional Chinese medicine（TCM）external therapies for flexor tendon stenosing tenosynovitis using network Meta-analysis（NMA）. [Methods] Databases including PubMed，Embase，The Cochrane Library，China National Knowledge Infrastructure（CNKI），VIP，and Wanfang Database were searched for randomized controlled trials （RCTs）on TCM external therapies for treating stenosing tenosynovitis of the flexor tendons. The search period spanned from database inception to October 24，2025. Literature was retrieved using defined search terms and strategies，followed by initial and full-text screening based on inclusion and exclusion criteria. Quality assessment and data extraction were performed，with statistical analysis conducted using Review Manager 5.4 and Stata 15.1. [Results] A total of 49 studies involving 5 379 patients were included after screening. These studies encompassed nine intervention methods：acupuncture，acupuncture knife therapy，warm acupuncture，herbal external wash，medicated plaster application，massage therapy，fire needle therapy，moxibustion，and local injection therapy. Regarding clinical efficacy rates，acuproctotherapy，warm acupuncture，moxibustion，acupuncture，and fire needle therapy demonstrated superior outcomes compared to nerve block therapy. In indirect comparisons among TCM external therapies：warm acupuncture outperformed acuproctotherapy and herbal external wash；moxibustion outperformed acupuncture；and fire needle therapy outperformed massage. Regarding VAS scores，needle knife and warm acupuncture demonstrated more significant efficacy than nerve block therapy. In indirect comparisons among TCM external therapies：warm acupuncture outperformed herbal external wash，medicated plaster application，acupuncture，and needle knife；needle knife outperformed herbal external wash；and fire needle outperformed herbal external wash. The cumulative probability under the receiver operating characteristic curve（SUCRA）revealed：for treatment efficacy， the top three interventions ranked by probability were warm acupuncture，acupuncture knife therapy，and moxibustion；for improving VAS scores，the top three interventions ranked by probability were warm acupuncture，acupuncture knife therapy，and acupuncture. [Conclusion] TCM external therapies effectively treat flexor tendon stenosing tenosynovitis and improve VAS scores. In clinical practice，appropriate TCM external treatment protocols can be selected based on the disease stage and patient condition. Based on SUCRA results，warm acupuncture ranked relatively higher in clinical efficacy rates，VAS score improvement，and treatment of patients with disease duration <6 months，demonstrating certain therapeutic advantages. However，due to limitations in the quality and quantity of included literature as well as evidence quality，careful selection should be made in clinical application based on individual patient circumstances. These conclusions require further validation through multicenter，large-sample randomized controlled trials to provide higher-quality evidence support for clinical practice. |
| Key words: network Meta-analysis stenosing tenosynovitis of the flexor tendons external treatment methods in traditional Chinese medicine |
