治疗后半规管BPPV新发现手法的系统评价与荟萃分析

文献信息

中文摘要

背景： 后半规管良性阵发性位置性眩晕（BPPV）通常采用Epley手法（EM）治疗。已开发出新的手法，在简便性和自我操作方面具有潜在优势。
目的： 评估并比较EM与新开发的替代手法治疗后半规管BPPV（PC-BPPV）的有效性。
方法： 对比较EM或安慰剂与PC-BPPV新治疗手法的随机对照试验（RCT）进行系统评价与荟萃分析。检索了电子数据库（Scopus、PubMed、ScienceDirect、OVID MEDLINE、PROSPERO和Cochrane Library）。采用随机效应模型进行配对荟萃分析，并计算风险差（RD）及其95%置信区间（CI）。使用Doi图和Luis Furuya-Kanamori（LFK）指数评估发表偏倚。
结果： 共纳入5项RCT，涉及422例患者；其中3项研究符合荟萃分析标准。合并的即刻治疗效果显示率比为1.66（95% CI：0.534-5.151），随访效果显示率比为1.64（95% CI：0.520-5.152），表明新手法（半翻滚法、Li手法、翻滚法和新替代手法）的治疗结果与EM相当，而较宽的置信区间反映了可用研究数量有限。LFK指数分别为1.74（即刻）和2.16（随访），分别提示轻度与重度发表偏倚。
结论： 统计数据表明，新开发的PC-BPPV治疗操作可能具有与EM相当的优势。这些技术似乎简单且总体耐受良好，提示其作为传统EM替代选择的潜力；然而，在得出明确结论之前，仍需更多稳健且针对具体手法的研究。
注册： PROSPERO ID：CRD42023466129。

英文摘要

BACKGROUND: Benign Paroxysmal Positional Vertigo (BPPV) of the posterior canal is commonly treated using the Epley Maneuver (EM). New maneuvers have been developed with potential benefits in ease and self-administration.
OBJECTIVE: To evaluate and compare the effectiveness of the EM with newly developed alternative maneuvers for treating posterior canal BPPV (PC-BPPV).
METHODS: A systematic review and meta-analysis was conducted of randomized controlled trials (RCTs) comparing the EM or placebo with new treatment maneuvers for PC-BPPV. Electronic databases (Scopus, PubMed, ScienceDirect, OVID MEDLINE, PROSPERO, and Cochrane Library) were searched. A pairwise meta-analysis using random-effects models was conducted, and the risk difference (RD) with 95% confidence intervals (CI) was calculated. Doi plots and the Luis Furuya-Kanamori (LFK) index were used to assess publication bias.
RESULTS: Five RCTs involving 422 patients were identified; three studies met criteria for meta-analysis. The pooled immediate treatment effect showed a rate ratio of 1.66 (95% CI: 0.534-5.151), and the follow-up effect showed a rate ratio of 1.64 (95% CI: 0.520-5.152), indicating that the new maneuvers (Half Somersault, Li Maneuver, Rolling over and New Alternate maneuver) demonstrated treatment outcomes comparable to the EM, while the wide confidence intervals reflect the limited number of available studies. The LFK indices were 1.74 (immediate) and 2.16 (follow-up), suggesting minor and major publication bias, respectively.
CONCLUSIONS: Statistical data indicated that newly developed procedures for treating PC-BPPV are potentially advantageous as the EM. These techniques appear simple, and generally well-tolerated, indicating their potential as alternative options to the traditional EM; however, more robust and maneuver-specific studies are needed before firm conclusions can be drawn.
REGISTRATION: PROSPERO ID: CRD42023466129.