《中国康复理论与实践》

《中国康复理论与实践》 ›› 2022, Vol. 28 ›› Issue (10): 1178-1189.doi: 10.3969/j.issn.1006-9771.2022.10.008

• 循证研究 • 上一篇    下一篇

青少年特发性脊柱侧凸患者静态站立及步行时生物力学变化的Meta分析

柯竟悦1,马圣楠1,张晓慧2,李古强3()   

  1. 1.滨州医学院康复医学院,山东烟台市 264003
    2.滨州医学院烟台附属医院,山东烟台市 264003
    3.滨州医学院康复工程研究院,山东烟台市 264003
  • 收稿日期:2022-03-15 修回日期:2022-08-24 出版日期:2022-10-25 发布日期:2022-11-08
  • 通讯作者: 李古强 E-mail:lgq100@bzmc.edu.cn
  • 作者简介:柯竟悦(1997-),女,汉族,福建莆田市人,硕士研究生,主要研究方向：肌肉骨骼康复、康复工程。|李古强(1969-),男,汉族,江苏徐州市人,硕士,副教授,主要研究方向：康复工程、运动康复、矫形器的临床应用与研究。
  • 基金资助:
    "十四五"残疾人事业规划前期研究重点课题暨2019年度中国残联研究课题(CJFJRRB29-2019)

Biomechanical differences of adolescent idiopathic scoliosis during static standing and level walking: a meta-analysis

KE Jingyue1,MA Shengnan1,ZHANG Xiaohui2,LI Guqiang3()   

  1. 1. School of Rehabilitation Medicine, Binzhou Medical University, Yantai, Shandong 264003, China
    2. Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264003, China
    3. School of Institute of Rehabilitation Engineering, Binzhou Medical University, Yantai, Shandong 264003, China
  • Received:2022-03-15 Revised:2022-08-24 Published:2022-10-25 Online:2022-11-08
  • Contact: LI Guqiang E-mail:lgq100@bzmc.edu.cn
  • Supported by:
    Key Research Project in the Early Stage of the "14th Five-Year Plan" for the Career Planning of the Disabled and Research Project of China Disabled Persons' Federation in 2019(CJFJRRB29-2019)

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摘要：

目的 将青少年特发性脊柱侧凸(AIS)患者与健康人进行比较,明确AIS患者在静态站立及步行时存在的生物力学特征的偏差。

方法 检索PubMed、Web of Science、EMBASE、Cochrane Library、中国知网、中国生物医学文献数据库、万方、维普数据库,检索时间均为自建库至2021年8月,纳入文献为AIS生物力学特征相关横断面研究,2名研究员独立提取数据并进行文献质量评价,采用RevMan 5.4软件进行分析。

结果 共纳入23项研究,1 092例研究对象。所纳入文献具有中等到高等的方法学质量。静态站立时,AIS患者足底压力中心的椭圆面积(ES = 0.69, 95%CI 0.35~1.02, P < 0.001)、前后向转移速度(ES = 0.59, 95%CI 0.29~0.89, P < 0.001)、内外向转移速度(ES = 0.47, 95%CI 0.12~0.83, P < 0.05)均大于正常对照组,而骨盆冠状面倾斜情况(ES = 0.10, 95%CI -0.16~0.36, P > 0.05)与正常对照组相比无显著性差异。步行中,AIS患者膝关节矢状面活动度(ES = -0.59, 95%CI -1.00~-0.17, P = 0.005)、踝关节矢状面活动度(ES = -0.55, 95%CI -0.96~-0.14, P = 0.008)均小于正常对照组,臀中肌(ES = 1.21, 95%CI 0.23~2.18, P = 0.02)、腰方肌(ES = 1.13, 95%CI 0.68~1.57, P < 0.001)、竖脊肌(ES = 1.20, 95%CI 0.75~1.65, P < 0.001)肌电活动持续时间长于正常对照组,而步速(ES = -0.12, 95%CI -0.45~0.21, P = 0.49)与对照组相比无显著性差异。亚组分析结果表明,AIS患者脊柱凹侧步长(ES = -0.37, 95%CI -0.72~-0.02, P = 0.04)小于正常对照组,而患者总体步长特征(ES = -0.22, 95%CI -0.76~0.31, P = 0.42)与正常对照组相比无显著性差异。

结论 与健康人相比,AIS患者在时空特征、运动力学特征与肌电信号特征三个方面均有特征性的生物力学变化。

关键词: 青少年特发性脊柱侧凸, 生物力学, 静态站立, 步行, Meta分析

Abstract:

Objective To identify the biomechanical deviations of patients with adolescent idiopathic scoliosis (AIS) during static standing and level walking.

Methods Cross-sectional, observational studies comparing biomechanical characteristics between individuals with AIS and healthy controls were searched in the databases of PubMed, Web of Science, EMBASE, Cochrane Library, CNKI, CBM, Wanfang data and VIP. The retrieval time was from the establishment of the database to August, 2021. Quality assessment and data extraction were performed independently by two reviewers. The data were analyzed with RevMan 5.4.

Results A total of 23 studies were finally included, with a total of 1 092 subjects. The overall methodological quality was moderate to high level. During static standing, the sway area (ES = 0.69, 95%CI 0.35 to 1.02, P <0.001), anteroposterior transfer speed (ES = 0.59, 95%CI 0.29 to 0.89, P <0.001) and mediolateral transfer speed (ES = 0.47, 95%CI 0.12 to 0.83, P <0.05) of plantar pressure center were more in AIS group than in the control group, however, there was no significant difference in the inclination of pelvic frontal plane (ES = 0.10, 95%CI -0.16 to 0.36, P> 0.05). During walking, the sagittal range of motion of knee (ES = -0.59, 95%CI -1.00 to -0.17, P = 0.005) and ankle (ES = -0.55, 95%CI -0.96 to -0.14, P = 0.008) were less in AIS group than in the control group, and the duration of EMG activity of the gluteus medius (ES = 1.21, 95%CI 0.23 to 2.18, P = 0.02), the quadratus lumborum (ES = 1.13, 95%CI 0.68 to 1.57, P <0.001) and the erector spinae (ES = 1.20, 95%CI 0.75 to 1.65, P <0.001) was longer in AIS group than in the control group, while no significant difference was observed in the step speed (ES = -0.12, 95%CI -0.45 to 0.21, P = 0.49). Compared with the control group, the step length of the spinal concave side (ES = -0.37, 95%CI -0.72 to -0.02, P =0.04) was shorter, but the overall step length (ES = -0.22, 95%CI -0.76 to 0.31, P = 0.42) was not significantly different in AIS group.

Conclusion Compared with the healthy controls, some characteristic biomechanical changes were exhibited in the AIS patients, including spatiotemporal characteristics, kinematic and mechanical characteristics, and electromyographic signal characteristics.

Key words: adolescent idiopathic scoliosis, biomechanics, static standing, walking, meta-analysis

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