《中国康复理论与实践》

《中国康复理论与实践》 ›› 2022, Vol. 28 ›› Issue (11): 1278-1287.doi: 10.3969/j.issn.1006-9771.2022.11.007

• 循证研究 • 上一篇    下一篇

治疗性运动对功能性踝关节不稳姿势控制和踝周肌肉功能影响的Meta分析

柴良伟,刘华(),黄秋玉,孙喜妹,李凯洋,马景   

  1. 首都体育学院，北京市 100191
  • 收稿日期:2022-05-20 修回日期:2022-09-08 出版日期:2022-11-25 发布日期:2022-12-20
  • 通讯作者: 刘华 E-mail:liuhua@cupes.edu.cn
  • 作者简介:柴良伟(1999-)，男，汉族，山西临汾市人，硕士研究生，主要研究方向：运动损伤的预防与康复。|刘华(1978-)，女，汉族，博士，副教授，硕士研究生导师，主要研究方向：运动康复。
  • 基金资助:
    1.北京高校优质本科课程项目(145122005/004);2.北京高等教育本科教学改革创新项目(145122002/007)

Effect of therapeutic exercise on posture control and muscular function around ankle in patients with functional ankle instability: a meta-analysis

CHAI Liangwei,LIU Hua(),HUANG Qiuyu,SUN Ximei,LI Kaiyang,MA Jing   

  1. Capital University of Physical Education and Sports, Beijing 100191, China
  • Received:2022-05-20 Revised:2022-09-08 Published:2022-11-25 Online:2022-12-20
  • Contact: LIU Hua E-mail:liuhua@cupes.edu.cn
  • Supported by:
    Beijing Quality Undergraduate Programme in Universities(145122005/004);Beijing Higher Education Undergraduate Teaching Reform Innovation Project(145122002/007)

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摘要：

目的 对治疗性运动对功能性踝关节不稳(FAI)患者姿势控制和踝周肌肉功能的效果进行Meta分析。

方法 检索PubMed、Web of Science、Embase、SPORTdiscus、Medline、Science Direct、EBSCO、Springlink、中国知网、维普、万方数据库不同类型运动干预FAI的随机对照试验，时间范围自建库至2021年12月。由2名研究人员对纳入文献进行质量和结果证据等级评估，采用RevMan 5.4进行分析。

结果 最终纳入随机对照试验14篇，共434例受试者。与无运动干预相比，治疗性运动明显减少睁闭眼下压力中心偏移(睁眼, SMD = -0.28, 95%CI -0.46~-0.09, P = 0.003; 闭眼, SMD = -0.24, 95%CI -0.40~-0.09, P = 0.001)；增强运动任务前腓骨长肌激活(SMD = 0.38, 95%CI 0.05~0.71, P = 0.03)，运动任务后腓骨长肌(SMD = 0.53, 95%CI 0.16~0.90, P = 0.005)和胫骨前肌(SMD = 0.47, 95%CI 0.10~0.84, P = 0.01)激活。任务前胫骨前肌激活(SMD = 0.48, 95%CI -0.14~1.11, P = 0.13)、踝关节外翻/内翻峰力矩比无显著性差异(SMD = -0.15, 95%CI -0.46~0.16, P = 0.340)。

结论 治疗性运动可减少FAI患者压力中心偏移，使腓骨长肌执行动态任务前产生预备性收缩，腓骨长肌和胫骨前肌在完成任务后产生代偿性收缩，从而使踝关节更好应对外界干扰，维持关节稳定，预防再次损伤。

关键词: 功能性踝关节不稳, 姿势控制, 肌肉功能, 运动, Meta分析

Abstract:

Objective To explore the effect of exercise on the postural control and muscular function around the ankle in patients with functional ankle instability (FAI) with meta-analysis.

Methods Randomized controlled trials about therapeutic exercise for FAI published before December, 2021 were searched from PubMed, EBSCO, SPORTdiscus, Medline, Science Direct, Springlink, Web of Science, Embase CNKI, VIP and Wanfang Data. The quality and evidence grades of the researches were evaluated by two researchers, and the outcomes were analyzed with RevMan 5.4.

Results Fourteen randomized controlled trials were finally included, involving 434 subjects. Compared with no exercise intervention, therapeutic exercise might significantly improve the movement of center of pressure whether with eye-open or eye-closed (eye-open, SMD = -0.28, 95%CI -0.46 to -0.09, P= 0.003; eye-closed, SMD = -0.24, 95%CI -0.40 to -0.09, P = 0.001); while therapeutic exercise might also enhance the activation of the peroneus longus before dynamic task (SMD = 0.38, 95%CI 0.05 to 0.71, P = 0.03), and activation of the peroneus longus (SMD = 0.53, 95%CI 0.16 to 0.90, P = 0.005) and tibialis anterior (SMD = 0.47, 95%CI 0.10 to 0.84, P = 0.01) after dynamic task. There was neither significant difference in the activation of the tibialis anterior (SMD = 0.48, 95%CI -0.14 to 1.11, P = 0.13), nor the peak torque ratio of eversion to inversion isokinetic strength (SMD = -0.15, 95%CI -0.46 to 0.16, P= 0.340) before dynamic task between the two groups.

Conclusion Therapeutic exercise can decrease movement of center of pressure, enable anticipatory contraction of peroneus longus before dynamic tasks and compensatory contraction of peroneus longus and tibialis anterior after tasks, to make it easier to deal with external interference, maintain articular stability and prevent re-injury.

Key words: functional ankle instability, postural control, muscular function, exercise, meta-analysis

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