运动干预防治踝关节不稳效应的Meta分析

Preventing ankle instability through exercise： A meta-analysis

目的探讨运动干预防治踝关节不稳的效应机制，以期为运动干预防治踝关节不稳提供循证依据。方法通过计算机检索NCBI、CNKI、维普、万方数据库中建库至2014年12月所发表的运动干预防治踝关节不稳的随机对照试验，并辅以手工检索。南3位研究人员采用Cochranehandbook提供的文献质量评价标准对纳人义献进行质量评估。由3位研究人员对纳入文献结局指标进行数据抽取，采用Rev-Man5．2版软件对效果和运动功能数据进行分析。结果初检出文献665篇，其中英文文献357篇，中文文献308篇。经阅读文章题目和摘要，获得92篇文献。进一步查找和阅读全文，剔除不符合纳入标准的文献，最终纳入14篇RCT文献，其中英义12篇，中文2篇。经研究分析发现，运动干预可明显改善踝关节不稳症状和功能[SMD：0．98，95％CI（0．65，1．31），P〈0．01]，并提高肌力[SMD=1．50，95％CI（0．99，2．01），P〈0．01]、平衡能力和姿势稳定性[SMD=-0．54，95％CI（-0．84，-0．25），P〈0．01]，但不能有效地改善本体感觉[SMD=-0．27，95％CI（-0．60，0．06），P〉0．05]和神经肌肉功能[SMD=-0．02，95％CI（-0．51，0．47），P〉0．05]。结论运动干预可有效地改善踝关节不稳患者踝关节肌力、平衡能力和姿势稳定性，这些因素可能是运动干预缓解踝关节不稳症状，提高踝关节功能，防治踝关节不稳的主要机制，但肌力干预的针对性有待提高；另外，纳入文献中所采用的运动干预方法不能有效地改善踝关节的本体感觉和神经肌肉功能，这可能与运动十预方式的选择有关。

Objective To explore the effect and mechanism of preventing ankle instability through exer- cise, so as to provide evidence-based references for practice. Methods The randomized and controlled trials （RCT） on preventing ankle instability through exercise published before December 2014 were searched for in the NCBI, CNKI, VIP and Wanfang databases by computer, supplemented by manual searching. Each study＇s quality was evaluated according to the standards of the Cochrane handbook by 3 researchers. The outeome indexes were ex- tracted and analyzed using RevMan 5.2 software. Results After the initial selection, 665 papers （ 357 in English and 308 in Chinese） were retained. From these 92 were chosen after reading the titles and abstracts. Uhimately, 14 RCT studies （ 12 in English and 2 in Chinese） met the inclusion criteria. They showed that exercise improved ankle function and symptoms of ankle instability significantly [ SMD= 0.98, 95%CI （0.65,1.31） , P〈0.01 ] , improved muscle strength [ SMD= 1.50, 95%CI （0.99,2.01） , P〈0.011 , improved balance and postural stability [ SMD= -0.54, 95%C1 （-0.84,-0.25）,P〈0.01], but did not improve proprioception or neuromuscular functioning sig- nificantly. Conclusions Exercise can effectively improve muscle strength, balance and postural stability, but not proprioception or neuromuscular functioning. The details of these findings may be related to the exercise intervention chosen.