本体感觉训练对全膝关节置换术患者关节功能恢复的荟萃分析

The effect of proprioceptive training on knee joint recovery among patients with total knee replacement.. A Meta-analysis of randomized controlled trials

目的应用荟萃分析评价本体感觉训练对全膝关节置换患者的关节功能恢复的疗效。方法利用计算机检索中国生物医学文献数据库、中国知网、万方数据库及维普数据库、PubMed、MEDLINE、EMbase及CochraneLibrary数据库，同时手工检索相关杂志和资料中关于本体感觉训练对膝关节置换术患者功能恢复的临床随机对照试验，截止日期为2017年11月，由2位研究人员筛选文献、整理资料、提取数据、质量评价，随后采用RevMan5．3软件对数据进行整合和荟萃分析。结果共纳入文献5篇，包括278例患者。分析结果显示试验组在对照组的基础上进行本体感觉训练后，其关节功能评分较对照组明显改善，SMD=0．38，95％CI（0．26，049），P〈0．0001。本体感觉能明显改善病变膝关节的功能（P=0．0006）、改善关节活动度（P=0．006）、提高肌力（P=0．005）及稳定性（P〈0．0001）。结论有计划、有针对性的本体感觉训练可有效提高全膝关节置换患者的关节稳定性，增强平衡与协调能力，提高中老年患者的生活质量，是一种值得推荐的综合康复治疗方案。

Objective To systematically review the effect of proprioceptive training for knee joints recovery among patients with total knee replacement （TKR）. Methods We searched Chinese BioMedical Literature Database, CNKI, WanFang database, Chinese Scientific Journals Full-text Database, PubMed, EMbase, MEDLINE and Cochrane Library for randomized controlled trials （RCT） about proprioceptive training for knee joint recovery after TKR and the retrieval covered the period to November 2017. Two reviewers independently selected studies, extracted data, evaluated quality, and analyzed data, which was conducted using the RevMan software. Results Five studies involving 278 patients were selected. Meta-analysis showed that the knee joint function score was significantly increased in the proprioceptive training group than that in the control group [standard mean difference （SMD） =0. 38, 95% CI （0. 26, 049）, P〈 0. 0001 ]. Moreover, proprioceptive training could significantly improve the joints＇ function （P=0. 0006）, up-regulate the joints＇ range of motion （P= 0. 006） and increase the strength （P= 0. 005） and stability （P〈0. 0001） of knee joints compared with those in the control group. Conclusions Proprioceptive training on the basis of routine rehabilitation can improve the joints＇ stability, enhance the balance and coordination, and increase the quality of life in elderly comprehensive rehabilitation program.