功能性训练对青少年特发性脊柱侧弯疗效的Meta分析

A Meta-analysis of the effect of functional training on idiopathic scoliosis in adolescents

目的评价功能性训练对青少年特发性脊柱侧弯(AIS)患者Cobb角、躯干倾斜角、生活质量的改善效果,以期为预防和治疗AIS提供更为准确可靠的指导。方法检索中国知网、万方、维普、Web of Science、PubMed、ScienceDirect数据库,依据纳入标准进行文献筛选,收集随机对照实验(RCT),使用Cochrane风险偏倚评价方法学质量,Revman 5.3软件对结局指标[Cobb角、躯干倾斜角(ATR)、患者问卷SRS-22]进行合并效应量、亚组分析。结果共10个RCT(AIS患者398名)纳入研究,高、中、低质量研究分别有2,5和3篇。对Cobb角的影响中,与其他非手术治疗相比,功能性训练可以降低患者Cobb角(MD=-6.56,95%CI=-7.30~-5.83,P<0.01,I2=0);进一步亚组分析显示,亚组Cobb角、年龄、干预周期、对照组方式的效应量差异均无统计学意义(P值均>0.05)。与无干预组相比,功能性训练组可以使患者Cobb角减小(MD=-5.25,95%CI=-7.90~-2.60,P<0.01,I2=61%)。对ATR的影响中,功能性训练组可以降低患者ATR(MD=-1.91,95%CI=-2.25~-1.57,P<0.01,I2=0)。对生活质量的影响中,功能性训练对患者SRS-22问卷功能、疼痛改善效果均无统计学意义(P值均>0.05),对自我形象(MD=0.64,95%CI=0.53~0.75)、心理健康(MD=0.44,95%CI=0.15~0.74)、满意度(MD=0.58,95%CI=0.11~1.06)改善效果均有统计学意义(P值均<0.05)。结论功能性训练不仅可以降低AIS患者的Cobb角和ATR,还可以使患者的生活质量得到较好的改善,但由于异质性和偏倚的影响,尚需开展更多高质量的研究加以验证。

Objective To evaluate the effect of functional training on the improvement of Cobb Angle,ATR and quality of life in adolescent idiopathic scoliosis.Methods Database of CNKI,WanFang,WeiPu,Web of Science,PubMed were reconnoitered for the purpose of research articles of Interest.Literature was screened according to the inclusion criteria,randomized controlled trials(RCTS)were collected and Cochrane risk bias assessment methodology quality was used,and Revman 5.3 software was used to conduct combined effector subgroup analysis on outcome indicators(Cobb Angle,ATR,SRS-22 patient questionnaire).Results A total of 10 RCT(398 AIS patients)were included in the study.There were two high-,five moderate-and three low-quality studies,respectively.Compared with other non-operative treatments,functional training could reduce Cobb horn in patients,MD=-6.56(95%CI=-7.30--5.83,P<0.01,I2=0).Further subgroup analysis showed that there were no statistically significant differences in effect size between the subgroups of Cobb Angle,age,intervention period and control method at the time of inclusion(P>0.05).Compared with the non-intervention blank group,the functional training group could reduce the Cobb Angle of patients(MD=-5.25,95%CI=-7.90--2.60,P<0.01),with high heterogeneity(I2=61%).Effect on angle of trunk rotation(ATR):functional training group could reduce patients'ATR,MD=-1.91(95%CI=-2.25--1.57,P<0.01,I2=0).The impact on the quality of life:functional training of patients with SRS-22 questionnaire function,pain had no statistical significance(P>0.05),and self-image(MD=0.64,95%CI=0.53-0.75,P<0.01),mental health(MD=0.44,95%CI=0.15-0.74,P<0.01),satisfaction(MD=0.58,95%CI=0.11-1.06,P=0.02)were statistically significant.Conclusion Functional training can not only reduce the Cobb Angle and ATR of AIS patients,but also improve the quality of life in terms of self-image,mental health and satisfaction of the patients.However,due to heterogeneity and bias,more high-quality studies are needed to verify.