踝足矫形器改善脑性瘫痪儿童运动功能:12项随机对照试验证据的Meta分析

Ankle-foot orthoses improve motor function of children with cerebral palsy:a Meta-analysis based on 12 randomized controlled trials

目的:脑性瘫痪因其高发病率及高致残率,严重影响儿童身心健康。佩戴踝足矫形器是该病一项重要治疗措施,但关于其改善脑性瘫痪儿童运动功能的效果方面还不十分确切。为此,文章系统评价了踝足矫形器改善脑瘫儿童运动功能的效果。方法:第一作者检索PubMed、EMbase、Web of Science、Cochrane Library、CBM、中国知网、万方和维普数据库,检索时限从建库至2020-09-09。根据制定的入组标准,纳入有关踝足矫形器治疗脑性瘫痪儿童的随机对照试验。至少2名评价员独立提取数据,使用Cochrane 5.1.0偏倚风险评估工具对纳入研究的质量进行评估,采用RevMan 5.3软件进行数据分析。结果:①纳入12项质量较高的随机对照试验,共480例脑性瘫痪儿童,其中踝足矫形器组239例为佩戴踝足矫形器,对照组241例不佩戴踝足矫形器,治疗疗程0-48周;②Meta分析结果显示,踝足矫形器组在GMFM-88-D/E区评分(MD=6.26,95%CI:3.54-8.98,P<0.00001)、MAS评分(MD=-0.60,95%CI:-0.80至-0.40,P<0.00001)、摆动位平均踝背屈角度(MD=14.96,95%CI:12.03-17.90,P<0.00001)、运动功能改善有效率(MD=2.99,95%CI:1.19-7.50,P=0.02)和步幅(MD=0.06,95%CI:0.04-0.09,P<0.00001)的改善方面均优于对照组。结论:现有的12项随机对照试验证据表明,脑性瘫痪患儿无论是佩戴踝足矫形器行走,亦或是佩戴一定时间后解除踝足矫形器行走,其短期内(治疗0-48周)运动功能恢复效果均显著,但长期运动功能的恢复情况还有待进一步研究。

OBJECTIVE:Cerebral palsy seriously affects children's physical and mental health due to its high morbidity and disability rate.Ankle-foot orthoses are an important treatment for this disease.However,it is not very clear about the clinical effect of ankle-foot orthoses on the motor function of children with cerebral palsy.Therefore,this paper systematically assesses the clinical effect of ankle-foot orthoses on the improvement of motor function in children with cerebral palsy.METHODS:Literature retrieval was carried out in the electronic databases of PubMed,EMbase,Web of Science,Cochrane Library,CBM,CNKI,WanFang,and VIP.The time limit for retrieval was from the establishment of these databases to September 9,2020.According to the inclusion and exclusion criteria,randomized controlled trials of ankle-foot orthoses in the treatment of children with cerebral palsy were included.At least two evaluators extracted the data independently and used Cochrane 5.1.0 bias risk assessment tool to evaluate the quality of included studies.The data were analyzed by Revman 5.3 software.RESULTS:In the end,a total of 12 randomized controlled trials with high quality,involving 480 children with cerebral palsy,were included in this study.Among them,239 patients in the ankle-foot orthosis group wore ankle-foot orthosis;241 patients in the control group did not wear ankle-foot orthosis.The treatment course was 0-48 weeks.Meta-analysis results showed that the improvement of Gross Motor Function Measure-88-D/E score(mean difference(MD)=6.26,95%confidence interval(CI):3.54-8.98,P<0.00001),modified Ashworth scale score(MD=-0.60,95%CI:-0.80 to-0.40,P<0.00001),dorsiflexion mean in swing(MD=14.96,95%CI:12.03-17.90,P<0.00001),effectiveness in improving motor function(MD=2.99,95%CI:1.19-7.50,P=0.02),and stride length(MD=0.06,95%CI:0.04-0.09,P<0.00001)in the ankle-foot orthosis group was better than that in the control group.CONCLUSION:Evidence from these 12 randomized controlled trials indicates that no matter walking with ankle-foot orthosis,or walking without ankle-foot orthosis after wearing for a certain period of time,in the short time,it has remarkable clinical value in improving motor function.However,further studies on the long-term recovery of motor function are required.