关节松动治疗慢性踝关节不稳功能恢复的荟萃分析

Joint mobilization treatment for chronic ankle instability function recovery:a meta-analysis

目的:慢性踝关节不稳的特征表现为不同程度的平衡稳定性下降、本体感觉异常以及背屈活动度受限等症状。关节松动能有效改善关节活动范围、刺激本体感觉的恢复。文章系统性分析关节松动对慢性踝关节不稳患者功能恢复的影响。方法:对中国知网(CNKI)、Pub Med、EBSCO、Web of Science和Cochrane Library等电子数据库进行检索,收集关于关节松动干预慢性踝关节不稳的随机对照试验。中文检索词为:关节松动术、松动、慢性踝关节不稳、踝关节不稳;英文检索词为:mobilization with movement、Joint Mobilization、Maitland、Mulligan’s、chronic ankle instability、CAI、ankle instability。检索时间为各数据库建立到2021年6月。按照《Cochrane干预措施系统评价手册》当中的"偏倚风险评估"工具对筛选过后的文献进行风险评估,使用Rev Man5.3软件进行Meta分析。结果:①最终纳入符合标准的随机对照试验9篇,共336名受试者。②Meta分析结果显示:关节松动可有效改善慢性踝关节不稳患者的坎伯兰踝关节不稳定工具(CAIT)评分[MD=5.79,95%CI(4.95,6.62),P<0.00001];经过单次关节松动干预后,测量踝关节背屈活动度,负重弓步测试[MD=0.93,95%CI(-0.53,2.38),P=0.21]或非承重倾角仪测试[MD=1.53,95%CI(-1.69,4.76),P=0.35]均无明显改善。经过6次关节松动干预后,测量踝关节背屈活动度(负重弓步测试)有显著改善[MD=4.45,95%CI(0.41,8.49),P=0.03];关节松动对平衡功能(星状伸展平衡测试)干预有较好改善效果[MD=6.17,95%CI(3.12,9.23),P<0.00001]、尤其对前向和后内向改善最为明显(P<0.05);但是关节松动未能有效改善慢性踝关节不稳的疼痛[MD=-0.74,95%CI(-2.01,0.53),P=0.25]。③根据不同干预方式进行亚组分析发现,动态关节松动术对踝关节背屈活动(负重弓步测试)的改善效果优于关节松动术。结论:①关节松动可有效改善踝关节背屈活动度以及平衡能力,但改善疼痛效果不明显,应再进一步研究。②动态关节松动术对踝关节背屈活动度(负重弓步测试)改善优于关节松动术。

OBJECTIVE:The characteristics of chronic ankle instability are often manifested as varying degrees of decreased balance and stability,proprioception,and limited do rsiflexion range of motion.Joint mobilization can effectively improve the range of joint motion and stimulate the recovery of proprioception.This article systematically analyzed the effect of joint mobilization on the functional recovery of patients with chro nic ankle instability.METHODS:Electronic databases such as CNKI,PubMed,EBSCO,Web of Science,and Cochrane Library were searched.Randomized controlled trials on joint mobilization intervention for chronic ankle instability were collected.The key words were"mobilization with movement,joint mobilization,Maitland,M ulligan’s,chronic ankle instability,CAI,ankle instability in Chinese and English.The search time was from the establishment of the database to J une 2021.According to the Bias Risk Assessment"tool in the Cochrane Intervention System Evaluation Monual,the risk assessment of the selected lite rature was carried out,and the RevMan 5.3 software was used for meta-analysis.RESULTS:(1)Nine randomized controlled trials involving 336 subjects were finally included.(2)Meta-analysis results showed that joint mobilization co uld effectively improve the Cumbe rland ankle instability tool score of chronic ankle instability patients[MD=5.79,95%CI(4.95,6.62),P<0.00001].After a single joint mobilization intervention,there was no significant im p rovement in the ankle dorsiflexion range of motion measured in weight bearing lunge test[MD=0.93,95%CI(-0.53,2.38),P=0.21]or non-weight bearing inclinometer test[MD=1.53,95%C/(-1.69,4.76),P=0.35].After six joint mobilization interventions,the ankle dorsiflexion range of motion measured by weight bearing lunge test had been significantly improved[MD=4.45,95%CI(0.41,8.49),P=0.03].Joint mobilization surgery had a better improvement in balance(star excursion balance test)inte rvention[MD=6.17,95%CI(3.12,9.23),P<0.00001],especially the forward and backward inward improvement was the most obvious(P<0.05),Howeve r,joint mobilization surgery failed to effectively improve the pain of chronic ankle instability[MD=0.74,95%CI(-2.01,0.53),P=0.25].(3)A subgroup analysis based on different intervention methods found that dynamic joint mobilization was better than joint mobilization in improving ankle dorsiflexion range of motion(weight bearing lunge test).CONCLUSION:(1)J oint mobilization can effectively improve the range of motion and balance of the ankle joint,but the effect of improving pain is not obvious,and further research should be done.(2)Mobilization with movement im p roves ankle dorsiflexion range of motion(weight bearing lunge test)better than joint mobi ization.