功能性踝关节不稳本体感觉特征的Meta分析

Proprioception characteristics of functional ankle instability:a meta-analysis

目的:功能性踝关节不稳表现为本体感觉异常、神经肌肉控制能力下降以及反复性踝扭伤,严重影响其日常活动。本体感觉作为功能性踝关节不稳的重要方面,与对侧肢体和健康人群相比是否存在本体感觉的缺陷尚不明晰。因此,文章旨在分析功能性踝关节不稳的本体感觉特征。方法:计算机检索PubMed,Web of Science,EBSCO-host,Ovid,EMbase和中国知网数据库,搜索有关功能性踝关节不稳本体感觉特征的观察性研究,暴露因素为运动觉、关节位置觉、力觉中至少一项本体感觉缺陷,检索时限为各数据库建库至2022年2月。由2名研究者根据纳入与排除标准独立筛选文献并根据纽卡斯尔-渥太华量表与美国医疗保健研究和质量机构制定的横断面研究质量评价表评价纳入研究的质量,提取有关运动觉、关节位置觉、力觉与设定目标的绝对误差,使用RevMan 5.3软件进行Meta分析。结果:共纳入26项观察性研究,其中4项队列研究,6项病例-对照研究,16项横断面研究,均为中等以上质量文献。Meta分析结果显示:单侧功能性踝关节不稳患者相比于对侧肢体和健康人群存在内翻运动觉缺陷(SMD=0.53,95%CI:0.36-0.71,P<0.00001);单侧功能性踝关节不稳患者相比于对侧肢体存在内翻关节位置觉(主动与被动复制)的缺陷(SMD=1.60,95%CI:0.77-2.43,P=0.0002);单侧功能性踝关节不稳患者相比于健康人群存在内翻关节位置觉(主动与被动复制)的缺陷(SMD=0.66,95%CI:0.25-1.07,P=0.002);单侧功能性踝关节不稳患者相比于健康人群存在主动外翻关节位置觉缺陷(SMD=3.68,95%CI:1.85-5.52,P<0.0001);单侧功能性踝关节不稳患者相比于健康人群存在被动外翻关节位置觉缺陷(SMD=-0.61,95%CI:-1.19至-0.02,P=0.04);单侧功能性踝关节不稳患者与健康人群在跖屈关节位置觉(主动与被动复制)方面无显著性差异(SMD=0.80,95%CI:-0.19-1.79,P=0.11);单侧功能性踝关节不稳患者与健康人群在背屈关节位置觉(主动与被动复制)方面无显著性差异(SMD=0.86,95%CI:-0.01-1.74,P=0.05);单侧功能性踝关节不稳患者相比于健康人群存在冠状面运动的力觉缺陷(SMD=1.35,95%CI:0.85-1.85,P<0.00001),并且亚组分析显示,单侧功能性踝关节不稳患者相比于健康人群,外翻力觉误差大于与内翻力觉误差(P=0.44)。结论:单侧功能性踝关节不稳患者与对侧肢体相比存在内翻运动觉缺陷,而与健康人群相比存在内翻运动觉、主被动内翻关节位置觉、主动外翻关节位置觉、内翻和外翻的力觉缺陷。

OBJECTIVE:Functional ankle instability is characterized by proprioceptive deficits,decreased neuromuscular control,and recurrent ankle sprains,which severely affect the patient’s daily activities.Proprioception as an important aspect of functional ankle instability,whether there is a deficit in proprioception compared to contralateral limbs and healthy individuals is not known.Therefore,this systematic review aims to analyze the proprioceptive characteristics of functional ankle instability.METHODS:We searched the CNKI,PubMed,Web of Science,EBSCO-host,Ovid,and EMbase databases from inception to February 2022 to collect observational studies about the proprioception characteristics of functional ankle instability,exposure to at least one proprioceptive deficit in kinesthesia,joint position sense,and force sense.Two researchers independently screened the articles according to the inclusion and exclusion criteria,and evaluated the quality of the included studies according to the Newcastle-Ottawa Scale and the cross-sectional study quality evaluation form developed by the American Institute for Healthcare Research and Quality,and extracted absolute errors relating kinesthesia,joint position sense,and force sense to set target.Metaanalysis was then performed using RevMan 5.3 software.RESULTS:A total of 26 observational studies were included,including 4 cohort studies,6 case-control studies and 16 cross-sectional studies,all of which were of medium to high quality.Meta-analysis results showed that patients with unilateral functional ankle instability had inversion kinesthesia defects compared with the contralateral limbs and healthy people(SMD=0.53,95%CI:0.36-0.71,P<0.00001).Compared with the contralateral limb,patients with unilateral functional ankle instability had the defect of inversion joint position sense(active vs.passive replication)(SMD=1.60,95%CI:0.77-2.43,P=0.0002).Compared with healthy people,unilateral functional ankle instability patients had the defect of inversion joint position sense(active vs.passive replication)(SMD=0.66,95%CI:0.25-1.07,P=0.002).Compared with healthy people,unilateral functional ankle instability patients had the defect of active eversion joint position sense(SMD=3.68,95%CI:1.85-5.52,P<0.0001).Compared with healthy people,unilateral functional ankle instability patients had the defect of passive eversion joint position sense(SMD=-0.61,95%CI:-1.19 to-0.02,P=0.04).There was no significant difference between patients with unilateral functional ankle instability and healthy subjects in plantarflexion joint position sense(active vs.passive replication)(SMD=0.80,95%CI:-0.19 to 1.79,P=0.11).There was no significant difference between patients with unilateral functional ankle instability and healthy subjects in dorsiflexion joint position sense(active vs.passive replication)(SMD=0.86,95%CI:-0.01 to 1.74,P=0.05).Patients with unilateral functional ankle instability had coronal plant motion force sense deficits compared with healthy individuals(SMD=1.35,95%CI:0.85 to 1.85,P<0.00001).Subgroup analysis showed that patients with unilateral functional ankle instability had greater eversion force sense error than those with inversion force sense error compared with the healthy population(P=0.44).CONCLUSION:Compared with the contralateral limbs,patients with unilateral functional ankle instability have the defects of inversion kinesthesia.Compared with healthy people,unilateral functional ankle instability patients have the defects of inversion kinesthesia,active and passive inversion joint position sense,active eversion joint position sense and force sense of inversion and eversion.