治疗性运动对功能性踝关节不稳姿势控制和踝周肌肉功能影响的Meta分析

Effect of therapeutic exercise on posture control and muscular function around ankle in patients with functional ankle instability:a meta-analysis

目的对治疗性运动对功能性踝关节不稳(FAI)患者姿势控制和踝周肌肉功能的效果进行Meta分析。方法检索PubMed、Web of Science、Embase、SPORTdiscus、Medline、Science Direct、EBSCO、Springlink、中国知网、维普、万方数据库不同类型运动干预FAI的随机对照试验,时间范围自建库至2021年12月。由2名研究人员对纳入文献进行质量和结果证据等级评估,采用RevMan 5.4进行分析。结果最终纳入随机对照试验14篇,共434例受试者。与无运动干预相比,治疗性运动明显减少睁闭眼下压力中心偏移(睁眼,SMD=-0.28,95%CI-0.46~-0.09,P=0.003;闭眼,SMD=-0.24,95%CI-0.40~-0.09,P=0.001);增强运动任务前腓骨长肌激活(SMD=0.38,95%CI 0.05~0.71,P=0.03),运动任务后腓骨长肌(SMD=0.53,95%CI 0.16~0.90,P=0.005)和胫骨前肌(SMD=0.47,95%CI 0.10~0.84,P=0.01)激活。任务前胫骨前肌激活(SMD=0.48,95%CI-0.14~1.11,P=0.13)、踝关节外翻/内翻峰力矩比无显著性差异(SMD=-0.15,95%CI-0.46~0.16,P=0.340)。结论治疗性运动可减少FAI患者压力中心偏移,使腓骨长肌执行动态任务前产生预备性收缩,腓骨长肌和胫骨前肌在完成任务后产生代偿性收缩,从而使踝关节更好应对外界干扰,维持关节稳定,预防再次损伤。

Objective To explore the effect of exercise on the postural control and muscular function around the ankle in patients with functional ankle instability(FAI)with meta-analysis.Methods Randomized controlled trials about therapeutic exercise for FAI published before December,2021 were searched from PubMed,EBSCO,SPORTdiscus,Medline,Science Direct,Springlink,Web of Science,Embase CNKI,VIP and Wanfang Data.The quality and evidence grades of the researches were evaluated by two researchers,and the outcomes were analyzed with RevMan 5.4.Results Fourteen randomized controlled trials were finally included,involving 434 subjects.Compared with no exercise intervention,therapeutic exercise might significantly improve the movement of center of pressure whether with eye-open or eye-closed(eye-open,SMD=-0.28,95%CI-0.46 to-0.09,P=0.003;eye-closed,SMD=-0.24,95%CI-0.40 to-0.09,P=0.001);while therapeutic exercise might also enhance the activation of the peroneus longus before dynamic task(SMD=0.38,95%CI 0.05 to 0.71,P=0.03),and activation of the peroneus longus(SMD=0.53,95%CI 0.16 to 0.90,P=0.005)and tibialis anterior(SMD=0.47,95%CI 0.10 to 0.84,P=0.01)after dynamic task.There was neither significant difference in the activation of the tibialis anterior(SMD=0.48,95%CI-0.14 to 1.11,P=0.13),nor the peak torque ratio of eversion to inversion isokinetic strength(SMD=-0.15,95%CI-0.46 to 0.16,P=0.340)before dynamic task between the two groups.Conclusion Therapeutic exercise can decrease movement of center of pressure,enable anticipatory contraction of peroneus longus before dynamic tasks and compensatory contraction of peroneus longus and tibialis anterior after tasks,to make it easier to deal with external interference,maintain articular stability and prevent re-injury.