减重训练对前交叉韧带重建术后患者临床疗效的系统评价与Meta分析

Efficacy of Weight Lose Training in Anterior Cruciate Ligament Reconstruction:A Systematic Review and Meta-analysis

目的:通过Meta分析的方法评价减重训练对前交叉韧带重建术(anteriorcruciate ligament reconstruction,ACLR)术后患者的临床疗效。方法:通过计算机检索PubMed、Web of Science、The Cochrane Library、Embase CNKI、万方、维普数据库中有关减重训练对ACLR术后患者临床疗效的随机对照试验,检索时间为建库至2022年5月4日,纳入6篇随机对照试验,共395例患者,减重组进行常规康复训练联合减重训练,对照组进行常规康复训练。结果:1)在IKDC评分上,术后3个月时减重组显著高于对照组[MD=7.96,95%CI(6.04,9.89),P<0.000 01],术后6个月[MD=4.88,95%CI(-1.27,11.02),P=0.12]时两组之间没有显著的统计学差异;2)在lysholm评分上,术后1个月[MD=7.85,95%CI(6.79,8.91),P=0.02]和术后3个月[MD=7.38,95%CI(6.39,8.38),P<0.000 01]减重组均高于对照组;3)在关节活动度测量上,减重组优于对照组[MD=3.09,95%CI(1.13,5.06),P=0.002];4)在iEMG肌电值测量上,减重组优于对照组[MD=1.40,95%CI(0.68,2.12),P=0.000 1];5)在腱骨结点T2值的测量上,术后3个月[MD=-15.41,95%CI(-18.73,-12.09),P<0.000 01]减重组优于对照组;6)在移植物信号强度测量上,术后1个月[MD=0.85,95%CI(0.69,1.01),P<0.000 01]减重组均优于对照组;7)在膝关节被动位置觉测量上,膝关节在0°~40°[MD=-0.55,95%CI(-0.77,-0.33),P<0.000 01]、40°~80°[MD=-0.59,95%CI(-0.81,-0.38),P<0.000 01]、80°~120°[MD=-0.57,95%CI(-0.78,-0.37),P<0.000 01]区间减重组均优于对照组。结论:相比常规的康复训练,减重训练能够更有效的改善ACLR术后患者的膝关节活动度、本体感觉、主观功能评分等膝关节功能表现,且患者有更好的影像学表现。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究的验证。

Objective:To evaluate the clinical effect of weight lose training on patients after anterior cruciate ligament reconstruction by meta-analysis.Methods:The randomized control trials on the clinical efficacy of weight lose training on patients after anterior cruciate ligament reconstruction were searched in PubMed,Web Of Science,The Cochrane Library,Embase,CNKI,Wanfang,and Weipu databases,and two researchers independently screened the literatures according to the inclusion and exclusion criteria.A total of 6 randomized control trials with 395 patients were included in this study.After anterior cruciate ligament reconstruction,the weight lose group received conventional rehabilitation training combined with weight lose training,and the control group received conventional rehabilitation training only.The Meta-analysis was performed using Revman 5.3 software.Results:1)The IKDC score of the weight lose group was significantly higher than that of control group at 3 months after surgery[MD=7.96,95%CI(6.04,9.89),P<0.00001],but there was no significant difference between the two groups and at 6 months after surgery[MD=4.88,95%CI(-1.27,11.02),P=0.12];2)The Lysholm score of the weight lose group were higher than those of control group at 1 month after surgery[MD=7.85,95%CI(6.79,8.91),P=0.02]and 3 months after surgery[MD=7.38,95%CI(6.39,8.38),P<0.00001];3)The joint range of motion of the weight lose group was better than that of control group[MD=3.09,95%CI(1.13,5.06),P=0.002];4)The iEMG of the weight lose group was better than the control group[MD=1.40,95%CI(0.68,2.12),P=0.0001];5)The T2 value of the tendon-bone node in the weight lose group was better than that of the control group at 3 months after surgery[MD=-15.41,95%CI(-18.73,-12.09),P<0.00001];6)The signal intensity of the weight lose group was better than that of the control group at 1 month after surgery[MD=0.85,95%CI(0.69,1.01),P<0.00001];7)The passive position sense of the weight lose group was better than that of control group at 0°~40°[MD=-0.55,95%CI(-0.77,-0.33]),P<0.00001],40°~80°[MD=-0.59,95%CI(-0.81,-0.38),P<0.00001],and 80°~120°[MD=-0.57,95%CI(-0.78,-0.37),P<0.00001].Conclusion:Compared with conventional rehabilitation training,weight lose training is more effectively improve the knee function such as ROM and proprioception subjective function score,and the imaging performance is also better.Limited by the number and quality of included studies,this conclusion needs to be verified by more high-quality studies.