脊柱侧凸特定运动疗法治疗青少年特发性脊柱侧凸效果的Meta分析

The effect of physiotherapeutic scoliosis specific exercises on adolescent idiopathic scoliosis:a meta analysis

目的:通过Meta分析评价单独应用脊柱侧凸特定运动疗法(physiotherapeutic scoliosis specific exercises,PSSE)与其他保守治疗方法治疗青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)的临床疗效。方法:计算机检索建库至2023年7月PubMed、Web of Science、The Cochrane Library、WanFang Data和CNKI数据库,搜集应用PSSE疗法(PSSE疗法组)与其他保守治疗(对照组)作用于AIS的随机对照试验(RCT)研究,由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,通过Jadad评分量表对纳入研究的文献质量进行评价,采用RevMan 5.4软件对纳入文献中所报道的Cobb角、躯干旋转角(angle of trunk rotation,ATR)、国际脊柱侧凸研究学会22项问卷量表(Scoliosis Research Society-22,SRS-22)等数据进行Meta分析,并根据Cobb角度数和治疗时长进行亚组分析。结果:共纳入14篇文献,包含16个RCT(有2篇文献中分别包含2项RCT),文献质量评价结果显示纳入研究为中高质量,共包括944例AIS患者。Meta分析结果显示,与对照组相比,PSSE疗法组在降低脊柱侧凸患者Cobb角(MD=-1.64;95%CI:-2.78,-0.50;P<0.05)、ATR(MD=-1.45;95%CI:-2.58,-0.32;P<0.05)、提高SRS-22生活质量评分(MD=0.25;95%CI:0.17,0.33;P<0.05)方面更优。亚组分析结果显示,与对照组相比,PSSE疗法组持续治疗时长≤6个月(MD=-2.88;95%CI:-3.85,-1.91;P<0.05)、纳入时Cobb角<25°(MD=-2.41;95%CI:-3.51,-1.30;P<0.05)组的治疗效果更好,Cobb角度数更小。在改善ATR方面,PSSE疗法组持续治疗时长≤6个月(MD=-2.63;95%CI:-3.30,-1.96;P<0.05)与对照组相比ATR度数更低,差异有统计学意义(P<0.05)。结论:与其他保守治疗相比,PSSE疗法在改善AIS患者Cobb角、降低ATR及提高生活质量等方面具有优势,对于Cobb角<25°的轻度脊柱侧凸患者的治疗效果较好;PSSE疗法持续治疗时长≤6个月对AIS患者Cobb角及ATR的改善效果更明显。

Objectives:To evaluate with meta-analysis the clinical effects of physiotherapeutic scoliosis specific exercises(PSSE)comparing with other conservative treatments in treating adolescent idiopathic scoliosis(AIS).Methods:PubMed,Web of Science,The Cochrane Library,WanFang Data and China National Knowledge Infrastructure(CNKI)were searched by computer from their establishments to July 2023.The randomized controlled trials(RCTs)of PSSE therapy(PSSE therapy group)and other conservative treatments(control group)in treating AIS were collected.Two researchers independently screened the literature,extracted data and assessed the risk of bias of the included studies.Meta analysis was performed using RevMan 5.4 software on the Cobb angle,angle of trunk rotation(ATR),and quality of life score of Scoliosis Research Society-22(SRS-22)scale reported in the included literature,and subgroup analysis was carried on according to Cobb angle and treatment duration.Results:A total of 14 studies were included,consisting of 16 RCTs(2 studies included 2 RCTs each),involving 944 AIS patients.The quality of the literature was of medium and high.Meta analysis results showed that,comparing with the control group,the PSSE therapy group was superior in reducing Cobb angle of AIS patients(MD=1.64;95%CI:2.78,0.50;P<0.05)and ATR(MD=1.45;95%CI:-2.58,-0.32;P<0.05),and improving the SRS-22 quality of life score(MD=0.25;95%CI:0.17,0.33;P<0.05).The results of subgroup analysis showed that for the AIS patients with duration of treatment≤6 months(MD=-2.88;95%CI:-3.85,-1.91;P<0.05)and a Cobb angle<25°at enrollment(MD=-2.41;95%CI:-3.51,-1.30;P<0.05),the PSSE therapy group had a better effect with a smaller Cobb angle(P<0.05)than the control group.In terms of ATR improvement,for the patients with treatment duration≤6 months(MD=2.63;95%CI:3.30,1.96;P<0.05),the PSSE therapy group had a lower ATR degree comparing with the control group(P<0.05).Conclusions:Comparing with other conservative treatments,PSSE therapy has advantages in improving the Cobb angle,reducing ATR and improving the quality of life in AIS patients,especially for mild scoliosis patients with Cobb angle<25°.PSSE therapy has a better therapeutic effect on reducing the Cobb angle and ATR more obviously in AIS patients with duration of treatment≤6 months.