中国组织工程研究

中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (24): 3930-3936.doi: 10.12307/2024.094

• 骨与关节循证医学 evidence-based medicine of the bone and joint • 上一篇    

平衡训练对慢性踝关节不稳影响效果的Meta分析

王悦同1，彭  亮2，苏玉莹2，3，刘嘉俊3   

  1. 北京体育大学，1教育学院，3体能训练学院，北京市   100086；2 渤海大学体育学院，辽宁省锦州市   121013
  • 收稿日期:2023-05-30 接受日期:2023-07-04 出版日期:2024-08-28 发布日期:2023-11-22
  • 通讯作者: 苏玉莹，北京体育大学博士，北京体育大学体能训练学院，北京市 100086；渤海大学体育学院，辽宁省锦州市 121013
  • 作者简介:王悦同，女，1995年生，汉族，河南省人，北京体育大学在读博士。
  • 基金资助:
    辽宁省教育厅2022年基本科研项目--青年项目(LJKQR20222558)，项目负责人：苏玉莹

Effect of balance training on chronic ankle instability: a meta-analysis

Wang Yuetong1, Peng Liang2, Su Yuying2, 3, Liu Jiajun3   

  1. 1College of Education, Beijing Sport University, Beijing 100086, China; 2Physical Education College, Bohai University, Jinzhou 121013, Liaoning Province, China; 3School of Strength and Conditioning Training, Beijing Sport University, Beijing 100086, China
  • Received:2023-05-30 Accepted:2023-07-04 Online:2024-08-28 Published:2023-11-22
  • Contact: Su Yuying, PhD, Physical Education College, Bohai University, Jinzhou 121013, Liaoning Province, China; School of Strength and Conditioning Training, Beijing Sport University, Beijing 100086, China
  • About author:Wang Yuetong, Doctoral candidate, College of Education, Beijing Sport University, Beijing 100086, China
  • Supported by:
    2022 Basic Scientific Research Project of Liaoning Provincial Department of Education -- Youth Project, No. LJKQR20222558 (to SYY)

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摘要：


文题释义：

慢性踝关节不稳：踝关节及关节组织周围发生结构性或功能性的改变 ，踝关节出现不稳定感和活动限制，并经常发生反复性扭伤。临床上主要表现为肌无力、韧带松弛、失控感、间断性疼痛、反复崴脚和功能下降等症状。
平衡能力：指人体在受到外力作用施加时能够通过神经肌肉控制维持身体的正常姿态以保持稳定的状态，包括动态平衡能力和静态平衡能力。


目的：慢性踝关节不稳临床上主要表现为肌无力、间断性疼痛和反复崴脚等症状，严重影响运动锻炼和日常生活。本体感觉缺失、腓骨反应时间延长和外翻力量减弱等可能是造成慢性踝关节不稳的主要原因，因此通过运动干预可以有效改善踝关节不稳相关症状。通过Meta分析定量评价平衡训练对慢性踝关节不稳康复干预的效果，为慢性踝关节不稳患者科学制定运动处方提供可靠的理论基础和实践依据。

方法：检索中国知网、维普、Web of Science和PubMed数据库关于平衡训练对慢性踝关节不稳患者症状康复和动态平衡影响的随机对照试验文献，文献发表时间为各数据库建库至2022-11-23。包括2名评审人员依据物理治疗证据量表对纳入文献进行文献质量评估，主要结局指标为自我功能评分量表，次要结局指标为星形偏移平衡测试，均为连续性变量。采用RevMan 5.3和Stata-SE 15软件对纳入文献进行森林图绘制、Meta回归、亚组分析、敏感性分析和发表偏倚评价。
结果：①共纳入18篇随机对照试验文献，包括慢性踝关节不稳患者641例。整体上文献的方法学质量较高。②Meta分析结果显示，平衡训练可以改善慢性踝关节不稳患者的功能康复效果(SMD=0.82，95%CI：0.41-1.23，P < 0.000 1)。Meta回归显示干预时间可能是产生异质性的主要原因(P=0.008)。③亚组分析结果显示，干预6周(SMD=0.98，95%CI：0.31-1.65，P=0.03)、每周干预大于3次(SMD=0.87，95%CI：0.30-1.44，P=0.003)和每次干预时间小于20 min(SMD=0.89，95%CI：0.61-1.66，P < 0.000 1)是改善慢性踝关节不稳患者功能康复效果的最佳康复方案。④Meta分析结果还显示，平衡训练可以改善星形偏移平衡测试前侧(SMD=0.56，95%CI：0.31-0.80，P < 0.05)、后内侧(SMD=0.88，95%CI：0.45-1.32，P < 0.05)和后外侧(SMD=0.84，95%CI：0.22-1.46，P < 0.05)伸展程度。

结论：当前临床证据表明，平衡训练可以改善慢性踝关节不稳患者的踝关节不稳功能症状和提高动态平衡能力，建议通过每周干预大于3次，每次干预小于20 min的干预时间以获得更好的康复效果。

https://orcid.org/0009-0009-6218-8428 (王悦同) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 慢性踝关节不稳, 平衡训练, 动态平衡能力, 功能康复, 星形偏移平衡测试, 自我功能评分量表, Meta分析, 踝关节损伤, 神经肌肉控制, 本体感觉

Abstract: OBJECTIVE: Chronic ankle instability is mainly characterized by symptoms such as muscle weakness, intermittent pain, and repeated sprains, which seriously affect exercise and daily life. Loss of proprioception, prolongation of fibular reaction time, and weakening of valgus force may be the main symptoms of chronic ankle instability, so exercise intervention can effectively improve the symptoms related to ankle instability. Meta-analysis was used to quantitatively evaluate the effect of balance training on the rehabilitation intervention of chronic ankle instability, providing a reliable theoretical basis and practical basis for chronic ankle instability patients to scientifically formulate exercise prescriptions.
METHODS: The randomized controlled trial of balance training on symptom rehabilitation and dynamic equilibrium of patients with chronic ankle instability was retrieved on CNKI, VIP, Web of Science, and PubMed. The literature was published from the inception to November 23, 2022. Two reviewers were included to evaluate the quality of the included literature based on the physical therapy evidence scale. The primary outcome measure is the Self Functional Rating Scale, and the secondary outcome measure is the Star Shift Balance Test, both of which are continuous variables. Forest mapping, meta-regression, subgroup analysis, sensitivity analysis, and publication bias evaluation were performed on the included literature using RevMan 5.3 and Stata-SE 15 software.  
RESULTS: (1) A total of 18 articles of randomized controlled trials were screened and 641 patients with chronic ankle instability were included in the study. Overall, the methodological quality of the literature was relatively high. (2) Meta-analysis results showed that balance training improved the functional rehabilitation effect of chronic ankle instability patients (SMD=0.82, 95%CI:0.41-1.23, P < 0.000 1). Meta-regression exhibited that intervention time might be the main reason for heterogeneity (P=0.008). (3) The subgroup analysis results revealed that 6 weeks of intervention (SMD=0.98, 95%CI:0.31-1.65, P=0.03), more than 3 interventions per week (SMD=0.87, 95%CI:0.30-1.44, P=0.003), and each intervention time less than 20 minutes (SMD=0.89, 95%CI:0.61-1.66, P < 0.000 1) were the best rehabilitation plans to improve the functional rehabilitation effect of chronic ankle instability patients. (4) Meta-analysis results also showed that balance training improved the stretching degree of the anterior side (SMD=0.56, 95%CI:0.31-0.80, P < 0.05), posterior inner side (SMD=0.88, 95%CI:0.45-1.32, P < 0.05), and posterior outer side (SMD=0.84, 95%CI:0.22-1.46, P < 0.05) of the star shift balance test.
CONCLUSION: Current clinical evidence shows that balance training can improve ankle instability symptoms and elevate dynamic equilibrium ability in chronic ankle instability patients. It is recommended to intervene more than 3 times a week, with each intervention lasting less than 20 minutes, to achieve better rehabilitation effects. 

Key words: chronic ankle instability, balance training, dynamic balance ability, functional rehabilitation, star excursion balance test, self-reported function scale, meta-analysis, ankle injury, neuromuscular control, proprioception

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