中国组织工程研究

中国组织工程研究 ›› 2020, Vol. 24 ›› Issue (26): 4251-4256.doi: 10.3969/j.issn.2095-4344.2770

• 组织构建循证医学 evidence-based medicine in tissue construction • 上一篇    下一篇

系统回顾和量化倒走治疗膝骨关节炎的Meta分析

陈泽华1，叶翔凌1，陈伟健1，许学猛1，2   

  1. 1广州中医药大学第五临床医学院，广东省广州市  510405；2广东省第二中医院，广东省广州市  510405

  • 收稿日期:2019-11-08 修回日期:2019-11-14 接受日期:2019-12-05 出版日期:2020-09-18 发布日期:2020-09-03
  • 通讯作者: 许学猛，教授，主任医师，博士生导师，广州中医药大学第五临床医学院，广东省广州市 510405；广东省第二中医院，广东省广州市 510405
  • 作者简介:陈泽华，男，1989年生，湖南省邵阳市人，广州中医药大学在读博士，主治医师，主要从事骨关节病研究。
  • 基金资助:
    广东省名中医传承工作室建设项目(粤中医办函[2017]17号)；广东省省级工业与信息化发展专项资金(粤财工[2016]69号)；国家中医药管理局重点专科建设项目(粤中医[2012]7号)；广东省自然科学基金－博士启动(2014A030310128)；广东省中医优势病种突破项目(粤中医函[2015]19号)；广东省科技计划项目(20191401)

Effectiveness of backward walking training on knee osteoarthritis: a systematic review and meta-analysis

Chen Zehua1, Ye Xiangling1, Chen Weijian1, Xu Xuemeng1, 2   

  1. 1The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China; 2The Second Chinese Medicine Hospital of Guangdong Province, Guangzhou 510405, Guangdong Province, China

  • Received:2019-11-08 Revised:2019-11-14 Accepted:2019-12-05 Online:2020-09-18 Published:2020-09-03
  • Contact: Xu Xuemeng, Professor, Chief physician, Doctoral supervisor, the Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China; the Second Chinese Medicine Hospital of Guangdong Province, Guangzhou 510405, Guangdong Province, China
  • About author:Chen Zehua, MD candidate, Attending physician, the Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • Supported by:
    Guangdong Province Famous Chinese Medicine Heritage Studio Construction Project, No. Guangdong Traditional Chinese Medicine Office Letter [2017]17; Guangdong Provincial Special Fund for Industrial and Information Development, No. Guangdong Finance and Industry [2016]69; National Administration of Traditional Chinese Medicine Key Specialized Construction Project, No. Guangdong Traditional Chinese Medicine [2012]7; Guangdong Natural Science Foundation-Doctor Launched, No. 2014A030310128; Breakthrough Projects of Superiority Diseases of Traditional Chinese Medicine in Guangdong Province, No. [2015]19; Guangdong Science and Technology Plan Project, No. 20191401

PDF

34

摘要：

文题释义：

倒走：又称倒行、倒退走、退步走。同正走相反，倒走是一种反序运动，是康复训练和疾病辅助治疗的一种常见方法。研究表明，倒走可以通过影响股内侧肌斜/股外侧肌的活动率而减轻女性髌股疼痛综合征患者症状。同时，倒走对提高下肢本体感觉、步态协同作用和改善肢体平衡有很好的作用。

异质性评价：由于纳入同一个Meta分析的所有研究都存在差异，这种不同研究间的各种变异，称之为异质性。这些变异主要是研究对象、研究设计、干预措施、结果测量上的变异。异质性评价是Meta分析的重要组成部分,是保证Meta分析结论可靠性的关键步骤。

 

背景：目前大多数研究者认为倒走可改善膝骨关节炎患者的症状，被用来进行膝骨关节炎的康复及辅助治疗，但尚缺乏循证医学证据。

目的：系统地回顾和量化倒走对膝骨关节炎影响的科学证据，明确倒走对膝骨关节炎的作用。

方法：在中英文电子数据库(PubMed、CINAHL、Embase英文数据库和中国知网、万方、中国生物医学文献数据库、维普中文数据库)中进行倒走相关文献的检索，筛选随机对照实验，采用Meta分析来评估倒走对膝骨关节炎的影响。共有7篇文献，231例患者纳入研究。

结果与结论：①Meta分析发现：倒走配合传统治疗较单纯传统治疗可更好地减轻疼痛[MD=-1.05，95%CI(-1.46，-0.63)，P=0.000 1]、改善膝关节功能[SMD=-0.98，95%CI(-1.33，-0.64)，P < 0.000 01]、增强股四头肌肌力[SMD=1.07，95%CI(0.52，1.63)，P=0.000 2]和提高活动能力[MD=-0.41，95%CI(-0.67，0.16), P=0.001]；②倒走与正走对膝骨关节炎WOMAC评分的影响没有明显差异[SMD=-0.43，95%CI (-0.94，-0.08)，P=0.10]；③Meta分析表明，倒走配合传统治疗比单纯传统治疗对膝骨关节炎患者有更好的临床疗效。而在传统治疗基础上配合倒走和正走对改善膝骨关节炎患者WOMAC评分的治疗效果相当，但这需要高质量大样本的随机对照试验验证。

ORCID: 0000-0002-1204-679X(陈泽华)

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

关键词: 倒走, 膝骨关节炎, WOMAC, 股四头肌肌力, TUG测试, Meta分析

Abstract:

BACKGROUND: Backward walking is mainly considered to improve the symptoms of patients with knee osteoarthritis, which is used for rehabilitation and adjuvant treatment of knee osteoarthritis, but there is no evidence for evidence-based medicine.

OBJECTIVE: To systematically review and quantify the evidence for the effect of backward walking on knee osteoarthritis in order to clarify the effect of backward walking on knee osteoarthritis.

METHODS: PubMed, CINAHL, EMBASE, CNKI, CBM, WanFang and VIP were searched for relevant literature. After randomized controlled trials were screened, a meta-analysis was used to evaluate the effectiveness of backward walking on knee osteoarthritis. A total of 7 articles involving 231 patients were included in the result analysis.

RESULTS AND CONCLUSION: Meta-analysis found that: compared with conventional treatment alone, the combination of conventional treatment with backward walking was better in pain relief [mean difference (MD)=-1.05, 95% confidence interval (CI) (-1.46, -0.63), P= 0.000 1], improving knee joint function [standardized mean difference (SMD)=-0.98, 95% CI (-1.33, -0.64), P < 0.000 01], enhancing quadriceps strength [SMD=1.07, 95% CI (0.52, 1.63), P=0.000 2] and improving timed up to go performance [MD=-0.41, 95% CI (-0.67, 0.16), P=0.001]. However, there was no significant difference in the WOMAC score after backward and forward walking [SMD=-0.43, 95% CI (-0.94, -0.08), P=0.10]. Meta-analysis results indicate that the combination of backward walking with conventional treatment has better clinical efficacy than conventional treatment alone for knee osteoarthritis patients. However, on the basis of conventional treatment, backward walking has comparable effects on WOMAC scores as compared with forward walking, which needs further large-sample high-quality randomized controlled trials to be verified.

Key words: backward walking, knee osteoarthritis, WOMAC, quadriceps strength, TUG test, meta-analysis

中图分类号: