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功能性训练对青少年特发性脊柱侧弯疗效的Meta分析

韩娜娜 余蕾 黄晖明

韩娜娜, 余蕾, 黄晖明. 功能性训练对青少年特发性脊柱侧弯疗效的Meta分析[J]. 中国学校卫生, 2021, 42(8): 1169-1174. doi: 10.16835/j.cnki.1000-9817.2021.08.012
引用本文: 韩娜娜, 余蕾, 黄晖明. 功能性训练对青少年特发性脊柱侧弯疗效的Meta分析[J]. 中国学校卫生, 2021, 42(8): 1169-1174. doi: 10.16835/j.cnki.1000-9817.2021.08.012
HAN Nana, YU Lei, HUANG Huiming. A Meta-analysis of the effect of functional training on idiopathic scoliosis in adolescents[J]. CHINESE JOURNAL OF SCHOOL HEALTH, 2021, 42(8): 1169-1174. doi: 10.16835/j.cnki.1000-9817.2021.08.012
Citation: HAN Nana, YU Lei, HUANG Huiming. A Meta-analysis of the effect of functional training on idiopathic scoliosis in adolescents[J]. CHINESE JOURNAL OF SCHOOL HEALTH, 2021, 42(8): 1169-1174. doi: 10.16835/j.cnki.1000-9817.2021.08.012

功能性训练对青少年特发性脊柱侧弯疗效的Meta分析

doi: 10.16835/j.cnki.1000-9817.2021.08.012
基金项目: 

国家社会科学基金一般项目 18BTY100

详细信息
    作者简介:

    韩娜娜(1995-),女,山西霍州人,硕士,主要研究方向为运动人体科学、运动与健康促进

    通讯作者:

    黄晖明,E-mail: 2739175096@qq.com

  • 中图分类号: G808  R179  R726.8

A Meta-analysis of the effect of functional training on idiopathic scoliosis in adolescents

  • 摘要:   目的  评价功能性训练对青少年特发性脊柱侧弯(AIS)患者Cobb角、躯干倾斜角、生活质量的改善效果,以期为预防和治疗AIS提供更为准确可靠的指导。  方法  检索中国知网、万方、维普、Web of Science、PubMed、ScienceDirect数据库,依据纳入标准进行文献筛选,收集随机对照实验(RCT),使用Cochrane风险偏倚评价方法学质量,Revman 5.3软件对结局指标[Cobb角、躯干倾斜角(ATR)、患者问卷SRS-22]进行合并效应量、亚组分析。  结果  共10个RCT(AIS患者398名)纳入研究,高、中、低质量研究分别有2,5和3篇。对Cobb角的影响中,与其他非手术治疗相比,功能性训练可以降低患者Cobb角(MD=-6.56,95%CI=-7.30~-5.83,P < 0.01,I2=0);进一步亚组分析显示,亚组Cobb角、年龄、干预周期、对照组方式的效应量差异均无统计学意义(P值均>0.05)。与无干预组相比,功能性训练组可以使患者Cobb角减小(MD=-5.25,95%CI=-7.90~-2.60,P < 0.01,I2=61%)。对ATR的影响中,功能性训练组可以降低患者ATR(MD=-1.91,95%CI=-2.25~-1.57,P < 0.01,I2=0)。对生活质量的影响中,功能性训练对患者SRS-22问卷功能、疼痛改善效果均无统计学意义(P值均>0.05),对自我形象(MD=0.64,95%CI=0.53~0.75)、心理健康(MD=0.44,95%CI=0.15~0.74)、满意度(MD=0.58,95%CI=0.11~1.06)改善效果均有统计学意义(P值均 < 0.05)。  结论  功能性训练不仅可以降低AIS患者的Cobb角和ATR,还可以使患者的生活质量得到较好的改善,但由于异质性和偏倚的影响,尚需开展更多高质量的研究加以验证。
  • 图  1  文献纳入筛选流程

    Figure  1.  Research about flow chart of inserting literature

    图  2  功能性训练对青少年特发性脊柱侧弯疗效的发表偏倚

    Figure  2.  Publication bias of the effect of funcational training on idiopathic scoliosis in adolescents

    图  3  功能性训练对其他非手术治疗AIS患者Cobb角影响

    Figure  3.  Forest plot of the effect of functional training on the Cobb angle in AIS patients

    表  1  纳入研究的基本特征

    Table  1.   Basic characteristics of included studies

    第一作者及年份 纳入时Cobb角/(°) 样本量 男/女 年龄/岁 失访人数 第一作者及年份 纳入时Cobb角/(°) 样本量 男/女 年龄/岁 失访人数
    章恒亮(2014)[16] T: 27.20±8.01 15 9/6 15.2±1.44 0 Monticone(2014)[18] T: 19.3±3.9 55 16/39 12.5±1.1 12
    C: 30.77±7.86 15 8/7 14.54±2.31 C: 19.2±2.5 55 14/41 12.4±1.1
    刘娜(2017)[19] T: 27.83±7.17 12 4/8 10.91±3.39 0 Toledo(2011)[21] T: 15.10±2.51 10 6/4 10.0±3.0 0
    C: 28.00±7.91 11 2/9 10.09±3.53 C: 9.80±2.9 10 5/5 10.0±3.0
    黄霞(2010)[17] T: 16.07±5.81 15 6/9 12.60±4.65 0 Zakaria(2012)[22] T: 28.0±2.97 20 0/20 18.21±2.34 0
    C: 16.13±5.98 15 5/10 12.47±5.27 C: 27.2±2.6 20 0/20 17.88±2.39
    Kim(2016)[20] T: 23.63±1.5 12 0/12 15.60±1.1 0 Hwangbo(2016)[23] T: 22.07±6.81 8 0/8 18.14±1.60 0
    C: 24.0±2.6 12 0/12 15.3±0.8 C: 18.21±3.95 8 0/8 18.88±1.55
    Kuru(2015)[13] T1:33.4±8.9 15 1/14 12.9±1.4 0 Zheng(2018)[24] T: 27.03±3.57 30 7/22 12.4±0.9 7
    T2:30.3±7.6 15 3/12 15.3±0.8 C: 28.0±3.60 30 5/19 12.3±0.8
    C: 30.3±6.6 15 2/13 13.1±1.7
    注: T表示实验组,C表示对照组。
    下载: 导出CSV

    表  2  纳入研究的运动干预特征

    Table  2.   Characteristics of sports intervention included studies

    第一作者及年份 功能性训练干预组 对照组 干预频次 干预周期 结局指标
    章恒亮(2014)[16] 核心肌力训练 支具 T: 1~2次/d,20~35 min/次; C: 22 h/d 6个月 Cobb角
    刘娜(2010)[19] 稳定性训练 被动手法 T/C: 6次/周、30 min/次 12周 Cobb角
    黄霞(2017)[17] 功能矫形体操 被动拉伸 T: 2次/d,10 min/次; C: 2次/d 6个月 Cobb角
    Kim(2016)[20] Schroth训练 被动拉伸 T/C: 3次/周、60 min/次 12周 Cobb角
    Kuru(2015)[13] T1:(有监督)Schroth训练; 无干预 T: 1.5 h/d,3 d/周 6个月 Cobb角,ATR
    T2:(无监督)家庭Schroth训练 无干预 T: 1.5 h/d,3 d/周
    Monticone(2014)[18] 核心肌力训练、本体感觉训练 被动拉伸 T/C: 1~2次/周、30~60 min/次 (42.8±9.1)个月 Cobb角,ATR,SRS-22患者问卷
    Tolebo(2011)[21] 本体感觉训练 无干预 T: 2次/周、25~30 min/次 12周 Cobb角
    Zakaria(2012)[22] 核心肌力训练 被动拉伸 T/C: 3次/周 3个月 Cobb角
    Hwangbo(2016)[23] Schroth训练 被动拉伸 T/C: 3次/周 12周 Cobb角
    Zheng(2018)[24] 稳定性训练 矫形器 T: 10~15 min/d; C: 23 h/d 12个月 Cobb角,SRS-22患者问卷
    注: T表示实验组,C表示对照组。
    下载: 导出CSV

    表  3  功能性训练对AIS患者Cobb角指标的亚组分析

    Table  3.   Subgroup analysis of functional training on Cobb angle indicators in AIS patients

    亚组 选项 文章数量 I2值/% P异质性 效应模型 MD值(MD值95%CI) P
    患者纳入时Cobb角 10~25 4 0 0.50 固定 -6.69(-7.56~-5.82) 0.60
    /(°) >25~45 3 12 0.32 固定 -6.26(-7.61~-4.91)
    年龄/岁 <14 3 0 0.56 固定 -6.80(-7.68~-5.91) 0.37
    ≥14 4 2 0.25 固定 -6.08(-7.37~-4.79)
    干预周期/月 <6 4 0 0.67 固定 -5.69(-7.08~-4.31) 0.13
    ≥6 3 0 0.52 固定 -6.95(-7.82~-6.08)
    对照组方式 支具矫形器 2 30 0.23 随机 -7.58(-10.69~-4.46) 0.51
    被动拉伸 5 0 0.54 随机 -6.50(-7.26~-5.75)
    下载: 导出CSV
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  • 收稿日期:  2021-01-29
  • 修回日期:  2021-04-05
  • 网络出版日期:  2021-08-20
  • 刊出日期:  2021-08-25

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