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

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

韩娜娜^{1, 2},
余蕾^{1, 2},
黄晖明^{1, 2, ,}

1.
宁波大学体育学院，浙江 315211
2.
宁波大学大健康研究院

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
计量
- 文章访问数: 1405
- HTML全文浏览量: 704
- PDF下载量: 131
- 被引次数: 0
出版历程
- 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

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

HAN Nana^{1, 2},
YU Lei^{1, 2},
HUANG Huiming^{1, 2
, ,}

1.
College of Physical Education, Ningbo University, Ningbo(315211), Zhejiang Province, China

摘要

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。
- 体育和训练 /
- 脊柱侧凸 /
- 健康促进 /
- Meta分析 /
- 青少年
Abstract: Objective To evaluate the effect of functional training on the improvement of Cobb Angle, ATR and quality of life in adolescent idiopathic scoliosis. Methods Database of CNKI, WanFang, WeiPu, Web of Science, PubMed were reconnoitered for the purpose of research articles of Interest. Literature was screened according to the inclusion criteria, randomized controlled trials (RCTS) were collected and Cochrane risk bias assessment methodology quality was used, and Revman 5.3 software was used to conduct combined effector subgroup analysis on outcome indicators (Cobb Angle, ATR, SRS-22 patient questionnaire). Results A total of 10 RCT (398 AIS patients) were included in the study. There were two high-, five moderate-and three low-quality studies, respectively. Compared with other non-operative treatments, functional training could reduce Cobb horn in patients, MD=-6.56 (95%CI=-7.30--5.83, P < 0.01, I²=0). Further subgroup analysis showed that there were no statistically significant differences in effect size between the subgroups of Cobb Angle, age, intervention period and control method at the time of inclusion (P>0.05). Compared with the non-intervention blank group, the functional training group could reduce the Cobb Angle of patients (MD=-5.25, 95%CI=-7.90--2.60, P < 0.01), with high heterogeneity (I²=61%). Effect on angle of trunk rotation(ATR): functional training group could reduce patients' ATR, MD=-1.91 (95%CI=-2.25--1.57, P < 0.01, I²=0). The impact on the quality of life: functional training of patients with SRS-22 questionnaire function, pain had no statistical significance (P>0.05), and self-image (MD=0.64, 95%CI=0.53-0.75, P < 0.01), mental health (MD=0.44, 95%CI=0.15-0.74, P < 0.01), satisfaction (MD=0.58, 95%CI=0.11-1.06, P=0.02) were statistically significant. Conclusion Functional training can not only reduce the Cobb Angle and ATR of AIS patients, but also improve the quality of life in terms of self-image, mental health and satisfaction of the patients. However, due to heterogeneity and bias, more high-quality studies are needed to verify.
- Physical education and training /
- Scoliosis /
- Health promotion /
- Meta-analysis /
- Adolescent

HTML全文

图 1 文献纳入筛选流程

Figure 1. Research about flow chart of inserting literature

下载: 全尺寸图片幻灯片

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

下载: 全尺寸图片幻灯片

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

下载: 全尺寸图片幻灯片

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_异质性值	效应模型	MD值(MD值95%CI)	P值
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)

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