【摘要】 目的:通过Meta分析评价本体感觉训练对运动员踝关节扭伤发生率、动态神经肌肉控制能力、姿势稳定性和关节位置觉的影响。方法:运用计算机系统检索PubMed、Cochrane Library、EMbase、中国期刊全文数据库(CNKI)、万方数据库(Wangfang Data)、维普中文期刊全文数据库(VIP)、中国生物医学文献数据库(CBMdisc),以运动员为研究对象,纳入国内外有关本体感觉训练改善运动员踝关节功能的随机对照试验(RCTs)。检索时间为建库至2019年12月31日,同时追溯相关文献的参考文献。由2名研究人员独立筛选文献、提取数据、评价文献质量,采用RevMan 5.3软件进行数据分析,根据Cochrane协作网提供的系统评价手册,连续性变量以均数差(MD)及95%可信区间(CI)为效应指标,二分类变量采用风险比(RR)及95%CI为效应指标。通过χ~2检验和I~2检验综合判断是否存在异质性,当P≥0.1且I2≤50%时,采用固定效应模型;当P<0.1或I2>50%时,采用随机效应模型。结果:共纳入11项RCTs,共1 776例运动员。Meta分析结果显示:与对照组比较,试验组本体感觉训练后踝关节扭伤发生率明显降低[RR=0.61,95%CI(0.41,0.90),P=0.01];与对照组比较,试验组本体感觉训练后其后外侧和后内侧最大伸远距离明显增加[MD=4.44,95%CI(3.66,5.23),P<0.00 001;MD=4.21,95%CI(3.18,5.24),P<0.00 001],差异具有统计学意义;但前侧最大伸远距离的改善效果无明显区别,差异无统计学意义(P>0.05);试验组运动员患侧踝关节在中、外侧方向的姿势摇摆显著低于对照组;试验组运动员踝关节跖屈、背屈、中侧、外侧方向上的位置觉感知能力明显优于对照组。结论:本体感觉训练可有效降低运动员踝关节扭伤发生率,改善动态神经肌肉控制能力,提升姿势稳定性,增强踝关节位置觉,值得临床应用。但绝对疗效还不确切,仍需大样本、高质量的随机对照试验进一步验证其疗效,为临床康复提供更加可靠的循证依据。更多还原

【Abstract】 Objective: To explore the effects of proprioception training on the incidence of athletes’ ankle sprains, dynamic neuromuscular control, postural stability and joint position perception. Methods: Data were searched from the databases of PubMed,Cochrane Library, EMbase, China National Knowledge Infrastructure(CNKI), Wanfang Database(Wangfang Data), Chinese Journal Full-text Database(VIP), China Biomedical Literature Database(CBMdisc). Athletes were included in the randomized controlled trials(RCTs) who were treated with proprioception training to improve the function of athlete’s ankle joint. The retrieval time for each database was from the establishment of the database to December 31,2019, and the references of related documents were traced. Two researchers independently searchered the literature, extracted data, and evaluated the quality of the literature. RevMan5.3 software was used to analyze the data. According to the systematic review manual provided by the Cochrane Collaboration Network, the continuous variables use mean difference(MD) and 95% confidence interval(CI) as indicators, and binary variables use risk ratio(RR) and 95%CI as indicators. The statistical heterogeneity was judged comprehensively by chi-square test(χ2 test) and the Heterogeneity test(I2 test). If P≥0.1 and I2≤50%, a fixed effects model would be used. In contrast, if P<0.1 or I2>50%, a random effects model would be used.Results: A total of 11 RCTs and 1 776 athletes were included. The results of Meta analysis showed that compared with the control group, the incidence of ankle sprains in the experimental group was significantly reduced after proprioceptive training [ RR=0.61,95%CI(0.41, 0.90), P=0.01]; compared with the control group, the posterolateral and posterior medical maximum extension distances of the experimental group increased significantly after proprioception training [MD=4.44, 95%CI(3.66, 5.23), P<0.00 001; MD=4.21,95%CI(3.18, 5.24), P<0.00 001] and the difference was statistically significant; but there was no significant difference in the improvement effect of the anterior maximum extension distance, and the difference was not statistically significant(P>0.05). The postural sway of the affected ankle joint in the experimental group was significantly lower than that in the control group; the athletes in the experimental group had better position perception ability in the ankle joint plantar flexion, dorsiflexion, middle and lateral directions than the control group. Conclusion: Proprioceptive training can effectively reduce the incidence of athletes’ ankle sprains, improve dynamic neuromuscular control, improve postural stability, and enhance ankle joint position perception, which is worthy of clinical application.However, the absolute effect is not yet clear, so large samples and high-quality randomized controlled trials are still needed to further verify the efficacy of proprioception training, so as to provide more reliable evidence-based evidence for clinical rehabilitation.更多还原