脑性瘫痪儿童选择性脊神经后根切断术的荟萃分析

Selective posterior rhizotomy for cerebral palsy in children: a meta-analysis

摘要:

［目的］以荟萃分析评估选择性脊神经后根切断术（selective posterior rhizotomy, SPR）改善脑性瘫痪儿童下肢步态、关节运动等方面的疗效。［方法］文献检索在 PubMed、Embase、Web of Science、Cochrane 图书馆、CBM、CNKI、万方、VIP 电子数据库中进行。纳入有关 SPR 治疗脑性瘫痪的对照研究进行荟萃分析，至少 2 名研究员独立筛选文献、提取数据和评估，使用 Cochrane 5.1.0 偏倚风险评估工具对纳入的 RCTs 质量进行评估，使用 MINORS 评估 nRCTs 的方法学质量，数据分析采用 Revman 5.3 软件。［结果］共检索到 4 115 篇文献，其中英文 1 829 篇，中文 2 284 篇；经过筛选后 7 项研究纳入本荟萃分析，均为英文文献，共计 219 例脑瘫患者，其中 SPR 组 112 例，非 SPR 组 107 例。荟萃分析结果显示：SPR 对脑瘫患者步态（步长）、关节运动 （膝关节伸展、踝关节背伸、踝关节跖屈、足前进角）等方面的改善优于非 SPR 组（P<0.05）。而步频、步速，关节运动中的髋关节屈伸、髋关节伸展、膝关节屈伸、屈膝摆动，以及骨盆倾斜角和骨盆旋转角，SPR 组与非 SPR 组差异无统计学意义 （P> 0.05）。［结论］SPR 能够改善脑性瘫痪儿童步态质量以及膝关节、踝关节的运动学参数，SPR 对下肢远端关节的改善更明显。

Abstract:

[Objective] To evaluate the efficacy of selective posterior rhizotomy (SPR) in improving lower limb gait and joint kinematics of cerebral palsy in children by a meta-analysis. [Methods] Literature retrieval was carried out in PubMed, Embase, Web of Science, Co- chrane Library, CBM, CNKI, Wanfang and VIP electronic databases to search the controlled studies on SPR for cerebral palsy. At least 2 re- searchers independently screened the literature and extracted data. The quality of the included RCTs was assessed by using the Cochrane 5.1.0, a bias risk assessment tool, and then the methodological quality of nRCTs by using MINORS. Finally, the meta-analysis was conduct- ed by Revman 5.3 software. [Results] A total of 4 115 articles were retrieved, including 1 829 in English and 2 284 in Chinese. A total of 219 patients with cerebral palsy were included in the meta-analysis after screening, including 112 in the SPR group and 107 in the nonSPR group. As results of meta-analysis, the SPR improved gait (step length) and joint kinematics, involving knee extension, ankle dorsiflex- ion, ankle plantar flexion, foot forward angle, which proved significantly better than those of the non-SPR group (P＜0.05) . However, there were no significant differences in step frequency, step speed, hip flexion and extension, hip extension, knee flexion and extension, knee swing, pelvic inclination and pelvic rotation angle between SPR group and non-SPR group (P＞0.05) . [Conclusion] The SPR does improve gait quality and kinematics parameters of knee and ankle in children with cerebral palsy, which is more obviously in the distal joint of the lower limb.