不同非手术方法治疗青少年特发性脊柱侧凸效果的系统综述与网状 Meta 分析. (Chinese)

Efficacy of different nonsurgical treatments for adolescent idiopathic scoliosis: a systematic review and network meta-analysis. (English)

OBJECTIVE: There is an increasing number of intervention modalities for the conservative treatment of adolescent idiopathic scoliosis, and a comprehensive assessment of the comparative efficacy between different non-surgical intervention modalities is lacking. The authors compared the effectiveness of different nonsurgical therapies to intervene in adolescent idiopathic scoliosis by network meta-analysis, with the aim of providing clinicians with an evidence-based medical reference for the nonsurgical treatment of adolescent idiopathic scoliosis. METHODS: Two researchers independently searched for randomized controlled trials on non-surgical interventions for adolescent idiopathic scoliosis published from January 2014 to August 2024 in Web of Science, PubMed, Embase, and Cochrane Library. The Cochrane Risk of Bias tool in Review Manager 5.4 was applied to evaluate the quality of the literature. GRADEPro software was used for evidence assessment, and R Studio was used for pairwise analysis as well as network meta-analysis. The outcome indicators were ranked by surface under the cumulative ranking curve to compare the clinical efficacy of different nonsurgical therapeutic interventions. RESULTS: (1) A total of 26 randomized controlled trials were included, with 1 212 patients who were randomly assigned to receive one of 19 different treatment options. (2) Risk of bias assessment showed that most of the included studies had a low risk of bias. (3) The order of probability of surface under the cumulative ranking curve in terms of cobb angle intervention (the smaller the probability, the better the intervention effect) showed that Schroth exercise and Hippotherapy training (5.5%) > Pelvic rotation correction and Schroth exercise (9.1%) > Schroth exercise and Sling exercise (19.3%). The surface under the cumulative ranking curve probability ranking in terms of angle of trunk rotation intervention (the smaller the probability, the better the intervention effect) showed Schroth exercise and Hippotherapy training (8.1%) > Schroth exercise and Sling exercise (12.7%) > Schroth exercise and Balance training (17.1%). The ranking of the probability of improvement in quality of life after treatment for surface under the cumulative ranking curve (the larger the probability, the better the effect) showed Lyon exercise (99.2%) > Schroth exercise and Sling exercise (84.8%) > Pelvic rotation correction and Schroth exercise (82.4%). CONCLUSION: Based on the surface under the cumulative ranking curve and network meta-analysis results, Schroth exercise combined with Hippotherapy training showed the best efficacy in reducing cobb angle and angle of trunk rotation in patients with adolescent idiopathic scoliosis, and Lyon exercise was more effective in improving quality of life. Due to the limited number of included studies, more high-quality literature should be introduced in the future to assess the durability of efficacy and provide more accurate clinical guidance. [ABSTRACT FROM AUTHOR]

目的: 青少年特发性脊柱侧凸保守治疗的干预方式越来越多, 尚缺乏全面评估不同非手术干预方式之间疗效对比的研究。通过网状 Meta 分析对比不同非手术疗法干预脊柱侧凸的有效性, 以期为临床医生提供非手术治疗的循证医学参考。方法: 2 名研究人员在 Web of Science、PubMed、Embase、Cochrane Library 独立检索 2014 年 1 月至 2024 年 8 月发表的有关青少年特发性脊柱 侧凸非手术干预的随机对照试验。应用 Review Manager 5.4 中 Cochrane 偏倚风险工具进行文献质量评价, 以 GRADEPro 软件进行证据评估, 采用 R Studio 进行成对分析以及网络荟萃分析, 结局指标通过累计曲线下面积排序, 比较不同非手术干预的临床疗效。 结果: ①共纳入 26 项随机对照试验, 共 1 212 例患者, 被随机分配接受 19 种不同治疗方式中的一种; ②偏倚风险评估显示, 大部分纳入研 究的偏倚风险均较低; ③Cobb 角累计曲线下面积排序 (概率越小干预效果越好) 显示, Schroth 运动联合马术治疗 (5.5% )>Schroth 运动联合骨 盆旋转矫正 (9.1%)>Schroth 运动联合悬吊训练 (19.3% );躯干旋转角度累计曲线下面积排序 (概率越小干预效果越好) 显示, Schroth 运动联合 马术治疗 (8.1%)>Schroth 运动联合悬吊训练 (12.7%)>Schroth 运动联合平衡训练 (17.1%);治疗后生活质量改善累计曲线下面积排序 (概率越 大效果越好) 显示, Lyon 运动 (99.2%)>Schroth 运动联合悬吊训练 (84.8%)>Schroth 运动联合骨盆旋转矫正 (82.4%)。结论: 根据累计曲线下面积排序以及网状 Meta 结果得出 Schroth 运动联合马术治疗青少年特发性脊柱侧凸在改善 Cobb 角度、降低躯干旋转 角度方面均展现出最佳效用; Lyon 运动对于改善生活质量效果更好。由于纳入研究数量有限, 未来应引入更多统一治疗持续周期与随访时 间的高质量文献, 以评估疗效的持久性, 进而提供更精准的临床指导。 [ABSTRACT FROM AUTHOR]

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