抗阻运动改善老年骨质疏松性骨折患者健康结局的Meta分析

doi:10.3761/j.issn.0254-1769.2023.10.014

摘要/Abstract

摘要：

目的系统评价抗阻运动对老年骨质疏松性骨折患者不同健康结局的改善效果。方法计算机检索PubMed、Embase、Cochrane Library、Web of Science、CINAHL Plus、中国知网和万方数据库从建库至2022年9月1日发表的随机对照临床试验，采用随机对照试验偏倚风险评估工具2.0（version 2.0 of the Cochrane tool for assessing risk of bias in randomized trial，RoB 2.0）对纳入研究进行质量评价，使用元分析V3软件进行Meta分析。结果纳入15项随机对照研究，共1 055例患者。Meta分析显示，抗阻运动可以有效改善老年骨质疏松性骨折患者的肌肉力量[SMD=0.746，95%CI（0.152，1.339），P=0.014]、平衡能力[SMD=0.439，95%CI（0.086，0.792），P=0.015]和移动能力[SMD=0.240，95%CI（0.074，0.407），P=0.005]；在行走速度测试方面的差异无统计学意义[SMD=0.203，95%CI（-0.008， 0.415），P=0.059]。结论抗阻运动能够有效提高老年骨质疏松性骨折患者肌肉力量、总体平衡能力和移动能力。在进行抗阻训练时，护理人员应针对患者的身体情况给予科学、高效的抗阻运动康复建议，指导患者完成运动计划，确保患者安全的同时促进患者健康结局的改善。

关键词: 骨质疏松性骨折, 老年人, 抗阻运动, Meta分析, 循证护理学

Abstract:

Objective To systematically assess the effects of resistance exercise on different health outcomes of older patients with osteoporotic fractures. Methods Databases，including Pubmed，Embase，Cochrane Library，Web of Science，CINAHL Plus，CNKI，Wanfang，were systematically searched for studies with randomized controlled trial research design from their inception to september 1，2022. Quality assessment of the included articles was performed by RoB2（Version 2 of the Cochrane tool for assessing risk of bias in randomized trial）. The meta-analysis was conducted using the Comprehensive Meta Analysis V3 software. Results 15 studies involving 1055 patients were finally included in this study.Meta analysis showed that resistance exercise could effectively improve muscle strength[SMD=0.746，95%CI（0.152，1.339），P=0.014]，balance ability[SMD=0.439，95%CI（0.086，0.792）. P=0.015] and mobile ability[SMD=0.240，95%CI（0.074，0.407），P=0.005] in older patients with osteoporotic fractures；however，there were no statistically significant differences in the improvement of walking speed[SMD=0.203，95%CI（-0.008，0.415），P=0.059]. Conclusion Resistance exercise can effectively improve pain，muscle strength，balance ability and mobility in older patients with osteoporotic fractures. During the resistance training，nurses should give patients scientific and efficient suggestions on resistance exercise rehabilitation according to the specific physical conditions of patients，and guide them to complete the exercise plan，so as to ensure the safety of patients and improve the physical function of patients.

Key words: Osteoporotic Fracture, Aged, Resistance Exercise, Meta-Analysis, Evidence-Based Nursing

汤昱暄, 梁小芹, 于明明. 抗阻运动改善老年骨质疏松性骨折患者健康结局的Meta分析[J]. 中华护理杂志, 2023, 58(10): 1238-1244.

TANG Yuxuan, LIANG Xiaoqin, YU Mingming. The effects of resistance exercise on health outcomes of older patients with osteoporotic fractures：a Meta-analysis[J]. Chinese Journal of Nursing, 2023, 58(10): 1238-1244.

图/表 2

参考文献 36

[1]	Brauer CA, Coca-Perraillon M, Cutler DM, et al. Incidence and mortality of hip fractures in the United States[J]. JAMA, 2009, 302(14):1573-1579. DOI PMID
[2]	Si L, Winzenberg TM, Jiang Q, et al. Projection of osteoporosis-related fractures and costs in China:2010-2050[J]. Osteoporos Int, 2015, 26(7):1929-1937. DOI PMID
[3]	上海市中西医结合学会骨质疏松专业委员会. 中国骨质疏松性骨折围手术期处理专家共识(2018)[J]. 中国临床医学, 2018, 25(5):860-867.
	Osteoporosis Professional Committee of Shanghai Society of Integrated Chinese and Western Medicine. Chinese expert consensus on perioperative management of osteoporotic fractures(2018)[J]. Chin J Clin Med, 2018, 25(5):860-867.
[4]	苏媛媛, 张伟宏, 宋晓月, 等. 抗阻运动对心血管疾病患者心脏康复作用的研究进展[J]. 中华护理杂志, 2017, 52(2):154-157.
	Su YY, Zhang WH, Song XY, et al. Research progress on the effect of resistance exercise on cardiac rehabilitation of patients with cardiovascular diseases[J]. Chin J Nurs, 2017, 52(2):154-157.
[5]	王英杰, 乔然, 于彤, 等. 低负荷小强度抗阻运动对卧床老年患者肌力和心肺功能的影响[J]. 中华护理杂志, 2021, 56(11):1605-1611. DOI URL
	Wang YJ, Qiao R, Yu T, et al. Effect of resistance exercise program on muscle strength and cardiopulmomary function in elderly bedridden patients[J]. Chin J Nurs, 2021, 56(11):1605-1611.
[6]	Hewitt J, Goodall S, Clemson L, et al. Progressive resistance and balance training for falls prevention in long-term residential aged care:a cluster randomized trial of the sunbeam program[J]. J Am Med Dir Assoc, 2018, 19(4):361-369. DOI URL
[7]	Feng S, Tian W, Sun Y, et al. Effect of robot-assisted surgery on lumbar pedicle screw internal fixation in patients with osteoporosis[J]. World Neurosurg, 2019, 125:e1057-e1062. DOI URL
[8]	聂明剑, 张智海, 冯强, 等. 12周社区运动干预对绝经后骨质疏松症女性骨密度的影响研究[J]. 中国骨质疏松杂志, 2019, 25(4):446-451.
	Nie MJ, Zhang ZH, Feng Q, et al. Effects of 12-week community exercise intervention on bone mineral density in postmenopausal women with osteoporosis[J]. Chin J Osteoporos, 2019, 25(4):446-451.
[9]	Giangregorio LM, Papaioannou A, Macintyre NJ, et al. Too fit to fracture:exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture[J]. Osteoporos Int, 2014, 25(3):821-835. DOI PMID
[10]	Gibbs JC, MacIntyre NJ, Ponzano M, et al. Exercise for impro-ving outcomes after osteoporotic vertebral fracture[J]. Coch-rane Database Syst Rev, 2019, 7:CD008618.
[11]	周剑, 华兴一, 汤健. 骨质疏松性骨折的诊疗与防治[J]. 临床内科杂志, 2020, 37(5):331-334.
	Zhou J, Hua XY, Tang J. Diagnosis,treatment and prevention of osteoporotic fracture[J]. J Clin Intern Med, 2020, 37(5):331-334.
[12]	Methods Group of Cochrane Methodology. A revised tool to assess risk of bias in randomized trials(RoB 2)[EB/OL]. (2019-08-22)[2022-04-16]. https://www.riskofbias.info/welcome/rob-2-0-tool.
[13]	Binder EF, Brown M, Sinacore DR, et al. Effects of extended outpatient rehabilitation after hip fracture:a randomized controlled trial[J]. JAMA, 2004, 292(7):837-846. DOI PMID
[14]	Berg OK, Stutzer JM, Hoff J, et al. Early maximal strength train-ing improves leg strength and postural stability in elderly following hip fracture surgery[J]. Geriatr Orthop Surg Rehabil, 2021, 12:21514593211015103.
[15]	张刚. 运动疗法联合中医三期辨证疗法对高龄骨质疏松性胸腰椎压缩骨折患者的临床疗效观察[D]. 成都: 成都体育学院, 2019.
	Zhang G. Clinical observation of exercise therapy combined with TCM three-stage syndrome differentiation therapy on elderly patients with osteoporotic thoracolumbar compression fracture[D]. Chengdu: Chengdu Sport University, 2019.
[16]	Chen BL, Zhong Y, Huang YL, et al. Systematic back muscle exercise after percutaneous vertebroplasty for spinal osteoporotic compression fracture patients:a randomized controlled trial[J]. Clin Rehabil, 2012, 26(6):483-492. DOI URL
[17]	杨霖, 何成奇, 雷中杰, 等. 无痛运动训练对女性骨质疏松脊柱压缩骨折患者的治疗效应[J]. 中国组织工程研究与临床康复, 2007, 11(45):9108-9111.
	Yang L, He CQ, Lei ZJ, et al. Effect of pain-free exercises on female osteoporosis patients with spinal compressive fracture[J]. Chin J Tissue Eng Res, 2007, 11(45):9108-9111.
[18]	Portegijs E, Kallinen M, Rantanen T, et al. Effects of resistance training on lower-extremity impairments in older people with hip fracture[J]. Arch Phys Med Rehabil, 2008, 89(9):1667-1674. DOI URL
[19]	Moseley AM, Sherrington C, Lord SR, et al. Mobility training after hip fracture:a randomised controlled trial[J]. Age Ageing, 2008, 38(1):74-80. DOI URL
[20]	Mard M, Vaha J, Heinonen A, et al. The effects of muscle strength and power training on mobility among older hip fracture patients[J]. Adv Physiother, 2008, 10(4):195-202. DOI URL
[21]	Catherine S, Lord SR, Herbert RD. A randomised trial of weight-bearing versus non-weight-bearing exercise for improving physical ability in inpatients after hip fracture[J]. Aust J Phy-siother, 2003, 49(1):15-22.
[22]	Mitchell SL, Stott DJ, Martin BJ, et al. Randomized controlled trial of quadriceps training after proximal femoral fracture[J]. Clin Rehabil, 2001, 15(3):282-290. DOI PMID
[23]	Mangione KK, Craik RL, Palombaro KM, et al. Home-based leg-strengthening exercise improves function 1 year after hip fracture:a randomized controlled study[J]. J Am Geriatr Soc, 2010, 58(10):1911-1917. DOI URL
[24]	Bergström I, Bergström K, Kronhed ACG, et al. Back extensor training increases muscle strength in postmenopausal women with osteoporosis,kyphosis and vertebral fractures[J]. Adv Phy-siother, 2011, 13(3):110-117.
[25]	Sylliaas H, Brovold T, Wyller TB, et al. Prolonged strength train-ing in older patients after hip fracture:a randomised controlled trial[J]. Age Ageing, 2012, 41(2):206-212. DOI PMID
[26]	Sylliaas H, Brovold T, Wyller TB, et al. Progressive strength training in older patients after hip fracture:a randomised controlled trial[J]. Age Ageing, 2011, 40(2):221-227. DOI PMID
[27]	Kronborg L, Bandholm T, Palm H, et al. Effectiveness of acute in-hospital physiotherapy with knee-extension strength training in reducing strength deficits in patients with a hip fracture:a randomised controlled trial[J]. PLoS One, 2017, 12(6):e0179867.
[28]	吴振斌, 叶丹丹, 陈西玲, 等. 骨密度及骨代谢指标与骨质疏松性骨折相关性研究[J]. 中国医药指南, 2022, 20(6):29-32.
	Wu ZB, Ye DD, Chen XL, et al. The correlation between bone mineral density and bone metabolism markers and osteoporotic fracture[J]. Guide China Med, 2022, 20(6):29-32.
[29]	邢清, 王亮, 马远征, 等. 骨质疏松性骨折患者心理评估及干预的临床研究[J]. 中国骨质疏松杂志, 2010, 16(6):447-449.
	Xing Q, Wang L, Ma YZ, et al. Clinical study of psychological evaluation and intervention in osteoporotic fracture patients[J]. Chin J Osteoporos, 2010, 16(6):447-449.
[30]	Hourigan SR, Nitz JC, Brauer SG, et al. Positive effects of exercise on falls and fracture risk in osteopenic women[J]. Osteoporos Int, 2008, 19(7):1077-1086. DOI PMID
[31]	瞿惠芳, 张文忠, 闫万军. 老年人肌肉功能的重建及其可训练性[J]. 中国组织工程研究与临床康复, 2010, 14(2):325-328.
	Qu HF, Zhang WZ, Yan WJ. Trainability and reconstruction of ageing’s muscle function[J]. Chin J Tissue Eng Res, 2010, 14(2):325-328.
[32]	许红璐, 尤黎明, 颜君, 等. 老年髋部骨折术后家庭康复情况及影响因素的研究[J]. 中华护理杂志, 2006, 41(5):464-466.
	Xu HL, You LM, Yan J, et al. Rehabilitation in the home and related factors among post-operative elders with hip fracture[J]. Chin J Nurs, 2006, 41(5):464-466.
[33]	陈梅, 陈晓文. 老年股骨颈骨折患者出院后家庭访视与康复指导[J]. 中华护理杂志, 2003, 38(9):14-16.
	Chen M, Chen XW. Home visiting and recovery coach of elderly patients with femoral neck fractures after their discharge from hospital[J]. Chin J Nurs, 2003, 38(9):14-16.
[34]	Joshua AM, DSouza V, Unnikrishnan B, et al. Effectiveness of progressive resistance strength training versus traditional balance exercise in improving balance among the elderly:a randomised controlled trial[J]. J Clin Diagn Res, 2014, 8(3):98-102.
[35]	Barry BK, Carson RG. The consequences of resistance training for movement control in older adults[J]. J Gerontol A Biol Sci Med Sci, 2004, 59(7):M730-M754. DOI URL
[36]	梁雷超, 吕娇娇, 黄灵燕, 等. 认知-姿势控制双任务在老年人跌倒研究中的应用进展[J]. 中国康复理论与实践, 2016, 22(11):1289-1293. DOI
	Liang LC, Lü JJ, Huang LY, et al. Advance in cognitive and postural control dual-task in falls of older people[J]. Chin J Re-habil Theory Pract, 2016, 22(11):1289-1293.