Rose Kristy J, Burns Joshua, Wheeler Danielle M, North Kathryn N
Institute of Neuroscience and Muscle Research, The Children's Hospital at Westmead, Discipline of Paediatrics and Child Health, Faculty of Medicine, University of Sydney, Sydney, Australia.
Cochrane Database Syst Rev. 2010 Feb 17(2):CD006973. doi: 10.1002/14651858.CD006973.pub2.
Reduced ankle dorsiflexion range of motion, or ankle equinus, is a common and disabling problem for patients with neuromuscular disease. Clinicians devote considerable time and resources implementing interventions to correct this problem although few of these interventions have been subject to rigorous empirical investigation.
To assess the effect of interventions to reduce or resolve ankle equinus in people with neuromuscular disease.
We searched the Cochrane Neuromuscular Disease Group Trials Specialized Register (August 2009), Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2009), MEDLINE (1966 to August 2009), EMBASE (1980 to August 2009), CINAHL 1982 to August 2009), AMED (1985 to August 2009) and The Physiotherapy Evidence Database (PEDro) (1929 to August 2009). We searched the reference lists of identified articles and also contacted known experts in the field to identify additional or unpublished data.
Randomised controlled trials evaluating interventions for increasing ankle dorsiflexion range of motion in neuromuscular disease. Outcomes included ankle dorsiflexion range of motion, functional improvement, foot alignment, foot and ankle muscle strength, health-related quality of life, satisfaction with the intervention and adverse events.
Two authors independently selected papers, assessed trial quality and extracted data.
Four studies involving 149 participants met inclusion criteria for this review. Two studies assessed the effect of night splinting in a total of 26 children and adults with Charcot-Marie-Tooth disease type 1A. There were no statistically or clinically significant differences between wearing a night splint and not wearing a night splint. One study assessed the efficacy of prednisone treatment in 103 boys with Duchenne muscular dystrophy. While a daily dose of prednisone at 0.75 mg/kg/day resulted in significant improvements in some strength and function parameters compared with placebo, there was no significant difference in ankle range of motion between groups. Increasing the prednisone dose to 1.5 mg/kg/day had no significant effect on ankle range of motion. One study evaluated early surgery in 20 young boys with Duchenne muscular dystrophy. Surgery resulted in increased ankle dorsiflexion range at 12 months but functional outcomes favoured the control group. By 24 months, many boys in the surgical group experienced a relapse of achilles tendon contractures.
AUTHORS' CONCLUSIONS: There is no evidence of significant benefit from any intervention for increasing ankle range of motion in Charcot-Marie-Tooth disease type 1A or Duchenne muscular dystrophy. Further research is required.
踝关节背屈活动度降低，即马蹄足，是神经肌肉疾病患者常见的致残性问题。临床医生投入大量时间和资源实施干预措施来纠正这一问题，尽管其中很少有干预措施经过严格的实证研究。
评估干预措施对减少或解决神经肌肉疾病患者马蹄足的效果。
我们检索了Cochrane神经肌肉疾病组试验专门注册库（2009年8月）、Cochrane对照试验中心注册库（《Cochrane图书馆》2009年第3期）、MEDLINE（1966年至2009年8月）、EMBASE（1980年至2009年8月）、CINAHL（1982年至2009年8月）、AMED（1985年至2009年8月）以及物理治疗证据数据库（PEDro）（1929年至2009年8月）。我们检索了已识别文章的参考文献列表，并联系了该领域的知名专家以识别其他或未发表的数据。
评估增加神经肌肉疾病患者踝关节背屈活动度干预措施的随机对照试验。结局包括踝关节背屈活动度、功能改善、足部对线、足踝肌肉力量、健康相关生活质量、对干预措施的满意度以及不良事件。
两位作者独立选择论文、评估试验质量并提取数据。
四项涉及149名参与者的研究符合本综述的纳入标准。两项研究评估了夜间夹板对总共26例1A型夏科 - 马里 - 图斯病儿童和成人的效果。佩戴夜间夹板与不佩戴夜间夹板之间在统计学或临床上均无显著差异。一项研究评估了泼尼松治疗对103例杜氏肌营养不良男孩的疗效。虽然与安慰剂相比，每日剂量为0.75mg/kg/天的泼尼松在一些力量和功能参数上有显著改善，但两组之间踝关节活动度无显著差异。将泼尼松剂量增加到1.5mg/kg/天对踝关节活动度没有显著影响。一项研究评估了20例杜氏肌营养不良幼龄男孩的早期手术。手术导致12个月时踝关节背屈活动度增加，但功能结局有利于对照组。到24个月时，手术组的许多男孩跟腱挛缩复发。
没有证据表明任何干预措施对增加1A型夏科 - 马里 - 图斯病或杜氏肌营养不良患者的踝关节活动度有显著益处。需要进一步研究。
