Kim Kyung-Min, Kim Joo-Sung, Cruz-Díaz David, Ryu Seungho, Kang Minsoo, Taube Wolfgang
Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL 33146, USA.
Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain.
J Clin Med. 2019 Jul 16;8(7):1037. doi: 10.3390/jcm8071037.
The objective of this systematic review with meta-analysis was to determine alterations in spinal and corticospinal excitability of ankle muscles in patients with chronic ankle instability (CAI) compared to uninjured controls. Independent researchers performed comprehensive literature searches of electronic databases and included studies that compared groups with and without CAI and investigated neural excitability with Hoffmann reflex (H-reflex) and/or transcranial magnetic stimulation (TMS). A fixed-effect meta-analysis was conducted to determine group differences for (1) soleus and fibularis maximal H-reflex (Hmax)/maximal M-wave (Mmax)-ratios, and (2) soleus and fibularis longus cortical motor thresholds (CMTs). Seventeen studies were included in the current meta-analysis. They showed that the Hmax/Mmax-ratios of the soleus and the fibularis longus in the CAI group were significantly lower than those in the uninjured control group (soleus: d = -0.41, < 0.001; fibularis longus: d = -0.27, = 0.04). There was no evidence for changes in the CMT. This systematic review is the first to demonstrate evidence that patients with CAI present decreased spinal reflex excitability in the soleus and fibularis longus. However, there is no evidence of changes in supraspinal excitability when considering only the CMT. The latter result needs to be interpreted with caution as all except one study demonstrate some changes at the supraspinal level with CAI.
本系统评价及荟萃分析的目的是确定与未受伤的对照组相比，慢性踝关节不稳（CAI）患者踝关节肌肉的脊髓和皮质脊髓兴奋性的改变。独立研究人员对电子数据库进行了全面的文献检索，纳入了比较有无CAI组并使用霍夫曼反射（H反射）和/或经颅磁刺激（TMS）研究神经兴奋性的研究。进行了固定效应荟萃分析，以确定（1）比目鱼肌和腓骨肌的最大H反射（Hmax）/最大M波（Mmax）比值，以及（2）比目鱼肌和腓骨长肌的皮质运动阈值（CMT）的组间差异。本荟萃分析纳入了17项研究。结果显示，CAI组比目鱼肌和腓骨长肌的Hmax/Mmax比值显著低于未受伤对照组（比目鱼肌：d = -0.41，P < 0.001；腓骨长肌：d = -0.27，P = 0.04）。没有证据表明CMT有变化。本系统评价首次证明，CAI患者比目鱼肌和腓骨长肌的脊髓反射兴奋性降低。然而，仅考虑CMT时，没有证据表明脊髓上兴奋性有变化。后一结果需要谨慎解释，因为除一项研究外，所有研究均表明CAI患者在脊髓上水平有一些变化。
