研究目的 踝关节损伤是体育运动中最常见的下肢损伤之一,且踝关节外侧损伤比例最高。护踝被认为可以有效预防该损伤,但不同类型护踝的保护机制未达成共识,且对不同运动人群的保护效果可能存在差异。因此本研究系统评估护踝类型对不同人群落地时踝关节运动生物力学的影响,以期为不同人群护踝类型的选择提供理论依据与实施方案。研究方法 检索Web of science、EBSCO、PubMed等数据库,纳入受试者为运动员或普通大学生,且与护踝相关的运动生物力学研究。选用Cochrane偏倚风险评估工具对纳入文献进行质量评价,采用Meta分析中的亚组分析确定不同类型护踝对踝关节运动学的影响,从而保证结果的针对性,并减少研究间异质性。结果 共13项研究(222名受试者)纳入Meta分析。结果显示,对于运动员,弹性护踝、半刚性护踝均可减少踝关节内翻(弹性护踝：26.70%,SMD=-1.647,P=0.040；半刚性护踝：25.84%,SMD=-0.562,P＜0.001)。但只有弹性护踝可减少踝关节跖屈8.37%(SMD=-3.42,P=0.021)。对于普通大学生,弹性护踝、半刚性护踝均可减小踝关节内翻(弹性护踝：35.39%,SMD=-1.000,P=0.013；半刚性护踝：31.11%,SMD=-0.881,P＜0.001)、跖屈(弹性护踝：23.30%,SMD=-1.381,P＜0.001；半刚性护踝：36.33%,SMD=-1.605,P＜0.001)。结论和建议 两种护踝对有5年以上训练史的业余运动员,特别是篮球、排球、跑步运动员均有一定的预防作用,其中弹性护踝能同时限制落地时踝关节内翻和跖屈,而半刚性护踝只能限制踝关节内翻,因此弹性护踝的预防效果更好。对于无任何训练背景的普通大学生,两种护踝均可限制踝关节内翻和跖屈,其中弹性护踝对内翻限制更大,半刚性护踝对跖屈限制更明显。因此,若普通大学生有跟腓韧带损伤史优先考虑选用弹性护踝,距腓前韧带损伤史则更适合半刚性护踝。
Objective Ankle injury is one of common lower extremity injuries in sports, and lateral ankle injuries occupy a highest proportion. ankle brace is regarded as an effective prevention method. However, there is no consensus on the influence of different ankle brace. Further, its effect on the different people groups was not well understood. The study aimed to examine the effects of ankle brace on the lower extremity biomechanics during landing. The results could provide comprehensive understanding of ankle brace’s preventing mechanism. Methods For this systematic review and meta-analysis, different electronic databases (Pubmed, Web of Science, EBSCO, PubMed and other databases) were searched to identify studies investigating the effect of ankle braces on lower limb biomechanics among athletes and collegiate students. After identification of relevant articles, Cochrane was used to evaluate the quality of eligible studies. For the meta-analyses, subgroup analysis was used to access the impact of ankle braces on the ankle biomechanics, which aimed to reduce the statistical heterogeneity. Results The criteria were met by 13 studies with a total of 222 participants. The results showed that semi-rigid ankle brace reduced the peak of ankle inversion by 25.8% compared to elastic ankle brace (SMD -0.562, P＜0.001). Moreover, the elastic ankle brace reduced ankle plant flexion during landing among athletes (SMD=-3.42, P=-0.021). As for collage students, both elastic ankle and semi-rigid ankle decreased the ankle inversion (elastic ankle brace: 35.4%, SMD=-1.000, P=-0.013; semi-rigid ankle brace: 31.11%, SMD=-0.881, P＜0.001) and ankle plant flexion (elastic ankle brace：23.30%,SMD=-1.381,P＜0.001；semi-rigid ankle brace：36.33%,SMD=-1.605,P＜0.001). Conclusion and suggestions (1) Elastic ankle brace had limited the inversion and plantar flexion, while semi-rigid ankle brace merely decreased the ankle inversion for collegiate athletes with training background. Results indicated that athletes were more suitable for elastic ankle brace. (2) As for collagiate students without training history, both elastic ankle and semi-rigid decreased the ankle inversion and plantar flexion. It was worth to noted that elastic ankle brace had greater restriction on inversion, while semi-rigid ankle brace presented more restriction on plantar flexion. Therefore, we can conclude that elastic ankle brace should be utilized if the athletes had calcaneofibular ligament injury. Moreover, the semi-rigid ankle brace was more suitable for the athletes who had history of the anterior talofibular ligament injury.