五芩溪对膝骨性关节炎患者关节功能、肌力和平衡功能的影响：系统评价和荟萃分析

摘要(中文译文)

近年来，越来越多的研究证实传统中医功法在治疗膝骨关节炎（KOA）方面具有潜在的治疗作用。然而，五禽戏（WQX）对KOA患者的疗效仍存在争议。本研究旨在系统评价五禽戏对KOA患者关节功能、肌肉力量、平衡功能和疼痛的影响。系统检索了PubMed、Cochrane、EMBASE、Web of Science、CNKI、万方和维普七个电子数据库，检索时间从建库至2025年11月，以识别所有关于五禽戏治疗KOA的随机对照试验（RCT）。两名评价者独立提取数据并使用Cochrane工具评估偏倚风险。结局指标包括关节功能评分［Lysholm评分和西安大略和麦克马斯特大学骨关节炎指数（WOMAC）］、膝关节屈伸肌峰力矩、平衡功能［包括动态跌倒指数（DFI）、接触时间测试（TCT）和总体稳定指数（OSI）］以及视觉模拟量表（VAS）评分。同时进行了亚组分析、敏感性分析和发表偏倚分析。采用推荐分级的评估、制定与评价（GRADE）方法评估证据质量。共纳入9项试验，涉及809名参与者。结果显示，五禽戏显著改善了Lysholm评分［均数差（MD）=6.34，95%置信区间（CI）：2.32至10.36，=0.002］、WOMAC评分（标准化均数差（SMD）=-0.67，95%CI：-1.08至-0.27，=0.001）、膝关节屈伸肌峰力矩（SMD=0.50，95%CI：0.36至0.65，<0.00001）和DFI评分（SMD=-0.95，95%CI：-1.15至-0.75，<0.00001）。然而，五禽戏对TCT、OSI或VAS评分未见显著影响。总体而言，证据质量从低到高不等。五禽戏可能是KOA的一种有效补充替代疗法，可改善KOA患者的关节功能和肌肉力量。然而，现有证据受到地理集中性、临床异质性、偏倚风险以及多个结局证据质量为低至中等程度的限制。因此，需要进一步开展高质量RCT以验证这些发现。https://www.crd.york.ac.uk/PROSPERO/view/CRD420251268070，注册号（CRD420251047102）。

Abstract

In recent years, an increasing number of studies have demonstrated the potential therapeutic effects of traditional Chinese exercises in the treatment of knee osteoarthritis (KOA). However, the effectiveness of Wuqinxi (WQX) for patients with KOA remains a subject of debate. This study aimed to systematically evaluate the effects of WQX on joint function, muscle strength, balance function, and pain in patients with KOA. A systematic search was conducted in seven electronic databases, including PubMed, Cochrane, EMBASE, Web of Science, CNKI, Wanfang, and VIP, from database inception to November 2025 to identify all randomized controlled trials (RCTs) on WQX for the treatment of KOA. Two reviewers independently extracted data and assessed the risk of bias using the Cochrane tool. Outcome measures included joint function scores [Lysholm and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)], peak torque of the flexor and extensor muscles of the knee, balance function [including dynamic fall index (DFI), time to contact test (TCT), and overall stability index (OSI)], and Visual Analog Scale (VAS) scores. Subgroup, sensitivity, and publication-bias analyses were also performed. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. A total of 9 trials involving 809 participants were included. The results showed that WQX significantly improved Lysholm scores [mean difference (MD) = 6.34, 95% confidence interval (CI): 2.32 to 10.36, = 0.002], WOMAC scores (standardized MD (SMD) = -0.67, 95% CI: -1.08 to -0.27, = 0.001), peak torque of the flexor and extensor muscles of the knee (SMD = 0.50, 95% CI: 0.36 to 0.65, < 0.00001), and DFI scores (SMD = -0.95, 95% CI: -1.15 to -0.75, < 0.00001). However, WQX showed no significant effects on TCT, OSI, or VAS scores. Overall, the certainty of evidence ranged from low to high. WQX may be an effective complementary and alternative therapy for KOA, improving joint function and muscle strength in patients with KOA. However, the available evidence is limited by geographic concentration, clinical heterogeneity, risk of bias, and low-to-moderate certainty for several outcomes. Therefore, further high-quality RCTs are needed to validate these findings. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251268070, identifier (CRD420251047102).

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