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[1]龔志兵,莊至坤,張煥堂,等.骨散外敷治療急性踝關節(jié)扭傷氣滯血瘀證的臨床研究[J].中醫(yī)正骨,2018,30(12):13-17，22.
　GONG Zhibing,ZHUANG Zhikun,ZHANG Huantang,et al.A clinical study of external application of Gusan(骨散)for treatment of qi-stagnation-blood-stasis-type acute ankle sprain[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(12):13-17，22.
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骨散外敷治療急性踝關節(jié)扭傷氣滯血瘀證的臨床研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期數(shù):
2018年12期
頁碼:
13-17，22
欄目:
臨床研究
出版日期:
2018-12-20

文章信息/Info

Title:
A clinical study of external application of Gusan(骨散)for treatment of qi-stagnation-blood-stasis-type acute ankle sprain
作者:
龔志兵; 莊至坤; 張煥堂; 張前進; 徐福東; 吳昭克
(福建省泉州市正骨醫(yī)院,福建 泉州 362000)
Author(s):
GONG Zhibing; ZHUANG Zhikun; ZHANG Huantang; ZHANG Qianjin; XU Fudong; WU Zhaoke
Quanzhou Orthopedic Hospital,Quanzhou 362000,Fujian,China
關鍵詞:
踝關節(jié);  扭傷和勞損;  氣滯血瘀;  中藥外敷;  骨散;  雙氯芬酸二乙胺乳膠劑;  臨床試驗
Keywords:
ankle joint;  sprains and strains;  qi stagnation blood stasis;  external applications(TCD);  Gusan;  diclofenac diethylamine emulgel;  clinical trial
摘要:
目的:觀察骨散外敷治療急性踝關節(jié)扭傷氣滯血瘀證的臨床療效及安全性。方法:將符合要求的100例急性踝關節(jié)扭傷氣滯血瘀證患者隨機分為2組,每組50例,分別采用骨散外敷和雙氯芬酸二乙胺乳膠劑外涂治療。骨散外敷踝關節(jié)扭傷處,第1周每天更換1次藥膏,第2周每2 d更換1次,連續(xù)外敷2周; 雙氯芬酸二乙胺乳膠劑外涂踝關節(jié)扭傷處,每天3次,連續(xù)外涂2周。分別于治療前及治療開始后1 d、3 d、7 d,比較2組患者踝關節(jié)疼痛視覺模擬量表(visual analogue scale,VAS)評分; 于治療2周后,采用Kofoed踝關節(jié)評分標準比較2組患者的綜合療效,并比較2組患者腫脹、瘀斑消退時間及并發(fā)癥發(fā)生情況。結果:①隨訪結果。骨散外敷組3例、雙氯芬酸二乙胺乳膠劑外涂組2例因發(fā)生嚴重過敏反應或未按時復診而退出。②腫脹和瘀斑消退時間。骨散外敷組腫脹和瘀斑消退時間均短于雙氯芬酸二乙胺乳膠劑外涂組[(6.69±1.20)d,(9.30±1.36)d,t=-9.914,P=0.000;(10.01±1.29)d,(12.52±0.97)d,t=-10.714,P=0.000]。③踝關節(jié)疼痛VAS評分。時間因素與分組因素存在交互效應(F=11.466,P=0.000); 2組患者踝關節(jié)疼痛VAS評分比較,組間差異有統(tǒng)計學意義,即存在分組效應(F=58.307,P=0.000); 治療前后不同時間點踝關節(jié)疼痛VAS評分的差異有統(tǒng)計學意義,即存在時間效應(F=569.721,P=0.000); 2組踝關節(jié)疼痛VAS評分隨時間均呈下降趨勢,但2組的下降趨勢不完全一致[(6.60±1.06)分,(3.51±0.75)分,(2.19±0.74)分,(0.91±0.88)分,F=387.163,P=0.000;(6.58±1.01)分,(4.15±0.85)分,(3.04±0.80)分,(2.38±0.98)分,F=203.139,P=0.000]; 治療前2組患者踝關節(jié)疼痛VAS評分比較,差異無統(tǒng)計學意義(t=0.054,P=0.957); 治療開始后1 d、3 d、7 d,骨散外敷組踝關節(jié)疼痛VAS評分均低于雙氯芬酸二乙胺乳膠劑外涂組(t=-4.292,P=0.000; t=-5.378,P=0.000; t=-6.689,P=0.000)。④綜合療效。治療2周后,骨散外敷組優(yōu)35例、良10例、及格2例,雙氯芬酸二乙胺乳膠劑外涂組優(yōu)20例、良19例、及格9例; 骨散外敷組的綜合療效優(yōu)于雙氯芬酸二乙胺乳膠劑外涂組(Z=-3.346,P=0.001)。⑤安全性。骨散外敷組2例患者和雙氯芬酸二乙胺乳膠劑外涂組1例患者出現(xiàn)輕度過敏反應,未給予特殊處理,停藥后癥狀消失; 2組并發(fā)癥發(fā)生率比較,差異無統(tǒng)計學意義(χ2=0.366,P=0.545)。結論:采用骨散外敷治療急性踝關節(jié)扭傷氣滯血瘀證,能緩解踝關節(jié)疼痛,消除踝關節(jié)腫脹和瘀斑,且并發(fā)癥少,其療效優(yōu)于雙氯芬酸二乙胺乳膠劑外涂。
Abstract:
Objective:To observe the clinical curative effects and safety of external application of Gusan(骨散,GS)for treatment of qi-stagnation-blood-stasis-type acute ankle sprain.Methods:One hundred patients with qi-stagnation-blood-stasis-type acute ankle sprain enrolled in the study were randomly divided into 2 groups,50 cases in each group,and were treated with external application of GS(group A)and external application of diclofenac diethylamine emulgel(group B)respectively.The GS was applied to the sprained spots of ankle for consecutive 2 weeks,once a day in the 1st week and every other day in the 2nd week; while the diclofenac diethylamine emulgel was applied to the sprained spots of ankle,3 times a day for consecutive 2 weeks.The ankle pain visual analogue scale(VAS)scores were compared between the 2 groups before treatment and at 1,3 and 7 days after the beginning of the treatment respectively.The total clinical curative effects were compared between the 2 groups after 2-week treatment by using Kofoed ankle scoring standards,and the extinction time of swelling and ecchymoses and complication incidences were also compared between the 2 groups.Results:Three patients in group A dropped out of the study for severe allergic reactions or delayed return-visit and 2 patients in group B dropped out of the study for delayed return-visit.The extinction time of swelling and ecchymoses were shorter in group A compared to group B(6.69+/-1.20 vs 9.30+/-1.36 days,t=-9.914,P=0.000; 10.01+/-1.29 vs 12.52+/-0.97 days,t=-10.714,P=0.000).There was interaction between time factorand group factor in ankle pain VAS scores(F=11.466,P=0.000).There was statistical difference in ankle pain VAS scores between the 2 groups,in other words,there was group effect(F=58.307,P=0.000).There was statistical difference in ankle pain VAS scores between different timepoints before and after the treatment,in other words,there was time effect(F=569.721,P=0.000).The ankle pain VAS scores presented a time-dependent decreasing trend in the 2 groups,while the 2 groups were inconsistent with each other in the decreasing trend of ankle pain VAS scores(6.60+/-1.06,3.51+/-0.75,2.19+/-0.74,0.91+/-0.88 points,F=387.163,P=0.000; 6.58+/-1.01,4.15+/-0.85,3.04+/-0.80,2.38+/-0.98 points,F=203.139,P=0.000).There was no statistical difference in ankle pain VAS scores between the 2 groups before treatment(t=0.054,P=0.957).The ankle pain VAS scores were lower in group A compared to group B at 1,3 and 7 days after the beginning of the treatment(t=-4.292,P=0.000; t=-5.378,P=0.000; t=-6.689,P=0.000).After 2-week treatment,35 patients obtained an excellent result,10 good and 2 fair in group A; while 20 patients obtained an excellent result,19 good and 9 fair in group B.The group A surpassed the group B in the total clinical curative effects(Z=-3.346,P=0.001).The mild allergic reaction was found in 2 patients in group A and 1 patient in group B,and the symptoms disappeared after GS and diclofenac diethylamine emulgel were withdrawed and no special treatment were performed.There was no statistical difference in complication incidences between the 2 groups(χ2=0.366,P=0.545).Conclusion:External application of GS can relieve ankle pain and remove ankle swelling and ecchymoses in the treatment of qi-stagnation-blood-stasis-type acute ankle sprain,and it has less complications,moreover,it surpasses external application of diclofenac diethylamine emulgel in the clinical curative effect.

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備注/Memo:
通訊作者:吳昭克 E-mail:[email protected] (收稿日期:2018-08-20 本文編輯:時紅磊) 本文第一作者為福建中醫(yī)藥大學在讀碩士研究生
更新日期/Last Update: 2019-05-30