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[1]俞益火,謝嫚花,周文軍,等.中醫(yī)理筋正骨手法治療慢性踝關(guān)節(jié)損傷的臨床研究[J].中醫(yī)正骨,2019,31(03):20-27.
　YU Yihuo,XIE Manhua,ZHOU Wenjun,et al.A clinical study of TCM sinew-adjusting and bone-setting manipulation for treatment of chronic ankle injury[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(03):20-27.
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中醫(yī)理筋正骨手法治療慢性踝關(guān)節(jié)損傷的臨床研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第31卷
期數(shù):
2019年03期
頁(yè)碼:
20-27
欄目:
臨床研究
出版日期:
2019-03-20

文章信息/Info

Title:
A clinical study of TCM sinew-adjusting and bone-setting manipulation for treatment of chronic ankle injury
作者:
俞益火1; 謝嫚花1; 周文軍1; 朱玲玲2; 姜鑫3
(1.永康市中醫(yī)院,浙江 永康 321300; 2.杭州市富陽(yáng)中醫(yī)骨傷醫(yī)院,浙江 杭州 311400; 3.上海交通大學(xué)醫(yī)學(xué)院附屬第九人民醫(yī)院,上海 200011)
Author(s):
YU Yihuo1; XIE Manhua1; ZHOU Wenjun1; ZHU Lingling2; JIANG Xin3
1.Yongkang Hospital of Traditional Chinese Medicine,Yongkang 321300,Zhejiang,China 2.Fuyang TCM Orthopedic-Traumatological Hospital,Hangzhou 311400,Zhejiang,China 3.The ninth People's Hospital Affiliated to Medical College of Shanghai Jiao Tong University,Shanghai 200011,China
關(guān)鍵詞:
踝損傷;  踝關(guān)節(jié);  正骨療法;  肌肉骨骼手法;  物理治療技術(shù);  關(guān)節(jié)松動(dòng)術(shù);  功能鍛煉;  臨床試驗(yàn)
Keywords:
ankle injuries;  ankle joint;  bone setting;  musculoskeletal manipulations;  physical therapy modalities;  joint mobilization;  functional exercise;  clinical trial
摘要:
目的:觀察中醫(yī)理筋正骨手法在慢性踝關(guān)節(jié)損傷治療中的作用。方法:將53例單側(cè)慢性踝關(guān)節(jié)損傷患者隨機(jī)分為2組,26例采用物理因子療法聯(lián)合Kaltenborn關(guān)節(jié)松動(dòng)術(shù)和功能鍛煉治療(常規(guī)康復(fù)組),27例在此基礎(chǔ)上增加中醫(yī)理筋正骨手法治療(聯(lián)合組)。物理因子療法隔天1次,連續(xù)治療1個(gè)月; Kaltenborn關(guān)節(jié)松動(dòng)術(shù)隔天1次,每次約20 min,連續(xù)治療1個(gè)月; 功能鍛煉每天1～2次,連續(xù)1個(gè)月; 中醫(yī)理筋正骨手法隔天1次,每次約10 min,連續(xù)治療1個(gè)月。分別于治療前及治療結(jié)束后比較2組患者踝關(guān)節(jié)疼痛視覺(jué)模擬量表(visual analogue scale,VAS)評(píng)分、美國(guó)足與踝關(guān)節(jié)協(xié)會(huì)(American Orthopedic Foot and Ankle Society,AOFAS)踝與后足功能評(píng)分、踝關(guān)節(jié)腫脹值以及踝關(guān)節(jié)主被動(dòng)背伸、跖屈、內(nèi)翻、外翻活動(dòng)度,并于治療結(jié)束后比較2組患者的綜合療效。結(jié)果:①踝關(guān)節(jié)疼痛VAS評(píng)分。治療前2組患者踝關(guān)節(jié)疼痛VAS評(píng)分比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(t=0.154,P=0.801); 治療結(jié)束后,2組患者踝關(guān)節(jié)疼痛VAS評(píng)分均低于治療前[聯(lián)合組:(4.20±0.72)分,(1.01±0.31)分,t=5.087,P=0.001; 常規(guī)康復(fù)組:(4.32±0.55)分,(1.76±1.27)分,t=4.162,P=0.001],聯(lián)合組踝關(guān)節(jié)疼痛VAS評(píng)分低于常規(guī)康復(fù)組(t=10.051,P=0.001)。②AOFAS踝與后足功能評(píng)分。治療前2組患者AOFAS踝與后足功能評(píng)分比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(t=0.621,P=0.418); 治療結(jié)束后,2組患者AOFAS踝與后足功能評(píng)分均高于治療前[聯(lián)合組:(49.56±12.11)分,(77.25±5.44)分,t=8.141,P=0.001; 常規(guī)康復(fù)組:(48.97±13.22)分,(63.65±6.26)分,t=7.924,P=0.001],聯(lián)合組AOFAS踝與后足功能評(píng)分高于常規(guī)康復(fù)組(t=14.632,P=0.001)。③踝關(guān)節(jié)腫脹值。治療前2組患者踝關(guān)節(jié)腫脹值比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(t=0.073,P=0.946); 治療結(jié)束后,2組患者踝關(guān)節(jié)腫脹值均小于治療前[聯(lián)合組:(1.12±1.88)cm,(0.47±0.26)cm,t=3.412,P=0.001; 常規(guī)康復(fù)組:(1.16±2.01)cm,(0.60±0.12)cm,t=3.071,P=0.001],聯(lián)合組踝關(guān)節(jié)腫脹值小于常規(guī)康復(fù)組(t=0.031,P=0.985)。④踝關(guān)節(jié)活動(dòng)度。治療前2組患者踝關(guān)節(jié)主被動(dòng)背伸、跖屈、內(nèi)翻、外翻活動(dòng)度比較,組間差異均無(wú)統(tǒng)計(jì)學(xué)意義(踝關(guān)節(jié)主動(dòng)活動(dòng)度:9.60°±4.26°,9.56°±4.37°,t=-0.112,P=0.898; 14.21°±5.37°,14.16°±5.33°,t=-0.018,P=0.988; 15.77°±4.32°,15.83°±4.10°,t=0.016,P=0.989; 8.01°±4.32°,8.11°±3.31°,t=0.019,P=0.987。踝關(guān)節(jié)被動(dòng)活動(dòng)度:14.01°±6.22°,13.64°±6.17°,t=-0.632,P=0.528; 25.12°±10.12°,25.43°±10.02°,t=0.197,P=0.846; 18.07°±7.25°,19.10°±7.38°,t=0.392,P=0.695; 11.57°±6.13°,11.25°±6.09°,t=-0.200,P=0.842)。治療結(jié)束后,聯(lián)合組踝關(guān)節(jié)主被動(dòng)背伸、跖屈、內(nèi)翻、外翻活動(dòng)度均大于常規(guī)康復(fù)組(踝關(guān)節(jié)主動(dòng)活動(dòng)度:16.20°±4.88°,12.95°±4.02°,t=-3.057,P=0.003; 28.61°±9.63°,20.21°±8.76°,t=-5.932,P=0.001; 21.51°±7.50°,18.51°±6.22°,t=2.097,P=0.035; 11.45°±5.41°,9.01°±5.17°,t=-2.640,P=0.011。踝關(guān)節(jié)被動(dòng)活動(dòng)度:18.50°±6.71°,16.44°±5.96°,t=-2.104,P=0.034; 38.72°±12.82°,32.27°±10.80°,t=-4.527,P=0.001; 23.43°±8.11°,20.43°±6.78°,t=2.920,P=0.005; 14.55°±7.01°,12.77°±8.13°,t=-2.640,P=0.001)。⑤綜合療效。治療結(jié)束后,聯(lián)合組治愈13例、顯效6例、有效6例、無(wú)效2例,常規(guī)康復(fù)組治愈10例、顯效5例、有效7例、無(wú)效4例; 2組患者綜合療效比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(Z=1.221,P=0.748)。結(jié)論:采用中醫(yī)理筋正骨手法治療慢性踝關(guān)節(jié)損傷,有助于緩解踝關(guān)節(jié)腫脹和疼痛,改善踝關(guān)節(jié)活動(dòng)度,促進(jìn)踝關(guān)節(jié)功能恢復(fù),療效確切。
Abstract:
Objective:To observe the clinical curative effects of TCM sinew-adjusting and bone-setting manipulation in treatment of chronic ankle injury.Methods:Fifty-three patients with chronic unilateral ankle injuries were randomly divided into 2 groups,26 cases in conventional rehabilitation group and 27 cases in combination therapy group.All patients in the 2 groups were treated with physical factors therapy combined with Kaltenborn joint mobilization and functional exercises,moreover,the patients in combination therapy group were treated with TCM sinew-adjusting and bone-setting manipulation.The physical factors therapy was performed on alternate days for consecutive one month.The Kaltenborn joint mobilization was performed on alternate days,20 minutes at a time for consecutive one month.The functional exercises were performed 1-2 times a day for consecutive one month.The TCM sinew-adjusting and bone-setting manipulation was performed on alternate days,10 minutes at a time for consecutive one month.The ankle pain visual analogue scale(VAS)scores,American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot function scores,ankle swelling value and range of motion(ROM)of ankle(including active and passive dorsal extension,plantar flexion,inversion and eversion)were recorded and compared between the 2 groups before the treatment and after the end of the treatment respectively,and the total clinical curative effects were compared between the 2 groups after the end of the treatment.Results:There was no statistical difference in ankle pain VAS scores between the 2 groups before the treatment(t=0.154,P=0.801).The ankle pain VAS scores were lower after the end of the treatment compared to pre-treatment(combination therapy group:4.20+/-0.72 vs 1.01+/-0.31 points,t=5.087,P=0.001; conventional rehabilitation group:4.32+/-0.55 vs 1.76+/-1.27 points,t=4.162,P=0.001),and the ankle pain VAS scores were lower in combination therapy group compared to conventional rehabilitation group(t=10.051,P=0.001).There was no statistical difference in AOFAS ankle-hindfoot function scores between the 2 groups before the treatment(t=0.621,P=0.418).The AOFAS ankle-hindfoot function scores were higher after the end of the treatment compared to pre-treatment(combination therapy group:49.56+/-12.11 vs 77.25+/-5.44 points,t=8.141,P=0.001; conventional rehabilitation group:48.97+/-13.22 vs 63.65+/-6.26 points,t=7.924,P=0.001),and the AOFAS ankle-hindfoot function scores were higher in combination therapy group compared to conventional rehabilitation group(t=14.632,P=0.001).There was no statistical difference in ankle swelling value between the 2 groups before the treatment(t=0.073,P=0.946).The ankle swelling value was smaller after the end of the treatment compared to pre-treatment(combination therapy group:1.12+/-1.88 vs 0.47+/-0.26 cm,t=3.412,P=0.001; conventional rehabilitation group:1.16+/-2.01 vs 0.60+/-0.12 cm,t=3.071,P=0.001),and the ankle swelling value was smaller in combination therapy group compared to conventional rehabilitation group(t=0.031,P=0.985).There was no statistical difference in the ROM of ankle(including active and passive dorsal extension,plantar flexion,inversion and eversion)between the 2 groups before the treatment(active ROM of ankle:9.60+/-4.26 vs 9.56+/-4.37 degrees,t=-0.112,P=0.898; 14.21+/-5.37 vs 14.16+/-5.33 degrees,t=-0.018,P=0.988; 15.77+/-4.32 vs 15.83+/-4.10 degrees,t=0.016,P=0.989; 8.01+/-4.32 vs 8.11+/-3.31 degrees,t=0.019,P=0.987; passive ROM of ankle:14.01+/-6.22 vs 13.64+/-6.17 degrees,t=-0.632,P=0.528; 25.12+/-10.12 vs 25.43+/-10.02 degrees,t=0.197,P=0.846; 18.07+/-7.25 vs 19.10+/-7.38 degrees,t=0.392,P=0.695; 11.57+/-6.13 vs 11.25+/-6.09 degrees,t=-0.200,P=0.842).The ROM of ankle(including active and passive dorsal extension,plantar flexion,inversion and eversion)was greater in combination therapy group compared to conventional rehabilitation group after the end of the treatment(active ROM of ankle:16.20+/-4.88 vs 12.95+/-4.02 degrees,t=-3.057,P=0.003; 28.61+/-9.63 vs 20.21+/-8.76 degrees,t=-5.932,P=0.001; 21.51+/-7.50 vs 18.51+/-6.22 degrees,t=2.097,P=0.035; 11.45+/-5.41 vs 9.01+/-5.17 degrees,t=-2.640,P=0.011; passive ROM of ankle:18.50+/-6.71 vs 16.44+/-5.96 degrees,t=-2.104,P=0.034; 38.72+/-12.82 vs 32.27+/-10.80 degrees,t=-4.527,P=0.001; 23.43+/-8.11 vs 20.43+/-6.78 degrees,t=2.920,P=0.005; 14.55+/-7.01 vs 12.77+/-8.13 degrees,t=-2.640,P=0.001).After the end of the treatment,13 patients were cured,6 good,6 fair and 2 poor in combination therapy group; while 10 patients were cured,5 good,7 fair and 4 poor in conventional rehabilitation group.There was no statistical difference in the total clinical curative effects between the 2 groups(Z=1.221,P=0.748).Conclusion:The TCM sinew-adjusting and bone-setting manipulation is helpful to relieving ankle swelling and pain,improving ankle ROM and promoting ankle function recovery with reliable curative effects in the treatment of chronic ankle injury.

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通訊作者:周文軍 E-mail:[email protected](收稿日期:2018-11-24 本文編輯:時(shí)紅磊)
更新日期/Last Update: 2019-03-30