[1]张柳,谢庆祥,李泳聪,等.火龙罐联合距下关节制动术治疗柔性平足症合并跟腱挛缩的临床研究[J].中医正骨,2025,37(11):10-19.
　ZHANG Liu,XIE Qingxiang,LI Yongcong,et al.Fire dragon cupping therapy combined with subtalar arthroereisis for treatment of flexible flatfoot complicated with achilles tendon contracture:a clinical study[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2025,37(11):10-19.
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火龙罐联合距下关节制动术治疗柔性平足症合并跟腱挛缩的临床研究()

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第37卷
期数:
2025年11期
页码:
10-19
栏目:
临床研究
出版日期:
2025-11-20

文章信息/Info

Title:
Fire dragon cupping therapy combined with subtalar arthroereisis for treatment of flexible flatfoot complicated with achilles tendon contracture:a clinical study
作者:
张柳; 谢庆祥; 李泳聪; 苏博源; 曾广龙
广州中医药大学东莞医院,广东 东莞 523000
Author(s):
ZHANG Liu; XIE Qingxiang; LI Yongcong; SU Boyuan; ZENG Guanglong
Dongguan Hospital,Guangzhou University of Chinese Medicine,Dongguan 523000,Guangdong,China
关键词:
扁平足;  跟腱;  挛缩;  火龙罐;  肌腱切断术;  距下关节制动术;  随机对照试验专题
Keywords:
flatfoot;  achilles tendon;  contracture;  fire dragon jar;  tenotomy;  subtalar joint arthroereisis;  randomized controlled trials as topic
摘要:
目的:探讨火龙罐联合距下关节制动术治疗柔性平足症合并跟腱挛缩的临床疗效和安全性。方法:将2023年7月至2025年2月收治的72例柔性平足症合并跟腱挛缩患者随机分为2组,每组36例,分别采用火龙罐联合距下关节制动术治疗(火龙罐组)和跟腱松解术联合距下关节制动术治疗(跟腱松解组)。火龙罐组在距下关节制动术后第1天开始火龙罐治疗,每次治疗35 min,隔天治疗1次,7 d为1个疗程,共4个疗程。分别于术前及术后3个月、6个月、12个月,记录并比较2组患者的足踝部疼痛视觉模拟量表(visual analogue scale,VAS)评分、美国足与踝关节协会(American Orthopedic Foot and Ankle Society,AOFAS)踝与后足评分及简明健康状况调查表(short form 36 health survey questionnaire,SF-36)评分; 分别于术前及术后12个月,测量并比较2组患者的跟骨倾斜角、距骨-第1跖骨角、距舟覆盖角、踝关节外翻角度、踝关节背伸活动度、踝关节背伸峰值力矩、步态时间、步长及双支撑期; 观察并比较2组患者的并发症发生情况。结果:①足踝部疼痛VAS评分。2组足踝部疼痛VAS评分随时间变化均呈下降趋势(F=995.560,P=0.000; F=873.277,P=0.000); 术后3个月、6个月,火龙罐组足踝部疼痛VAS评分均低于跟腱松解组(t=-9.917,P=0.000; t=-6.609,P=0.000)。②AOFAS踝与后足评分。手术前后AOFAS踝与后足评分总体随时间呈上升趋势(F=846.986,P=0.000); 火龙罐组AOFAS踝与后足评分高于跟腱松解组(F=8.378,P=0.004)。③SF-36评分。2组SF-36评分随时间变化均呈上升趋势(F=398.198,P=0.000; F=372.795,P=0.000); 术后3个月,火龙罐组SF-36评分高于跟腱松解组(t=12.401,P=0.000)。④影像学指标。术后12个月,2组跟骨倾斜角均大于术前(t=-38.292,P=0.000; t=-32.414,P=0.000),距骨-第1跖骨角及距舟覆盖角均小于术前(t=-41.976,P=0.000; t=-30.378,P=0.000; t=-18.481,P=0.000; t=-12.777,P=0.000),火龙罐组跟骨倾斜角大于跟腱松解组(t=2.588,P=0.012)、距骨-第1跖骨角及距舟覆盖角均小于跟腱松解组(t=-6.128,P=0.000; t=-3.115,P=0.002)。⑤生物力学参数。术后12个月,2组踝关节外翻角度均小于术前(t=8.642,P=0.000; t=4.890,P=0.000),踝关节背伸活动度均大于术前(t=-6.372,P=0.000; t=-13.711,P=0.000),步长均大于术前(t=-50.300,P=0.000; t=-41.169,P=0.000),双支撑期均短于术前(t=17.482,P=0.000; t=4.808,P=0.000); 火龙罐组踝关节背伸峰值力矩小于术前(t=71.900,P=0.000),跟腱松解组背伸峰值力矩与术前的差异无统计学意义(t=0.058,P=0.954); 火龙罐组步态时间短于术前(t=8.110,P=0.000),跟腱松解组步态时间长于术前(t=-12.161,P=0.000); 火龙罐组踝关节外翻角度和踝关节背伸活动度均小于跟腱松解组(t=-1.346,P=0.043; t=-4.853,P=0.000),步长大于跟腱松解组(t=1.503,P=0.014),双支撑期短于跟腱松解组(t=-1.795,P=0.016),踝关节背伸峰值力矩和步态时间与跟腱松解组的组间差异均无统计学意义(t=-4.302,P=0.284; t=-0.158,P=0.907)。⑥安全性。2组患者的并发症发生率比较,差异无统计学意义(χ2=0.633,P=0.426)。结论:火龙罐联合距下关节制动术治疗柔性平足症合并跟腱挛缩,可有效矫正足部畸形、缓解足踝部疼痛、改善步态和足踝部功能、提高患者生活质量,疗效优于跟腱松解术联合距下关节制动术,但在增加踝关节背伸活动度方面疗效不及跟腱松解术联合距下关节制动术,二者在恢复患者基本步行功能、消除足踝部异常生物力学负荷及安全性方面相当。
Abstract:
Objective:To investigate the clinical efficacy and safety of fire dragon cupping therapy combined with subtalar arthroereisis in treatment of flexible flatfoot complicated with achilles tendon contracture.Methods:Seventy-two patients diagnosed with flexible flatfoot and achilles tendon contracture,admitted from July 2023 to February 2025,were randomized into 2 groups,with 36 ones in each group.The patients were treated with fire dragon cupping therapy combined with subtalar arthroereisis(fire dragon cupping group)and achilles tendon release combined with subtalar arthroereisis(achilles tendon release group),respectively.On the first day following the subtalar arthroerei-sis,the fire dragon cupping was performed on patients at the affected parts once every other day,35 minutes at a time for consecutive 4 courses of treatment,7 days for each course.The foot-ankle pain visual analogue scale(VAS)score,the American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot score,and the short form 36 health survey questionnaire(SF-36)score were recorded and compared between the 2 groups before the procedure,at 3,6 and 12-month post-procedure.Furthermore,the radiographic parameters,e.g.,calcaneal pitch angle,talus-first metatarsal angle,talonavicular coverage angle,and the biomechanical parameters,e.g.,ankle valgus angle,ankle dorsal extension range of motion(ROM),peak torque for ankle dorsal extension,gait time,step length,double support phase,were measured and compared between the 2 groups before the procedure and at 12-month post-procedure,and the complications were also monitored and compared between the 2 groups.Results:①The foot-ankle pain VAS score.The foot-ankle pain VAS score presented a gradual decreasing tra-jectory over time in the 2 group(F=995.560,P=0.000; F=873.277,P=0.000).In addition,the foot-ankle pain VAS score was lower in fire dragon cupping group compared to achilles tendon release group at 3- and 6-month post-procedure(t=-9.917,P=0.000; t=-6.609,P=0.000).②The AOFAS ankle-hindfoot score.The AOFAS ankle-hindfoot score presented a gradual increasing trajectory over time in the 2 group before and after the procedure(F=846.986,P=0.000),and the AOFAS ankle-hindfoot score was higher in fire dragon cupping group compared to achilles tendon release group(F=8.378,P=0.004).③The SF-36 score.The SF-36 score presented a gradual increasing trajectory over time in the 2 group(F=398.198,P=0.000; F=372.795,P=0.000).In addition,the SF-36 score was higher in fire dragon cupping group compared to achilles tendon release group at 3-month post-procedure(t=12.401,P=0.000).④The radiographic parameters.The 2 groups showed significant improvements in all radiographic parameters at 12-month post-procedure compared to pre-procedure values(t=-38.292,P=0.000; t=-32.414,P=0.000; t=-41.976,P=0.000; t=-30.378,P=0.000; t=-18.481,P=0.000; t=-12.777,P=0.000).In addition,the calcaneal pitch angle was greater,the talus-first metatarsal angle,as well as talonavicular coverage angle,was smaller in fire dragon cupping group compared to achilles tendon release group(t=2.588,P=0.012; t=-6.128,P=0.000; t=-3.115,P=0.002).⑤The biomechanical parameters.The 2 groups showed significant improvements in the biomechanical parameters,such as ankle valgus angle,ankle dorsal extension ROM,step length,and double support phase,at 12-month post-procedure compared to pre-procedure values(t=8.642,P=0.000; t=4.890,P=0.000; t=-6.372,P=0.000; t=-13.711,P=0.000; t=-50.300,P=0.000; t=-41.169,P=0.000; t=17.482,P=0.000; t=4.808,P=0.000).The peak torque for ankle dorsal extension decreased in fire dragon cupping group at 12-month post-procedure compared to pre-procedure value(t=71.900,P=0.000),whereas the change in the achilles tendon release group was not significant(t=0.058,P=0.954).The gait time was shorter in fire dragon cupping group,while longer in achilles tendon release group at 12-month post-procedure compared to pre-procedure value(t=8.110,P=0.000; t=-12.161,P=0.000).In addition,the ankle valgus angle and ankle dorsal extension ROM were smaller,the step length was greater,and the double support phase was shorter in fire dragon cupping group compared to achilles tendon release group(t=-1.346,P=0.043; t=-4.853,P=0.000; t=1.503,P=0.014; t=-1.795,P=0.016),while the peak torque for ankle dorsal extension and gait time were not significantly different between the 2 groups at 12-month post-procedure(t=-4.302,P=0.284; t=-0.158,P=0.907).⑥Safety.The incidence of complications was comparable between the 2 groups(χ2=0.633,P=0.426).Conclusion:Fire dragon cupping therapy combined with subtalar arthroereisis can effectively correct the foot deformity,alleviate the foot-ankle pain,improve the gait and foot-ankle function,and enhance the patients' quality of life in treatment of flexible flatfoot complicated with achilles tendon contracture,its therapeutic efficacy is superior to that of achilles tendon release combined with subtalar arthroereisis.However,it is less effective than the latter in increasing ankle dorsal extension ROM.The two approaches are comparable in restoring basic walking function,eliminating abnormal biomechanical loads on the foot and ankle,as well as safety.

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中医正骨2025年11月第37卷第11期 J Trad Chin Orthop Trauma,2025,Vol.37,No.11(总819)
(总820)中医正骨2025年11月第37卷第11期 J Trad Chin Orthop Trauma,2025,Vol.37,No.11
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备注/Memo

备注/Memo:
基金项目:广东省医学科学技术研究基金项目(A2023480); 广东省中医药局科研项目(20241341); 东莞市社会发展科技项目(20231800900211)
通讯作者:曾广龙 E-mail:185858974@qq.com
更新日期/Last Update: 1900-01-01