[1]俞益火,谢嫚花,周文军,等.中医理筋正骨手法治疗慢性踝关节损伤的临床研究[J].中医正骨,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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中医理筋正骨手法治疗慢性踝关节损伤的临床研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第31卷
期数:
2019年03期
页码:
20-27
栏目:
临床研究
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; 谢嫚花1; 周文军1; 朱玲玲2; 姜鑫3
(1.永康市中医院,浙江 永康 321300; 2.杭州市富阳中医骨伤医院,浙江 杭州 311400; 3.上海交通大学医学院附属第九人民医院,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
关键词:
踝损伤;  踝关节;  正骨疗法;  肌肉骨骼手法;  物理治疗技术;  关节松动术;  功能锻炼;  临床试验
Keywords:
ankle injuries;  ankle joint;  bone setting;  musculoskeletal manipulations;  physical therapy modalities;  joint mobilization;  functional exercise;  clinical trial
摘要:
目的:观察中医理筋正骨手法在慢性踝关节损伤治疗中的作用。方法:将53例单侧慢性踝关节损伤患者随机分为2组,26例采用物理因子疗法联合Kaltenborn关节松动术和功能锻炼治疗(常规康复组),27例在此基础上增加中医理筋正骨手法治疗(联合组)。物理因子疗法隔天1次,连续治疗1个月; Kaltenborn关节松动术隔天1次,每次约20 min,连续治疗1个月; 功能锻炼每天1～2次,连续1个月; 中医理筋正骨手法隔天1次,每次约10 min,连续治疗1个月。分别于治疗前及治疗结束后比较2组患者踝关节疼痛视觉模拟量表(visual analogue scale,VAS)评分、美国足与踝关节协会(American Orthopedic Foot and Ankle Society,AOFAS)踝与后足功能评分、踝关节肿胀值以及踝关节主被动背伸、跖屈、内翻、外翻活动度,并于治疗结束后比较2组患者的综合疗效。结果:①踝关节疼痛VAS评分。治疗前2组患者踝关节疼痛VAS评分比较,差异无统计学意义(t=0.154,P=0.801); 治疗结束后,2组患者踝关节疼痛VAS评分均低于治疗前[联合组:(4.20±0.72)分,(1.01±0.31)分,t=5.087,P=0.001; 常规康复组:(4.32±0.55)分,(1.76±1.27)分,t=4.162,P=0.001],联合组踝关节疼痛VAS评分低于常规康复组(t=10.051,P=0.001)。②AOFAS踝与后足功能评分。治疗前2组患者AOFAS踝与后足功能评分比较,差异无统计学意义(t=0.621,P=0.418); 治疗结束后,2组患者AOFAS踝与后足功能评分均高于治疗前[联合组:(49.56±12.11)分,(77.25±5.44)分,t=8.141,P=0.001; 常规康复组:(48.97±13.22)分,(63.65±6.26)分,t=7.924,P=0.001],联合组AOFAS踝与后足功能评分高于常规康复组(t=14.632,P=0.001)。③踝关节肿胀值。治疗前2组患者踝关节肿胀值比较,差异无统计学意义(t=0.073,P=0.946); 治疗结束后,2组患者踝关节肿胀值均小于治疗前[联合组:(1.12±1.88)cm,(0.47±0.26)cm,t=3.412,P=0.001; 常规康复组:(1.16±2.01)cm,(0.60±0.12)cm,t=3.071,P=0.001],联合组踝关节肿胀值小于常规康复组(t=0.031,P=0.985)。④踝关节活动度。治疗前2组患者踝关节主被动背伸、跖屈、内翻、外翻活动度比较,组间差异均无统计学意义(踝关节主动活动度: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。踝关节被动活动度: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)。治疗结束后,联合组踝关节主被动背伸、跖屈、内翻、外翻活动度均大于常规康复组(踝关节主动活动度: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。踝关节被动活动度: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综合疗效。治疗结束后,联合组治愈13例、显效6例、有效6例、无效2例,常规康复组治愈10例、显效5例、有效7例、无效4例; 2组患者综合疗效比较,差异无统计学意义(Z=1.221,P=0.748)。结论:采用中医理筋正骨手法治疗慢性踝关节损伤,有助于缓解踝关节肿胀和疼痛,改善踝关节活动度,促进踝关节功能恢复,疗效确切。
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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备注/Memo

备注/Memo:
通讯作者:周文军 E-mail:2623733310@qq.com(收稿日期:2018-11-24 本文编辑:时红磊)
更新日期/Last Update: 2019-03-30