[1]赵廷虎△,陈汉鑫,李彦,等.平乐郭氏推拿理筋手法治疗慢性踝关节外侧不稳定的临床研究[J].中国中医骨伤科杂志,2024,32(01):25-30.[doi:10.20085/j.cnki.issn1005-0205.240105]
　ZHAO Tinghu,CHEN Hanxin,LI Yan,et al.Clinical Study on the Treatment of Chronic Lateral Ankle Instability with Pingle Guo's Massage Tendon Regulating Manipulation[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2024,32(01):25-30.[doi:10.20085/j.cnki.issn1005-0205.240105]
点击复制

平乐郭氏推拿理筋手法治疗慢性踝关节外侧不稳定的临床研究()
分享到：

《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第32卷
期数:
2024年01期
页码:
25-30
栏目:
临床研究
出版日期:
2024-01-15

文章信息/Info

Title:
Clinical Study on the Treatment of Chronic Lateral Ankle Instability with Pingle Guo's Massage Tendon Regulating Manipulation
文章编号:
1005-0205(2024)01-0025-06
作者:
赵廷虎1△; 陈汉鑫1; 李彦1; 白云波1; 贾斌1; 郑伟浩1; 王波1
1深圳平乐骨伤科医院(广东 深圳,518122)
Author(s):
ZHAO Tinghu1△; CHEN Hanxin1; LI Yan1; BAI Yunbo1; JIA Bin1; ZHENG Weihao1; WANG Bo1
1Shenzhen Pingle Orthopedic Hospital,Shenzhen 518122,Guangdong China.
关键词:
平乐郭氏推拿理筋手法;  慢性踝关节外侧不稳定;  康复锻炼;  疼痛;  肿胀;  距骨倾斜角
Keywords:
Pingle Guo's massage tendon manipulation;  chronic lateral ankle instability;  rehabilitation exercise;  pain;  swelling;  talus inclination angle
分类号:
R686.5
DOI:
10.20085/j.cnki.issn1005-0205.240105
文献标志码:
A
摘要:
目的:探讨平乐郭氏推拿理筋手法在慢性踝关节外侧不稳定(CLAI)治疗中的临床应用效果。方法:将随机选取的82例慢性踝关节外侧不稳定患者分为两组,对照组41例患者行踝关节功能康复锻炼治疗,观察组41例患者在此基础上加行平乐郭氏推拿理筋手法治疗。观察两组患者治疗前、1个疗程结束后、治疗后1个月及末次随访踝关节疼痛视觉模拟量表(VAS)评分和踝关节肿胀值,另记录两组患者治疗前和末次随访美国足踝关节协会(AOFAS)评分、距骨倾斜角和踝关节各韧带厚度,评价临床疗效和安全性。结果:1个疗程结束后、治疗后1个月及末次随访时两组患者VAS评分均依次降低,踝关节肿胀值均依次减小,差异有统计学意义(P<0.05); 但观察组与对照组相比以上时间点VAS评分均更低((3.76±0.71)分比(4.14±0.77)分,t=2.279,P=0.025;(2.52±0.58)分比(3.26±0.63)分,t=5.428,P<0.001;(1.84±0.46)分比(2.50±0.52)分,t=5.970,P<0.001),踝关节肿胀值均更小((0.80±0.25)cm比(0.92±0.28)cm,t=2.008,P=0.048;(0.64±0.18)cm比(0.75±0.23)cm,t=2.363,P=0.021;(0.49±0.16)cm比(0.60±0.21)cm,t=2.614,P=0.011)。末次随访时两组患者AOFAS评分均较治疗前升高,距骨倾斜角和关节各韧带厚度较治疗前减小,差异有统计学意义(P<0.05); 但观察组与对照组相比末次随访时AOFAS评分更高((86.59±7.27)分比(77.31±14.54)分,t=3.574,P=0.001),距骨倾斜角更小((4.39±0.76)°比(5.68±1.23)°,t=10.809,P<0.001),关节各韧带厚度更小((4.02±0.51)mm比(4.30±0.53)mm,t=2.393,P=0.019;(2.74±0.40)mm比(2.95±0.42)mm,t=2.276,P=0.026;(2.82±0.25)mm比(2.98±0.27)mm,t=2.731,P=0.008)。观察组患者临床疗效优于对照组(Z=8.023,P=0.018),总有效率高于对照组(92.31%比72.50%,χ2=5.313,P=0.021); 观察组和对照组并发症发生率分别为5.13%和10.00%,差异无统计学意义(P>0.05)。结论:采用平乐郭氏推拿理筋手法治疗慢性踝关节外侧不稳定患者,能在一定程度上缓解踝关节肿胀和疼痛,促进踝关节韧带、角度以及功能恢复,疗效显著且安全性好。
Abstract:
Objective:To explore the clinical efficacy of Pingle Guo's massage tendon regulating manipulation in the treatment of chronic lateral ankle instability(CLAI).Methods:A total of 82 patients with CLAI were randomly divided into two groups,41 patients in the control group were treated with ankle function rehabilitation exercise,and 41 patients in the observation group were treated with Pingle Guo's massage and tendon manipulation on this basis.The visual analogue scale(VAS)score of ankle pain and ankle swelling value at the last follow-up before treatment,after the end of a course of treatment and one month after treatment of the two groups were observed.The American orthopedic foot and ankle society(AOFAS)score,talus inclination angle and the thickness of ankle ligaments before treatment and at the last follow-up were recorded,and clinical efficacy and safety were evaluated.Results:The VAS scores and ankle swelling values of the two groups decreased successively after the end of a course of treatment,1 month after treatment and the last follow-up(P<0.05).However,the VAS scores at the above time points in the observation group were lower((3.76±0.71)points vs(4.14±0.77)points,t=2.279,P=0.025;(2.52±0.58)points vs(3.26±0.63)points,t=5.428,P<0.001;(1.84±0.46)points vs(2.50±0.52)points,t=5.970,P<0.001),and the ankle swelling values were smaller compared with the control group((0.80±0.25)cm vs(0.92±0.28)cm,t=2.008,P=0.048;(0.64±0.18)cm vs(0.75±0.23)cm,t=2.363,P=0.021;(0.49±0.16)cm vs(0.60±0.21)cm,t=2.614,P=0.011).At the last follow-up,the AOFAS score of the two groups was higher than that before treatment,and the talus inclination angle and the thickness of each joint ligament were lower than that before treatment(P<0.05).However,the AOFAS score of the observation group was higher((86.59±7.27)points vs(77.31±14.54)points,t=3.574,P=0.001),and the talus inclination angle was smaller((4.39±0.76)° vs(5.68±1.23)°,t=10.809,P<0.001),and the thickness of each joint ligament was smaller compared with the control group at the last follow-up((4.02±0.51)mm vs(4.30±0.53)mm,t=2.393,P=0.019;(2.74±0.40)mm vs(2.95±0.42)mm,t=2.276,P=0.026;(2.82±0.25)mm vs(2.98±0.27)mm,t=2.731,P=0.008).The clinical efficacy of the observation group was better than that of the control group(Z=8.023,P=0.018),and the total effective rate was higher than that of the control group(92.31% vs 72.50%,χ2=5.313,P=0.021).The incidence of complications in the observation group and the control group were 5.13% and 10.00%,and there was no significant difference(P>0.05).Conclusion:Pingle Guo's massage tendon manipulation in the treatment of patients with CLAI can alleviate ankle swelling and pain to a certain extent,and promote the recovery of ankle ligament,angle and function.The efficacy is significant and the safety is good.

参考文献/References:

[1] GUILLO S,ODAGIRI H,VAN ROOIJ F,et al.All-inside endoscopic anatomic reconstruction leads to satisfactory functional outcomes in patients with chronic ankle instability[J].Knee Surg Sports Traumatol Arthrosc,2021,29(4):1318-1324.
[2] PORTER D A,KAMMAN K A.Chronic lateral ankle instability:open surgical management[J].Foot Ankle Clin,2018,23(4):539-554.
[3] 艾阳平,甘伟,刘维久.平乐正骨手法治疗腰椎间盘突出症的影像学动态评估[J].颈腰痛杂志,2021,42(2):222-223.
[4] 覃伟,雷华平.平乐郭氏正骨理筋法配合中药在桡骨远端骨折患者术后康复中的应用[J].时珍国医国药,2022,33(7):1676-1678.
[5] 国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:193.
[6] 中华医学会骨科学分会足踝外科学组,中国医师协会骨科医师分会足踝外科专业委员会,中国中西医结合学会骨伤科分会足踝专家委员会,等.中国慢性踝关节外侧不稳定术后康复专家共识[J].中华骨与关节外科杂志,2019,12(10):747-753.
[7] 中国中西医结合学会骨伤科分会.外踝韧带损伤的中西医结合治疗专家共识[J].中华骨科杂志,2019,39(11):7-9.
[8] 郭春园.平乐郭氏正骨法[M].郑州:河南人民出版社,1959:32-96.
[9] 郭春园.世医正骨从新[M].北京:首都经济贸易大学出版社,2001:68-127.
[10] KIM S W,JUNG H G,LEE J S.Ligament stabilization improved clinical and radiographic outcomes for individuals with chronic ankle instability and medial ankle osteoarthritis[J].Knee Surg Sports Traumatol Arthrosc,2020,28(10):3294-3300.
[11] LI F,ZHU L,GENG Y,et al.Effect of hip replacement surgery on clinical efficacy,VAS score and Harris hip score in patients with femoral head necrosis[J].Am J Transl Res,2021,13(4):3851-3855.
[12] 卢镇生,郑建河,冯奕鑫.改良Brostrom术联合踝关节镜在踝关节扭伤致慢性踝关节不稳治疗中的应用[J].中国伤残医学,2021,29(6):19-21.
[13] MOK K M,HA S C W,CHAN Z Y S,et al.An inverted ankle joint orientation at foot strike could incite ankle inversion sprain:comparison between injury and non-injured cutting motions of a tennis player[J].Foot(Edinb),2021,48(6):1018-1024.
[14] 史旭,左华,王毓幸,等.踝外侧副韧带损伤对踝关节稳定性及软骨接触应变影响的有限元分析[J].中国组织工程研究,2023,27(31):4926-4931.
[15] 卜天生.五味甘露药浴颗粒联合中医理筋手法对慢性外侧踝关节不稳的临床疗效[J].甘肃医药,2021,40(9):820-821.
[16] 陈张,王晓东,寇智君,等.理筋手法联合探穴针罐法治疗陈旧性踝关节扭伤的临床研究[J].中医正骨,2021,33(3):20-25.
[17] 谢根东,张世明.慢性踝关节外侧不稳定的中医诊治研究[J].现代医药卫生,2020,32(20):3147-3150.
[18] 刘海军,胡皓,汪波.中西医结合康复治疗慢性踝关节不稳定的临床观察[J].中国中医药科技,2020,27(4):639-641.
[19] 柳博文,王宝剑,李建国,等.摇拔戳手法治疗外侧踝关节扭伤的在体力学参数及相关影响因素[J].中国中医骨伤科杂志,2021,29(4):27-31.
[20] ZHAO Y,ZHAO Y Z,YU S D.Clinical efficacy of sticking-needle acupuncture plus tendon-regulating manipulation in the treatment of acute ankle sprain[J].J Acupuncture and Tuina Science,2021,19(6):469-474.
[21] 温海宝,高景华,李建国,等.基于足踝三维有限元模型的摇拔戳手法治疗外侧踝关节扭伤关节面力学分析[J].中医杂志,2022,63(21):2066-2071.

备注/Memo

备注/Memo:
基金项目:广东省中医药局科研项目(20201353)
△通信作者 E-mail:fanye153331@163.com
更新日期/Last Update: 2024-01-15