摘要
外踝韧带损伤是四肢关节最常见的韧带损伤。祖国传统医学积累了大量的救治经验,近年来手术治疗外踝韧带损伤也取得长足进步。为提高广大医务工作者,尤其是基层医生的踝关节韧带损伤诊治水平,中国中西医结合学会骨伤科分会组织专家制定了该共识。工作组首先查阅文献,参照WHO《临床指南指定手册》和改良Delphi方法,拟定调查问卷表,100%获得反馈信息,在此基础上形成专家共识初稿,再经两次会议研讨形成最终共识。中医认为踝关节扭伤属“伤筋”范畴,气、血、经络三者瘀滞是主要病机;治疗原则强调筋骨并重、内外兼顾、急慢有别、防治结合、动静相宜,具体包括中药外敷和内服、推拿复位等。西医依据外伤史、局部临床表现、专科查体和影像学检查诊断,术前推荐行踝关节应力位X线摄片和MR检查。急性期多采用保守治疗;对病程3~6个月以上的机械性踝关节不稳,推荐手术治疗;对功能性踝关节不稳,推荐长时间的严格康复训练。手术方式包括韧带修复和韧带重建,但选择依据仍存在争议。
Lateral ankle ligament injury is the most common ligament injury in the extremities.Rich experience about Chinese traditional medicine has been accumulated in treating this injury.Currently,surgical treatment has also made great progress.In order to improve the diagnosis,treatment of the lateral ankle ligament injury,especially in the primary care institutions,the Society of Orthopaedics of the Chinese Association of Integrative Medicine developed the present expert consensus.Literatures in this field were retrieved,reviewed.Expert questionnaire was made according to the WHO Handbook for Guideline Development,modified Delphi method.The feedback rate was100%.Based on the above mentioned results,a preliminary draft of the Expert Consensus was formed.After several rounds of content,the final draft was determined through face-to-face discussion of the experts in two conferences.In the opinion of Chinese medicine,ankle sprain belongs to the category of“injury of the tissues”.The stasis of Qi,blood,meridians are its main pathogenesis.The principle of treatment emphasizes the following aspects,i.e.,the importance of both tissues,bones,the consideration of both internal,external status,the difference between acute,chronic condition,the combination of prevention,treatment,the appropriateness of exercises,rest.The interventions include external,oral application of traditional Chinese medicine,manipulation which aims to reduction,etc.The diagnosis in Western medicine is based on history of trauma,local clinical findings,physical examination,imaging tests.Stress radiographs,MRI of the ankle joints are recommended preoperatively.For acute patients,conservative treatment is often used.For patients with mechanical ankle instability,a course of disease more than3-6months,surgical treatment is recommended.Stricter,longer rehabilitation training is recommended for patients with functional ankle instability.Surgical procedures include ligament repair,reconstruction;however,the choice remains controversial.
作者
中国中西医结合学会骨伤科分会
马信龙
杨柳
Society of Orthopaedics, Chinese Association of Integrative Medicine;Ma Xinlong;Yang Liu
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2019年第11期653-659,共7页
Chinese Journal of Orthopaedics
