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%,χ^(2)=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。
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%,χ^(2)=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.
作者
赵廷虎
陈汉鑫
李彦
白云波
贾斌
郑伟浩
王波
ZHAO Tinghu;CHEN Hanxin;LI Yan;BAI Yunbo;JIA Bin;ZHENG Weihao;WANG Bo(Shenzhen Pingle Orthopedic Hospital,Shenzhen 518122,Guangdong China)
出处
《中国中医骨伤科杂志》
CAS
2024年第1期25-30,共6页
Chinese Journal of Traditional Medical Traumatology & Orthopedics
基金
广东省中医药局科研项目(20201353)。
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
Pingle Guo's massage tendon manipulation
chronic lateral ankle instability
rehabilitation exercise
pain
swelling
talus inclination angle
