手法松解配合中藥薰洗治療創(chuàng)傷性踝關(guān)節(jié)粘連臨床觀察

1、    【摘要】  目的：探討手法松解配合中藥薰洗治療創(chuàng)傷性踝關(guān)節(jié)粘連的臨床療效。方法：將創(chuàng)傷性踝關(guān)節(jié)粘連78例隨機(jī)分為治療組39例，對(duì)照組39例，對(duì)照組常規(guī)康復(fù)治療、治療組手法松解配合中藥薰洗進(jìn)行治療。結(jié)果：治療組主動(dòng)及被動(dòng)背伸、跖屈、內(nèi)收、外展ROM改善情況明顯優(yōu)于對(duì)照組（P0.05或P0.01。治療前后兩組AOFAS踝-后足評(píng)分比較，治療組疼痛、功能評(píng)分改善情況明顯優(yōu)于對(duì)照組（P0.05，治療組總療效優(yōu)于對(duì)照組（P0.05。結(jié)論：手法松解配合中藥薰洗治療創(chuàng)傷性踝關(guān)節(jié)粘連有良好療效，值得臨床上推廣運(yùn)用。 【關(guān)鍵詞】  手法松解 中

2、藥薰洗 創(chuàng)傷性踝關(guān)節(jié)粘連 AOFAS踝-后足評(píng)分系統(tǒng)    【Abstract objective】Reserching and discussing the clinic curative effection of handing practices to releasing combined with steaming of herbs to treat traumatic ankle adhesion.Methods:Deviding 78 patients of traumatic ankle adhesion into 2 groups randomly

3、,each of 39 patients.The comparing group accepted routine method of rehabilitation.The treating group acceptid handing practices to releasing combined with steaming of herbs.Results:The treating groups patientsactive range of motion and passive range of motion were improved statistically better than

4、 the comparing group(P0.05 or P0.01;The two groupsAOFAS were compared before and after the treatment,and the treating groups ache of the ankle and the scores of the function were improved statistically better than the comparing group (p0.05.The whole efficacy of treating group was statistically bett

5、er than the comparing group(P0.05).Conclusion:Handing practices to releasing combined with steaming of herbs to treating traumatic ankle adhesion is effective and it is worth of popularating in clinic.    【Key words】Handing practices to releasing steaming of herbs traumatic ankle adhe

6、sion AOFAS    踝關(guān)節(jié)創(chuàng)傷后進(jìn)行周期性外固定制動(dòng)或手術(shù)切開復(fù)位內(nèi)固定術(shù)均會(huì)造成踝關(guān)節(jié)粘連、功能障礙。我科自2002年起采用手法松解配合中藥薰洗治療創(chuàng)傷性踝關(guān)節(jié)粘連患者多例，取得滿意效果，現(xiàn)報(bào)告如下。    1  資料和方法    1.1  一般資料  自2002年12月2007年5月收治創(chuàng)傷性踝關(guān)節(jié)粘連患者78例。按照隨機(jī)數(shù)字表法按11平均分為2組，治療組39例，男22例，女17例；年齡2174歲，平均35±1.56歲；病程最短19天，最長(zhǎng)45天；損傷類

7、型：脛骨遠(yuǎn)端骨折4例，脛腓骨骨折6例，內(nèi)踝骨折2例，外踝骨折2例，三踝骨折5例，距骨骨折5例，跟骨骨折5例，外側(cè)副韌帶損傷4例，內(nèi)側(cè)副韌帶（三角韌帶）損傷3例，下脛腓韌帶損傷2例，跟腱斷裂1例；其中有內(nèi)固定者20例。對(duì)照組39例，男19例，女20例；年齡3876歲，平均54±1.25歲；病程最短14天，最長(zhǎng)41天；損傷類型：脛骨遠(yuǎn)端骨折5例，脛腓骨骨折5例，內(nèi)踝骨折3例，外踝骨折1例，三踝骨折4例，距骨骨折6例，跟骨骨折4例，外側(cè)副韌帶損傷5例，內(nèi)側(cè)副韌帶（三角韌帶）損傷2例，下脛腓韌帶損傷2例，跟腱斷裂2例；其中有內(nèi)固定者23例。各組患者一般資料經(jīng)統(tǒng)計(jì)學(xué)分析具有可比性（P0.05）

8、。    1.2  治療方法  早期以予以穩(wěn)定牢靠的固定，在傷后3周待外傷炎癥期過后，骨痂開始形成時(shí)進(jìn)行對(duì)照試驗(yàn)。    1.2.1  治療組  采用澳大利亞麥特蘭德（Maitland）級(jí)手法。級(jí)用于關(guān)節(jié)疼痛；級(jí)用于治療關(guān)節(jié)疼痛伴僵硬；級(jí)用于治療周圍組織粘連、攣縮而引起的關(guān)節(jié)活動(dòng)受限。先行踝關(guān)節(jié)附屬運(yùn)動(dòng)（長(zhǎng)軸牽引、前后向滑動(dòng)、后前向滑動(dòng)、上下    滑動(dòng)），再行關(guān)節(jié)被動(dòng)生理運(yùn)動(dòng)（背伸、跖屈、內(nèi)翻、外翻），每日2次，每次2030分鐘。中藥熏洗：川斷20g、伸筋草15g

9、、透骨草15g、穿山甲2g、川烏10g、威靈仙15g、蘇木10g、木瓜10g、路路通10g、三七10g。每劑藥加水20003000ml，煎沸1530min，去渣，倒入盆內(nèi)，先熏蒸，待冷卻至4050時(shí)再以踝部浸入藥液內(nèi)，每日12次，每次30min以上，2天1劑，10天為1個(gè)療程。    1.2.2  對(duì)照組  大功率HeNe激光照射，低、中頻電療，主動(dòng)活動(dòng)為主，沒有醫(yī)生的松動(dòng)手法及中藥薰洗進(jìn)行治療。    以上兩組均在治療前及治療后6周進(jìn)行各項(xiàng)指標(biāo)的評(píng)定。    1.3  觀察

10、方法及療效判斷  關(guān)節(jié)活動(dòng)評(píng)定：利用關(guān)節(jié)角度計(jì)，嚴(yán)格按規(guī)定方法，測(cè)定踝關(guān)節(jié)主動(dòng)活動(dòng)度（active range of motion,AROM）和關(guān)節(jié)被動(dòng)活動(dòng)度（passive range of motion,PROM）。采用按美國(guó)足外科學(xué)協(xié)會(huì)評(píng)分系統(tǒng)（AOFAS踝后足評(píng)分系統(tǒng)）1，評(píng)定踝關(guān)節(jié)功能?？偗熜袛鄻?biāo)準(zhǔn)：臨床痊愈：ROM為健側(cè)的90%以上，AOFAS踝后足總評(píng)分增加90%100%；顯效：ROM為健側(cè)基反應(yīng)70%90%，AOFAS踝后足總評(píng)分增加70%90%；有效：ROM為健側(cè)的30%70%，AOFAS踝后足總評(píng)分增加30%70%；無效：ROM為健側(cè)的30%以下，AOFAS踝后

11、足總評(píng)分增加少于30%。    1.4  統(tǒng)計(jì)學(xué)處理  計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差（x±s）表示，等級(jí)資料用秩和檢驗(yàn)，計(jì)量資料用t檢驗(yàn)，計(jì)數(shù)資料用x2檢驗(yàn)，所有數(shù)據(jù)均在SPSS13.0中處理，以P0.05為判斷標(biāo)準(zhǔn)。-     The paper shows that flavanones are abundant in longan nucleuses. It is significant to make full use of longan necleuses. It has a brillia

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