基于POLICE原则探讨新型支具对急性踝关节扭伤的短期临床疗效观察

发布时间：2018-04-26 22:15

本文选题：新型支具 + 急性踝关节扭伤　；参考：《广州中医药大学》2017年硕士论文

【摘要】：目的:对比支具和石膏固定在急性踝关节扭伤治疗中的运用,基于POLICE原则探讨新型支具对急性踝关节扭伤的短期临床疗效。方法:采用前瞻性对照研究方法。收集受伤在24小时内的急性踝关节扭伤的患者,将患者分为试验组(A)、对照组(B)和空白组(C)三组。试验组(A):就诊后,绷带包扎后予新型支具固定踝关节2～3周,受伤后24小时内予冰敷(每次15～20min,每2小时一次,持续冰敷48～72小时),受伤后3d内以休息、抬高患肢、主动活动脚趾消肿为主,3d后患者可部分负重行走。在疼痛可忍情况下,可室内行走,如疼痛难以忍受,可用拐杖辅助。对照组(B):绷带包扎后予石膏固定踝关节2～3周。受伤后24小时内予冰敷(每次15～20min,每2小时一次,持续冰敷48～72小时),受伤后3d内以抬高患肢、主动活动脚趾消肿为主,石膏固定期间避免负重。固定期间功能锻炼与观察组相同。拆除石膏后在疼痛可忍情况下,可室内行走,如疼痛难以忍受,可用拐杖辅助。空白组(C):绷带包扎后不予其余固定。受伤后24小时内予冰敷(每次15～20min,每2小时一次,持续冰敷48～72小时),受伤后3d内以休息、抬高患肢、主动活动脚趾消肿为主,3d后患者可部分负重行走。在疼痛可忍情况下,可室内行走,如疼痛难以忍受,可用拐杖辅助。接受治疗后3天、1周、2周、4周后分别对各组进行Povacz外侧副韧带疗效评分、Kofoed评分、VAS评分、临床症状体征积分。治疗4周后记录改善率、恢复工作时间及满意度,进行临床疗效综合评价。治疗12周末统计每组并发症发生率。结果:1.治疗1周、2周后,支具组的Povacz外侧副韧带疗效评分、Kofoed评分显著高于石膏组和空白组(P0.01),且支具组临床症状、体征积分显著低于石膏组和空白组(P0.01)。2.在治疗4周后,支具组和石膏组Povacz外侧副韧带疗效评分、Kofoed评分,临床症状体征积分、VAS评分及好转率、治愈率指标无显著统计学差异(P0.05)。但支具组治疗满意度显著高于石膏组和空白组(P0.01),其恢复工作时间明短于石膏组(P0.01),并发症发生率显著低于石膏组和空白组(P0.01)。3.支具组和石膏组在治疗1、2、4周后的相关随访指标普遍优于空白组(P0.05),且空白组3个月内并发症发生率显著高于支具和石膏组(P0.01)。结论:1.基于POLICE原则使用新型支具治疗急性踝关节扭伤,可比石膏固定能更快缓解疼痛、肿胀、改善踝关节功能。2.固定治疗在急性踝关节扭伤治疗中具有积极意义。新型支具的短期临床疗效与石膏相当,但新型支具固定比石膏固定具有更高的治疗满意度,且能缩短病程、降低并发症发生率,新型支具值得临床推广运用。
[Abstract]:Objective: to compare the application of brace and plaster fixation in the treatment of acute ankle sprain, and to explore the short-term clinical effect of new brace on acute ankle sprain based on POLICE principle. Methods: a prospective controlled study was used. The patients with acute ankle sprain within 24 hours were divided into three groups: test group, control group (B) and blank group (C). In the test group, after treatment, bandage bandages were used to fix ankle joint for 2 weeks, ice compress was given within 24 hours after injury (1520min, once every 2 hours, continuous ice compress 4872 hours, rest within 3 days after injury), The patients could walk with partial load after 3 days of active toe detumescence. In the case of pain tolerance, can walk indoors, if the pain is unbearable, can be aided by crutches. In the control group, the ankle joint was fixed with plaster for 2 weeks after bandage. Ice compress was given within 24 hours after injury (15 minutes 20 minutes, once every 2 hours, continuous ice compress 48472 hours, 3 days after the injury by raising the affected limb, active movement of toes to reduce swelling, gypsum fixation period to avoid weight bearing. The functional exercise during the fixed period was the same as that in the observation group. After removing gypsum, you can walk indoors in case of pain. If the pain is unbearable, it can be aided by crutches. Blank group: bandage bandage is not to be fixed after the rest. Ice compress was given within 24 hours after injury (15 minutes, 20 minutes, once every 2 hours, continuous ice compress for 4872 hours). After 3 days of injury, the patients could walk with partial load after rest, raising the affected limbs and removing swelling of the toes. In the case of pain tolerance, can walk indoors, if the pain is unbearable, can be aided by crutches. After 3 days, 1 week and 2 weeks and 4 weeks after treatment, the clinical symptoms and signs of each group were evaluated with Kofoed score and Kofoed score. After 4 weeks of treatment, the improvement rate, working time and satisfaction were recorded, and the clinical efficacy was evaluated. The incidence of complications in each group was calculated at the end of 12 weeks. The result is 1: 1. After 1 week and 2 weeks of treatment, the score of Povacz lateral collateral ligament therapeutic effect in the support group was significantly higher than that in the gypsum group and the blank group (P 0.01), and the clinical symptom and physical sign score in the support group was significantly lower than that in the plaster group and the blank group. After 4 weeks of treatment, there was no significant difference in curative effect score of Povacz lateral collateral ligament and Kofoed score, clinical symptom and sign score, improvement rate and cure rate between support group and gypsum group (P 0.05). However, the treatment satisfaction of the support group was significantly higher than that of the gypsum group and the blank group, and the recovery time was shorter than that of the gypsum group, and the incidence of complications was significantly lower than that of the gypsum group and the blank group. The related follow-up indexes of the two groups were higher than that of the blank group after 4 weeks treatment (P 0.05), and the incidence of complications in the blank group was significantly higher than that in the plaster group and the abutment group within 3 months (P 0.01). Conclusion 1. The treatment of acute ankle sprain with new brace based on POLICE principle can relieve pain and swelling more quickly than plaster fixation and improve ankle function. 2. Fixation therapy has positive significance in the treatment of acute ankle sprain. The short-term clinical efficacy of the new brace is equal to that of gypsum, but the new brace fixation has higher therapeutic satisfaction than gypsum fixation, and can shorten the course of disease and reduce the incidence of complications.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R274.3

【参考文献】