外踝理筋手法治疗陈旧性踝关节扭伤临床疗效观察

发布时间：2018-06-11 19:23

本文选题：陈旧性踝关节扭伤 + 外踝理筋手法　；参考：《北京中医药大学》2017年硕士论文

【摘要】：研究目的:科学地观察中医正骨手法中外踩理筋手法治疗陈旧性踝关节扭伤的临床疗效,较为客观地评估、验证外踝理筋手法的有效性,以期为陈旧性踝关节扭伤的临床治疗提供参考依据。研究方法:2015年9月至2016年12月,临床收集内收型单侧踝关节扭伤患者74例,最终由66例符合标准并资料完整,其中左侧33例,右侧33例。其中男性29例,女性37例,年龄16～64岁,平均36岁。扭伤到治疗时间最短者4周,最长者14个月,平均6.8个月。所有病例采用单盲法,随机分配至手法治疗组(治疗组)与功能锻炼组(对照组)。治疗组进行外踝理筋手法治疗,具体手法要点是:1,手摸心会,寻找点按筋结;2,手法理筋,行摇、拔、戳手法;3,捋顺脉络,轻捋收工。对照组行功能锻炼治疗,具体包括:1,足背身锻炼;足跖屈锻炼;3,踝关节内翻、外翻锻炼;4,提踵锻炼等。对两组患者治疗前后对疼痛学VAS评分、踝关节肿胀程度、A0FAS的Baird-Jackson踝关节评分、距骨倾斜角测量、PANAS-X具体情绪量表等指标进行监测。研究结果:1.74例患者中66例得到随访,随访时间最短者1个月,最长者6个月,平均4.2个月。2.VAS评分情况:治疗前两组VAS评分差异无统计学意义,具有可比性(p0.05)。治疗后,治疗组组内比较,治疗后较治疗前VAS评分下降,差异有统计学意义(p0.01),对照组组内比较治疗后较治疗前VAS评分下降,差异有统计学意义(p0.01);组间比较治疗组VAS评分降低程度明显优于比对照组(p0.01),差异有统计学意义。3.踝关节肿胀情况:治疗前两组患者的患侧踩关节肿胀情况无统计学差异(p0.05),具有可比性;治疗后两组患者的患侧踝关节肿胀情况无统计学差异(p0.05)。4.A0FAS评分情况:治疗前两组患者的A0FAS评分情况无统计学差异(p0.05);治疗后两组患者组内比较A0FAS评分均较治疗前有升高趋势且均有统计学差异(p0.05),治疗后两组患者组间比较A0FAS评分发现治疗组评分显著高于对照组,差异有统计学意义(p0.05)。5.距骨倾斜角变化情况:治疗前两组患者患侧距骨倾斜角无统计学差异,具有可比性(p0.05);治疗后,治疗组组间治疗前后距骨倾斜角变化无统计学差异(p0.05),对照组组间治疗前后距骨倾斜角变化无统计学差异(p0.05),两组组内比较同样无统计学差异(p0.05)。6.PANAS-X具体情绪量表评分情况:治疗前,两组患者的该评分无统计学差异,具有可比性(p0.05);治疗组组内比较治疗前后发现,正性情绪评分升高,负性情绪评分下降,与治疗前相比有统计学差异(p0.05);对照组组内比较治疗前后发现,正性情绪评分升高,负性情绪评分下降,与治疗前相比有统计学差异(p0.05);组间比较,治疗后对照组正性情绪评分升高较对照组明显,负性情绪评分下降较对照组明显,差异有统计学意义(p0.05)。研究结论:1.外踝理筋手法治疗陈旧性踝关节扭伤在缓解疼痛、改善患者踝关节功能方面临床疗效明显,并且优于目前西医常用的踝关节单纯功能疗法锻炼组。2.外踩理筋手法和踝关节功能疗法锻炼均不能改善踝关节的解剖关系,所以对于功能性踝关节不稳定疗效明显,对于机械性踩关节不稳定治疗效果一般。3.治疗组和对照组对改善踝关节肿胀程度无显著性差异。4.外踝理筋手法和功能锻炼治疗陈旧性踝关节扭伤再改善症状的同时,均对患者的情绪有积极作用,但是中医手法治疗组效果明显优于功能锻炼对照组。
[Abstract]:Objective: To observe the clinical effect of traditional Chinese medicine Orthopedic manipulation on old ankle sprain in the treatment of old ankle sprain, objectively evaluate and verify the effectiveness of the external malleolus manipulation in order to provide reference for the clinical treatment of old ankle sprains. Research methods: from September 2015 to December 2016, the clinical collection was collected. There were 74 cases of unilateral ankle sprain in 66 cases, of which 33 were in the left and 33 in the right, including 29 men, 37 women, 16~64 years old and 36 years. The shortest treatment time was 4 weeks, the longest was 14 months, averaging 6.8 months. The treatment group and the functional exercise group (control group). The treatment group was treated with the external malleolus manipulation, the main points were as follows: 1, hand touch the heart, looking for the points according to the tendons; 2, the manipulation of tendons, shaking, pulling, stamping techniques; 3, smoothing the chores, smoothing the work. The control group was treated with functional exercise treatment, including 1, foot back exercise, foot flexion exercise; 3, ankle varus valgus, valgus ankle joint varus, ankle joint varus, valgus Exercise; 4, heel exercise, and so on. Before and after treatment, the VAS score of pain learning, the degree of swelling of the ankle joint, the Baird-Jackson ankle joint score of A0FAS, the measurement of the talus inclination angle and the PANAS-X specific emotional scale were monitored. The results of the study were that 66 cases of the 1.74 patients were followed up for 1 months and the longest was 6 months. All 4.2 months.2.VAS score: before treatment, there was no statistical difference between the two groups before treatment (P0.05). After treatment, the treatment group was compared with the VAS score before treatment, and the difference was statistically significant (P0.01), compared with the VAS score before treatment in the control group, the difference was statistically significant (P0.01). The degree of VAS score reduction in the comparison group was significantly better than that of the control group (P0.01), and the difference was statistically significant.3. swelling of the ankle joint: there was no statistical difference between the two groups of patients before the treatment (P0.05), and the swelling of the ankle joint was not statistically different (P0.05).4.A0FAS after treatment. Score: the A0FAS score of the two groups before treatment was not statistically significant (P0.05); after treatment, the A0FAS scores in the two groups were all higher than before the treatment and were statistically different (P0.05). After the treatment, the two groups of patients compared with the A0FAS score found that the treatment group was significantly higher than the control group, the difference was statistically significant (P 0.05) the change of the talus inclination angle of.5.: there was no statistical difference between the two groups before treatment, and the talus angle was comparable (P0.05). After treatment, there was no statistical difference between the treatment group before and after treatment (P0.05), and there was no statistical difference between the control group before and after treatment (P0.05), and the same in the two groups was the same. There was no statistical difference (P0.05).6.PANAS-X specific emotional scale score: before treatment, there was no statistical difference between the two groups, and there was a comparability (P0.05). In the treatment group, the positive emotion score increased and the negative emotion score decreased before and after the treatment in the treatment group. Compared with the pre treatment group, there was a statistically significant difference (P0.05), and the comparison group was compared with the control group. Compared with the control group, the positive emotion score of the control group was significantly higher than that of the control group, and the negative emotion score was significantly lower than the control group, and the difference was statistically significant (P0.05). The study conclusion: 1. the 1. lateral malleolus manipulation method. The treatment of old ankle sprain in alleviating pain and improving the function of ankle joint is obvious, and it is superior to the common ankle joint function therapy exercise group in western medicine, which can not improve the anatomical relationship between the ankle joint and the ankle joint function exercise.2., so it is unstable for the functional ankle joint. The curative effect is obvious. There is no significant difference between the.3. treatment group and the control group for the improvement of the ankle joint swelling. The effect of the external malleolus manipulation and the functional exercise treatment on the old ankle sprains and the symptoms can be improved, while the symptoms have positive effects on the mood of the patients, but the effect of traditional Chinese medicine treatment group is effective. It was obviously better than the functional exercise control group.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R274.3

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