詹氏正骨手法配合中药薰药治疗陈旧性踝关节扭伤的临床研究

发布时间：2018-09-12 13:03

【摘要】：目的：通过詹氏正骨手法配合中药薰药治疗与单纯中药薰药治疗陈旧性踝关节扭伤的对比研究,综合比较詹氏正骨手法配合中药熏药治疗与单纯中药熏药治疗陈旧性踝关节扭伤之间的疗效差异,从疗效指标,多角度、多环节的评价詹氏正骨手法配合中药熏药的疗效。通过临床实践的研究、总结,研究手法治疗机理,建立詹氏正骨手法治疗陈旧性踝关节扭伤的诊疗规范,制定詹氏正骨手法治疗陈旧性踝关节扭伤的操作流程。以期为临床治疗提供参考依据。方法：根据纳入标准及排除标准,借助SPSS19.0统计分析系统对60例来源于詹氏医院门诊的陈旧性踝关节扭伤(筋脉失养型)患者随机分为2组,每组各30例。其中治疗组采用詹氏正骨手法配合中药薰药治疗,对照组单纯采用中药薰药治疗,对照组：中药薰药治疗方剂为来源于《中医伤科讲义》经验方“四肢损伤洗方”,使用XZQ-III型中药熏蒸器治疗,熏药时间为20分钟,每日一次。7次为一疗程,共治疗两个疗程。治疗组30例同样使用四肢损伤洗方中药熏药后,再采用詹氏正骨手法治疗。每天一次,每次15分钟,每7天为1个疗程,共治疗两个疗程。然后进行治疗前后VAS疼痛评分和Kofoed关节功能评分及根据《中医病证诊断疗效标准》对疗效进行评价,进行数据统计分析,来制定手法治疗的诊疗规范,形成詹氏正骨手法治疗陈旧性踝关节扭伤的标准操作流程。结果：(1)总体疗效：治疗组(詹氏正骨手法配合中药薰药治疗)30例,治愈13例,好转16例,未愈1例。对照组(单纯中药薰药治疗)30例,治愈5例,好转20例,无效5例。经卡方检验,两组差异有统计学意义(P0.05),表明两种方法治疗陈旧性踝关节扭伤均有效,但詹氏正骨手法配合中药薰药治疗疗效优于单纯中药薰药治疗。(2)VAS：两组受试者治疗前后局部压痛分值比较,治疗前两组局部压痛积分P0.05,差异无统计学意义,具有可比性。治疗组与对照组治疗前后局部压痛分值相比,治疗后一周开始往后所有P值均0.05,差异有统计学意义。可见从治疗后一周起治疗组疼痛减轻方面就优于对照组。(3)症状积分：治疗前两组症状积分P0.05,差异无统计学意义,具有可比性。治疗组与对照组评分相比,治疗后一周开始往后所有P值均0.05,差异有统计学意义。可见从治疗后一周起治疗组症状减轻方面就优于对照组。(4)疼痛、功能活动度积分：两组患者治疗前疼痛积分与功能活动积分比较P0.05,差异无统计学意义,具有可比性。治疗组与对照组疼痛积分比较,两组治疗一周后组间疼痛评分比较(P0.05)差异无统计学意义；治疗两周及三个月后随访两组间比较差异有统计学意义(P0.05),说明治疗组与对照组在治疗一周后疼痛评分改善差异不明显,治疗两周及三个月后治疗组疼痛评分改善方面优于对照组。治疗组与对照组功能活动积分相比,治疗后一周开始往后所有P值均0.05,差异有统计学意义。可见从治疗后一周起治疗组功能活动度改善方面就优于对照组。结论：本研究治疗组采用詹氏正骨手法配合中药薰药治疗陈旧性踝关节扭伤,对照组单纯使用中药薰药治疗陈旧性踝关节扭伤。受试者经治疗后在症状、体征改善上均比较明显,两种治疗方案对陈旧性踝关节扭伤均有显著疗效。治疗组的疼痛、功能和活动度的改善好于对照组；在关节功能上面治疗组明显优于对照组。而且在总体疗效上治疗组明显好于对照组。可见詹氏正骨手法配合中药薰药与单纯中药薰药治疗陈旧性踝关节扭伤相比在疗效的改善方面更具优势,对于陈旧性踝关节扭伤患者的总体疗效更佳,值得推广使用。
[Abstract]:Objective: To compare the curative effect of Zhan's Bone-setting manipulation combined with traditional Chinese medicine fumigation and traditional Chinese medicine fumigation on old ankle sprain, and to evaluate Zhan's Bone-setting manipulation combined with traditional Chinese medicine fumigation and traditional Chinese medicine fumigation on old ankle sprain. Through the study of clinical practice, summarize, study the mechanism of manipulation therapy, establish the diagnostic and therapeutic criteria of Zhan's manipulation for the treatment of old ankle sprain, and formulate the operation procedure of Zhan's manipulation for the treatment of old ankle sprain. Sixty patients with old ankle sprain (tendon and vein dystrophy) were randomly divided into two groups with the help of SPSS19.0 statistical analysis system, 30 cases in each group. The fumigating agent was "Limb Damage Washing Prescription" from "Handbook of Traumatology of TCM" and "Experience Prescription of Limb Damage". The fumigating time was 20 minutes, once a day. 7 times a course of treatment for two courses. Once, every 15 minutes, every 7 days for a course of treatment, a total of two courses of treatment. Then before and after treatment, VAS pain score and Kofoed joint function score and according to the < Chinese medicine syndrome diagnosis and curative effect standard > to evaluate the efficacy of statistical analysis of data, to formulate the diagnosis and treatment criteria of manipulation therapy, the formation of Jane's Bone-setting manipulation treatment of obsolete ankle. Results: (1) Total curative effect: 30 cases were cured, 13 cases were cured, 16 cases were improved and 1 case was not cured in the treatment group (Zhan's Bone-setting manipulation combined with Chinese herbal fumigation). 30 cases were cured, 5 cases were cured, 20 cases were improved and 5 cases were ineffective in the control group (Chinese herbal fumigation alone). The treatment of old ankle sprain was effective, but the effect of Zhan's Bone-setting manipulation combined with traditional Chinese medicine fumigation was better than that of traditional Chinese medicine fumigation alone. (2) VAS: The score of local tenderness before and after treatment was compared between the two groups, and the score of local tenderness before and after treatment was P 0.05, with no statistical significance. Compared with local tenderness score, all P values were 0.05 after one week of treatment, and the difference was statistically significant. It was obvious that the pain relief of the treatment group was better than that of the control group from one week after treatment. (3) Symptom score: The symptom score of the two groups before treatment was P 0.05, with no significant difference and comparability. After one week of treatment, all P values were 0.05, the difference was statistically significant. It can be seen that the treatment group was better than the control group in relieving symptoms from one week after treatment. (4) Pain, functional activity score: two groups of patients before treatment pain score and functional activity score compared P 0.05, there was no significant difference, with comparability. There was no significant difference in pain score between the two groups after one week of treatment (P 0.05); there was significant difference between the two groups after two weeks of treatment and three months of follow-up (P 0.05), indicating that there was no significant difference in the improvement of pain score between the treatment group and the control group after one week of treatment. The pain score of the treatment group was better than that of the control group. Compared with the functional activity score of the control group, all P values of the treatment group were 0.05 from the beginning of the week after treatment, and the difference was statistically significant. After treatment, the symptoms and signs of the subjects were improved obviously. Both of the two treatments had significant effects on the old ankle sprain. The pain, function and activity of the treatment group were better than those of the control group. The treatment group is obviously better than the control group in terms of joint function, and the overall effect of the treatment group is obviously better than the control group. It should be popularized.
【学位授予单位】：浙江中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R274.3

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