手法松解配合中药薰洗治疗创伤性踝关节粘连临床观察

1、    【摘要】  目的：探讨手法松解配合中药薰洗治疗创伤性踝关节粘连的临床疗效。方法：将创伤性踝关节粘连78例随机分为治疗组39例，对照组39例，对照组常规康复治疗、治疗组手法松解配合中药薰洗进行治疗。结果：治疗组主动及被动背伸、跖屈、内收、外展ROM改善情况明显优于对照组（P0.05或P0.01。治疗前后两组AOFAS踝-后足评分比较，治疗组疼痛、功能评分改善情况明显优于对照组（P0.05，治疗组总疗效优于对照组（P0.05。结论：手法松解配合中药薰洗治疗创伤性踝关节粘连有良好疗效，值得临床上推广运用。 【关键词】  手法松解 中

2、药薰洗 创伤性踝关节粘连 AOFAS踝-后足评分系统    【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    踝关节创伤后进行周期性外固定制动或手术切开复位内固定术均会造成踝关节粘连、功能障碍。我科自2002年起采用手法松解配合中药薰洗治疗创伤性踝关节粘连患者多例，取得满意效果，现报告如下。    1  资料和方法    1.1  一般资料  自2002年12月2007年5月收治创伤性踝关节粘连患者78例。按照随机数字表法按11平均分为2组，治疗组39例，男22例，女17例；年龄2174岁，平均35±1.56岁；病程最短19天，最长45天；损伤类

7、型：胫骨远端骨折4例，胫腓骨骨折6例，内踝骨折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，外侧副韧带损伤4例，内侧副韧带（三角韧带）损伤3例，下胫腓韧带损伤2例，跟腱断裂1例；其中有内固定者20例。对照组39例，男19例，女20例；年龄3876岁，平均54±1.25岁；病程最短14天，最长41天；损伤类型：胫骨远端骨折5例，胫腓骨骨折5例，内踝骨折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，外侧副韧带损伤5例，内侧副韧带（三角韧带）损伤2例，下胫腓韧带损伤2例，跟腱断裂2例；其中有内固定者23例。各组患者一般资料经统计学分析具有可比性（P0.05）

8、。    1.2  治疗方法  早期以予以稳定牢靠的固定，在伤后3周待外伤炎症期过后，骨痂开始形成时进行对照试验。    1.2.1  治疗组  采用澳大利亚麦特兰德（Maitland）级手法。级用于关节疼痛；级用于治疗关节疼痛伴僵硬；级用于治疗周围组织粘连、挛缩而引起的关节活动受限。先行踝关节附属运动（长轴牵引、前后向滑动、后前向滑动、上下    滑动），再行关节被动生理运动（背伸、跖屈、内翻、外翻），每日2次，每次2030分钟。中药熏洗：川断20g、伸筋草15g

9、、透骨草15g、穿山甲2g、川乌10g、威灵仙15g、苏木10g、木瓜10g、路路通10g、三七10g。每剂药加水20003000ml，煎沸1530min，去渣，倒入盆内，先熏蒸，待冷却至4050时再以踝部浸入药液内，每日12次，每次30min以上，2天1剂，10天为1个疗程。    1.2.2  对照组  大功率HeNe激光照射，低、中频电疗，主动活动为主，没有医生的松动手法及中药薰洗进行治疗。    以上两组均在治疗前及治疗后6周进行各项指标的评定。    1.3  观察

10、方法及疗效判断  关节活动评定：利用关节角度计，严格按规定方法，测定踝关节主动活动度（active range of motion,AROM）和关节被动活动度（passive range of motion,PROM）。采用按美国足外科学协会评分系统（AOFAS踝后足评分系统）1，评定踝关节功能。总疗效判断标准：临床痊愈：ROM为健侧的90%以上，AOFAS踝后足总评分增加90%100%；显效：ROM为健侧基反应70%90%，AOFAS踝后足总评分增加70%90%；有效：ROM为健侧的30%70%，AOFAS踝后足总评分增加30%70%；无效：ROM为健侧的30%以下，AOFAS踝后

11、足总评分增加少于30%。    1.4  统计学处理  计量资料以均数±标准差（x±s）表示，等级资料用秩和检验，计量资料用t检验，计数资料用x2检验，所有数据均在SPSS13.0中处理，以P0.05为判断标准。-     The paper shows that flavanones are abundant in longan nucleuses. It is significant to make full use of longan necleuses. It has a brillia

12、nt prospect in developing this natural resources. 【参考文献】  1Cai Changhe, Tang Xiaolang,Zhang Aiyu, etc. longan fruit pulp nutritional therapy value and its development application prospectJ. Food Science, 2002, 23 (8): 328.2Xu Jiankai. Longan high production technology question and answerM.

13、 Guangzhou: Guangdong Science and Technology Publishing Press,2001:56.3Tan Shuhui, Zhan Reting. Chinese medicine open country recognition handbook (2)M. Guangzhou: Guangdong Science and Technology Publishing Press,2004:208.4Nanjing college of pharmacy << Chinese medicine study >> compila

14、tion group Chinese medicine study (center book) M. Nanjing:Jiangsu People's Publishing Press,1976:628.5Xiao Gengsheng, Huang Ruqiang,Ceng Qingxiao,etc. Nutrition composition of Longan seedsJ.Food Science and Technology,2004,(1):93.6Xia Xingzhou, Zhang Hui, Wei Chuanwan. In the banyan tree leaf the flavonoid withdraws the condition researchJ.Food Research and De