踝关节创伤后手法治疗效果评估

Evaluation of the effect of maneuver for treatment of ankle injury

目的:观察常规康复治疗结合改良踝关节手法治疗对踝关节创伤患者的干预效应。方法:选择2000-01/2004-12在南京医科大学第一附属医院康复医学科就诊的踝关节创伤后功能障碍患者240例,均自愿参加观察。随机分为两组,对照组120例,手法组120例。对照组治疗方案包括蜡疗(30min/次,1～2次/d)、踝关节活动范围练习(4～6组/d,10～15min/次)、踝部主要肌群的肌力练习及步行训练。手法组在以上治疗方案基础上增加改良踝关节松动术手法治疗:①下胫腓关节:前后向或后前向滑动会增加踝关节活动范围。②胫距关节:包括分离牵引、前后向滑动、后向前滑动、向内侧滑动、向外侧滑动、屈伸摆动及翻转摆动。③距下关节:包括分离牵引、前后向滑动及后前向滑动。两组患者的治疗周期均为3个疗程,10d为1个疗程。评定治疗前及治疗3个疗程后患踝关节背屈及跖屈活动范围。结果:纳入踝关节创伤后功能障碍患者240例,全部进入结果分析,无脱落。两组患者治疗前后踝关节背屈及跖屈活动范围比较:对照组和手法组患者治疗3个疗程后踝关节背屈及跖屈活动范围均较治疗前显著增加犤(11±5,6±4)°,(28±12,18±6)°;(17±4,5±3)°,(40±10,17±7)°(t=4.49～6.01,P<0.01)犦。治疗3个疗程后手法组患者踝关节背屈及跖屈活动范围均较对照组显著增加(t=4.02,4.58,P<0.01)。结论:在常规康复治疗基础上结合改良踝关节手法治疗可以显著改善踝关节创伤患者踝关节的背屈及跖屈活动范围,干预效果优于单纯常规康复治疗。

AIM： To observe the interventoonal effect of routine rehabilitative therapy combined with modified maneuver therapy for ankle joint in patients with ankle injury. METHODS： Two hundred and forty patients hospitalized for functional impairment due to ankle injury in the Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University during January 2000 to December 2004 were willing to participate in the study. All the subjects were randomized into two groups, 120 cases in control group and 120 in maneuver group. Patients in the control group undertook wax therapy （30 minutes per time and once or twice per day）, training in motion range of ankle joint（4-6 times a day and 10-15 minutes once）, and muscle strength training in the main muscle group of ankle and walking training. Patients in the maneuver group received modified maneuver therapy for ankle joint in addition to the above-mentioned therapies. The details were as follows：（1）Inferior tibiofibular joint： Forward or backward gliding movement for purpose of expanding the motion range of ankle joint. （2）Tibial astragaloid joint： Detachment and traction, forward gliding movement, backward gliding movement, inward gliding movement, outward gliding movement, pendular movement of extension and flexion, and pendular movement of inversion. （3）Subtalar joint： Detachment and traction, forward gliding movement, and backward gliding movement. Duration of treatment was 30 days, 10 days as a course. Motion range of dorsiflexion and planter flexion of affected ankle joint was assessed before treatment and after 3-course treatment. RESULTS： All the 240 patients were involved in the result analysis. Motion range of dorsiflexion and planter flexion was expanded in the control and maneuver groups after 3-course treatment [（11±5,6±4）°, （28±12, 18±6）° ; （ 17±4,5±3 ）° （40± 10,17±7 ）°, t=4.49-6.01 ,P 〈 0.01], which was expanded more significantly in the latter group（t=4.02,4.58 ,P 〈 0.01）. CONCLUSION： Routine rehabilitative therapy combined with modified maneuver therapy for ankle joint has a significant effect on the improvement of the motion range of dorsiflexion and planter flexion in patients with ankle injury, which is superior to simple routine rehabilitative therapy.