半导体激光对踝关节扭伤患者疼痛症状的改善作用

Amelioration of semi-conductor laser on the pain symptom in patients with ankle joint sprain

目的:探讨半导体激光治疗改善踝关节扭伤患者疼痛症状的效果。方法:于2004年至8月至2007至8月选择在广州军区广州总医院康复理疗科治疗的对踝关节扭伤患者71例,采用随机数字表法将71例患者随机分为2组。治疗组36例和对照组35例,对照组采用电针(外踝扭伤者取昆仑,丘墟,申脉,阿是穴,阳陵泉,足三里;内踝扭伤者取太溪,照海,商丘,阿是穴,阳陵泉,足三里。患者坐位,用长5cm,直针为03mm毫针直刺进针,至患者有明显酸胀感为佳,接上G6805型电针治疗仪,断续波,频率35Hz,强度以患者耐受为度,通电20min后出针),结合推拿理筋复位手法(患者仰卧位,术者左手握患足掌部,右手托持足跟进行牵拉,同时以躁关节为轴心摇动患踝,继而实施扳压法:内踝伤向内翻跖屈扳动,另一手拇指着力于踝关节内侧间隙向外按压于疼痛的明显处,不超出正常生理范围为准,最后术者以两手掌跟分置患者内外踝对向挤压,并以双手拇指自踝关节前部分拨到足趾部,并在小腿前后、内外侧,及脚面,脚底进行放松按摩,每次20min,每天1次;并指导患者踝关节主动功能锻炼,如抬高患足,适当做跖趾关节和膝关节的伸屈运动),治疗组予以半导体激光照射治疗。主要照射踝关节扭伤的痛点,治疗10分钟至20分钟,1次/每天,10次为一个疗程,疗程间隔2天。治疗两个疗程后,采用K.W.Lovett于1916年提出的"手检查法"评定疗效。改善率为100%时为康复。改善率大于60%为显效,25%至60%为有效,小于25%为无效。踝关节扭伤疼痛的评价内容,使用目测类比评估法。评定以0分表示无痛,lO分表示患者感受最痛、无法忍受。结果:71例踝关节扭伤患者均进入结果分析。①经20次治疗后,治疗组总有效率高于对照组(97.2%,91.4%,P<0.01)。②疼痛视觉类比评估法(VAS)治疗前后比较:在镇痛方面,两组在治疗10次和20次后,疼痛较治疗前均有较为明显缓解(3.39±0.28,0.81±0.13,6.50±0.46;3.99±0.38,2.89±0.23,5.99±0.38),治疗组治疗第20次后较对照组评分明显降低(0.81±0.13,2.89±0.23,p<0.01)。结论:半导体激光照射治疗踝关节扭伤有明显临床疗效.并对患者的疼痛症状有明显的改善作用,较常规电针结合推拿理筋复位手法治疗更有效。半导体激光照射对踝关节扭伤患者疼痛的康复治疗有明显作用。

Objectives：This research is to investigate the therapeutic efficiency on the pain symptom in patients with ankle joint sprain through semi - conductor laser treatment. Methods： seventy one patients with ankle joint sprain ,who were treated at the Department of Rehabilitation, General Hospital of Guangzhon Military Command from. August 2004_ to August 2/Z/7, were sel _ected. They were divided into two groups according to rand numbers table method, treatment group （ n =36） and control group （ n = 35 ）. The patients in control group were treated with acupuncture （ Zusanli, Yanglingquan, Taixi, Zhaohai, Shangqiu, Kunlun, Qiuxu, Shenmali,Ashixue was taken as main points to treat）and Chinese naprapathy （pinching, grasping,rolling and pulling etc. on foot and leg, and the suitable passive activity on ankle joint for about 20 minutes）. The patients in the treatment group were only treated with semi - conductor laser therapy. The pain point of theankle joint was take as main point to treat, retraining last for 10 minutes, once a day, 10 times as a course, and the interval of a course was 2 days. After treating for 2 courses, the effects were evaluated with ＂Manual Muscle test ＂（MMT） made by K. W. Lovett in 1916 , When the improved rate was 100% it was rehabilitation; over 60% it w.as significant effect; 25% - 60% as efficiency, less than 25% as inefficiency. The evaluative content of ankle joint ache was detected withvisual analogue scale（ VAS）, O point as painless, 10 points as severe pain that could not bear. Results：Totally 71 patients with ankle joint sprain were involved in the result analysis. （ 1 ）After being treated for 20 time , total efficiency in treatment group was higher than that in the control group （ 97.2% ,91.4% , p 〈 0.01 ）. （2）Comparison between pre - treatment and post -treatment with VAS： In analgesia aspect, the ache after being treated for 10 times and 20 times had been lighted apparently as compared with before treatment （3.39 ＋ 0.28,0.81 ± 0.13,6.50 ± 0.46;3.99 ± 0.38,2.89 ± 0.23,5.99 ± 0.38）, and it decreased markedly after treating the 20th time in the treatment group as compared with the control group （0.81 ± 0.13,2.89 ± 0.23, p 〈 0.01）. Conclusion： The semiconductor laser therapy can enhance the clinical effects significantly in patients with ankle joint sprain, and has distinctly ameliorative action on the ache symptom, which is more effective as compared with acupuncture and Chinese naprapathy . The semi - conductor laser therapy has remarkably auto - action on the rehabilitative treatment on ache in patients with ankle joint sprain.