手法为主治疗儿童髋关节急性软组织损伤

Observation on the Curative Effect of Children’s Acute soft Tissue Injury of Hip Joint Treated with Manipulation

儿童髋关节急性软组织损伤多见“髋关节急性滑膜炎”或“髋关节软组织嵌顿症”。其临床特点是,患儿因运动后跌碰损伤或急性扁桃体炎等出现下肢跛行。早期多以膝痛为主诉,伴髋关节疼痛,腹股沟深压痛,髋内旋、外展活动受限,X线片检查发现髋关节间隙增宽,部分患者可见关节囊阴影增大。笔者运用手法加外用活血止痛中药制剂治疗30例(治疗组)与用患肢皮牵引和活血止痛中药内服治疗15例(对照组)。结果:两组愈显率比较,(治疗组96.7%,对照组73.3%),有显著差异P<0.05。经治疗2天内膝痛消失,治疗组29例(96.7%),对照组14例(93.3%),无显著差异,(P<0.05)。治疗1周内髋关节疼痛消失,治疗组28例,(93.3%),对照组7例(46.7%),有显著差异,(P<0.05)。故笔者认为以手法与外用药治疗优于下肢皮牵引和内服中药之法。膝痛是儿童髋关节软组织损伤早期的主诉之一,但临床检查膝部无阳性体征,经早期处理,膝痛症状消失较快,探其机理,认为与闭孔神经其分枝所支配区有关。当髋关节损伤或炎症反应刺激影响到闭孔神经或其分支时,闭孔神经所行经的膝关节因反射或放射等因素影响而出现疼痛。再者,患儿神经系统发育未成熟、对疼痛来源分辩定位能力差,诉说膝痛而不说髋关节疼痛,如忽视对髋关节的必要检查,会因漏诊而延误治疗。儿童髋关节暂时性滑膜炎与髋关节软组织嵌顿,发病机理多与运动损伤或急性炎症有关。临床表现大致相同,但其病理改变有轻重之别,故临床检查须细致加以分辩。手法治疗可根据其病理机制不同而灵活运用,通过手法可达到松解关节滑膜嵌顿与软组织痉挛,改善血液循环,增加组织新陈代谢而收到活血、消肿止痛的功效。手法治疗比传统患肢皮牵引疗法更直接、快速产生治疗效果,且方法简便,时间短、手法轻柔使患儿感觉舒适而易于接受。

Children’s acute soft tissue injury of hip joint also refer to “acute synovitis of hip-joint”or“ soft tissue impacted of hip-joint”. Characteristic of the disease is that the child suffered from limping after playing or due to falling down. Complaining pain knee in early stage with pain hip joint, deep pressing pain can be found at groin. The child has limited movement in hip-joint adtorsion abduction. Interspace of hip-joint is wider or shadow of joint capsule is increased at the x-ray film.The author cured 30 cases of them with manipulation and Chinese medication to promote blood circulation and relieve pain for external use. Other 15 cases ( control group) were treated with lower limb traction and Chinese oral medications to promote blood circulation and relieving pain. Curative effect is analyzed and mechanism of the treatment is probed into. Result: by comparison, 29 cases (96.7%) with manipulation and 11 cases(73.3%)in control group were recovered to took effect. P>0.05, it means that there is significant difference. Pain knee in some cases were relieved in 2 days, in which, there were 29 cases (96.7%) in manipulation group and 14 cases (93.9%) in control group. P>0.05, it means that there is not any difference. So the author thinks that the curative effect with manipulation and external medications is much better than the one with lower limb traction and oral medications in control group.