揿针配合手法治疗踝关节扭伤后遗症疗效观察

Effects of intradermal needling combined with tuina on ankle sprain sequelae

目的:比较揿针联合手法与单纯手法治疗踝关节扭伤后遗症的临床疗效差异。方法:90例陈旧性踝关节扭伤患者随机分为观察组和对照组,每组45例。对照组采用常规手法推拿治疗。观察组在常规手法推拿治疗结束后在阿是穴(最痛筋结点)、申脉/照海、解溪/中封、丘墟/商丘(根据内外侧踝关节损伤不同选穴,每次选取5个腧穴,包括2个痛点)将揿针埋入穴位皮下24~48h。两组患者每周治疗2次,共治疗4周8次,随访12个月。观察比较两组治疗前后"筋结点"压痛视觉模拟量表(VAS)分值,行走与跑步活动时踝关节疼痛程度分级人数变化,及随访期两组患者踝关节休息痛发生人数及发生次数,并对观察组患者进行满意度调查。结果:两组治疗后VAS评分、行走与跑步活动时踝关节疼痛分级人数均较治疗前改善,差异均有统计学意义(均P<0.05),且观察组踝关节跑步疼痛分级人数较对照组改善明显(P<0.05);随访期间观察组踝关节休息痛发生人数与发生次数均较对照组少(均P<0.05);观察组患者对揿针治疗满意度高。结论:揿针配合手法治疗可改善踝关节扭伤后遗症筋结点压痛、行走和跑步活动时疼痛,较单纯手法治疗能降低损伤关节休息痛发生,且治疗安全可靠。

Objective To compare the clinical efficacy differences between intradermal needling combined with tuina and tuina alone on ankle sprain sequelae. Methods Ninety patients with chronic ankle sprain were randomly divided into an observation group and a control group, 45 cases in each group. The patients in the control group were treated with conventional tuina. The patients in the observation group were treated with conventional tuina, followed by intradermal needling at ashi point（the most painful tendons node）, Shenmai（BL 62）/Zhaohai（KI 6）, Jiexi（ST 41）/Zhongfeng（LR 4）, Qiuxu（GB 40）/Shangqiu（SP 5） for 24 to 48 hours per treatment; acupoint selection was based on the different side of ankle sprain, and 5 acupoints were selected per treatment, including 2 painful points. The treatment was given twice per week, and totally 8 treatments were given within 4 weeks. The follow-up visit was 12 months. The pain of tendon joints was evaluated by visual analogue scale（VAS）; the patient number of severity of ankle pain during walking and running as well as the occurrence and frequency of ankle pain during rest in follow-up visit in the two groups were observed; the satisfaction survey was conducted in the observation group. Results Compared before treatment, VAS of tendon joints, the patient number of severity of ankle pain during walking and running were improved after treatment in the two groups（all P〈0.05）, and patient number of the severity of ankle pain during running in the observation group was superior to that in the control group（P〈0.05）. During follow-up visit, compare with the control group, the occurrence and frequency of ankle pain during rest in the observation group was significantly improved（both P〈0.05）; the satisfaction in the observation group was significant. Conclusion The intradermal needling combined with tuina could improve the tenderness of tendon joints and pain during walking and running in patients with ankle sprain sequelae; compared with tuina alone, it could reduce the occurrence of ankle pain during rest, which is safe and reliable.