推拿联合物理因子疗法治疗体操运动员踝关节外侧副韧带损伤的临床观察及肌骨超声影像学研究

Study on Tuina Combined with Physical Factor Therapy in the Clinical Observation and Musculoskeletal Ultrasound of Gymnastic Athlete’s Ankle Joint Lateral Collateral Ligament Injury

目的观察推拿联合物理因子疗法对体操运动员踝关节外侧副韧带损伤的临床效果,探讨肌骨超声测得的韧带厚度作为踝关节外侧副韧带损伤观察指标的可靠性。方法选取踝关节外侧副韧带Ⅰ~Ⅱ型损伤的体操运动员64例,采用全分析集意向性入组原则,分为物理因子治疗组(理疗组)与物理因子治疗+推拿组(推拿组)各32例。理疗组采用超声波及微波治疗,每次各10 min,每周3次。推拿组在理疗组治疗基础上采用推拿手法,每次20 min,每周3次。均连续治疗3个月。观察2组临床疗效,比较2组治疗不同时点踝关节距腓前韧带厚度和跟腓韧带厚度、踝关节周径、踝关节活动度评分。结果推拿组总有效率为96.88%(31/32),理疗组为90.63%(29/32),2组比较差异无统计学意义(P>0.05)。与本组治疗前比较,2组治疗后距腓前韧带厚度、跟腓韧带厚度减小(P<0.05);2组治疗后比较,推拿组距腓前韧带厚度、跟腓韧带厚度小于理疗组(P<0.05)。与本组治疗前比较,2组治疗1个月、治疗后踝关节周径差异有统计学意义(P<0.05);2组治疗1个月、治疗后踝关节周径比较差异无统计学意义(P>0.05)。与本组治疗前比较,2组治疗1个月、治疗后踝关节活动度评分差异有统计学意义(P<0.05);2组治疗1个月、治疗后比较,推拿组踝关节活动度评分优于理疗组(P<0.05)。结论推拿联合物理因子疗法可改善体操运动员踝关节外侧副韧带损伤症状,在改善距腓前韧带和跟腓韧带厚度、踝关节活动度方面均优于单纯物理因子疗法,肌骨超声测量可作为评价踝关节外侧副韧带损伤的重要指标。

Objective To observe the clinical efficacy of Tuina combined with physical factor therapy on the lateral ankle collateral ligament injury of gymnasts;To explore the reliability of ligament thickness measured by musculoskeletal ultrasound as an observation index for the lateral ankle ligament injury.Methods Totally 64 gymnasts diagnosed with type I–Ⅱinjury of the lateral collateral ligament of the ankle joint were selected.With the principle of intentional enrollment in the full analysis set,they were divided into physical factor therapy group(physical therapy group)and physical factor therapy+Tuina group(Tuina group),with 32 cases in each group.The physical therapy group received ultrasonic treatment and microwave treatment,each treatment for 10 minutes,3 times every week,and a course of treatment for 3 months.In the Tuina group,on the basis of physical therapy group,Tuina was used for 20 minutes each time,3 times every week,and 3 months was a course of treatment.Clinical efficacy of both groups were observed.Anterior talofibular ligament thickness and calcaneofibular ligament thickness,ankle circumference,ankle range of motion scores at different time points of both groups were compared.Results The total effective rates were 96.88%(31/32)in the Tuina group and 90.63%(29/32)in the physical therapy group,without statistical significance(P>0.05).Compared with before treatment,the thickness of anterior talofibular ligament and calcaneofibular ligament in both groups decreased after treatment(P<0.05);after treatment,the thickness of the anterior talofibular ligament and the thickness of the calcaneofibular ligament in the Tuina group were smaller than those in the physical therapy group(P<0.05).Compared with before treatment,the difference in ankle circumference between the two groups at 1 and 3 months of treatment was statistically significant(P<0.05);there was no statistical significance in ankle circumference between the two groups at 1 and 3 months of treatment(P>0.05).Compared with before treatment,there was statistical significance in ankle mobility scores between the two groups at 1 and 3 months of treatment(P<0.05);after 1 and 3 months of treatment,the ankle joint mobility score in the Tuina group was better than that in the physical therapy group(P<0.05).Conclusion Combined with physical factor therapy,Tuina therapy can improve the symptoms of lateral collateral ligament injury of the ankle joint of gymnasts.It is better than physical therapy in improving the thickness of the anterior talofibular ligament and the calcaneofibular ligament,and the mobility of the ankle joint.Musculoskeletal ultrasound measurement can be used as an important index to evaluate the injury of the lateral collateral ligament of ankle joint.