Dubin Joshua C, Comeau Doug, McClelland Rebecca I, Dubin Rachel A, Ferrel Ernest
Chiropractor, Dubin Chiropractic, Quincy, MA.
J Chiropr Med. 2011 Sep;10(3):204-19. doi: 10.1016/j.jcm.2011.02.001. Epub 2011 Jul 23.
The purpose of this article is to review the literature that discusses normal anatomy and biomechanics of the foot and ankle, mechanisms that may result in a lateral ankle sprain or syndesmotic sprain, and assessment and diagnostic procedures, and to present a treatment algorithm based on normal ligament healing principles.
Literature was searched for years 2000 to 2010 in PubMed and CINAHL. Key search terms were ankle sprain$, ankle injury and ankle injuries, inversion injury, proprioception, rehabilitation, physical therapy, anterior talofibular ligament, syndesmosis, syndesmotic injury, and ligament healing.
Most ankle sprains respond favorably to nonsurgical treatment, such as those offered by physical therapists, doctors of chiropractic, and rehabilitation specialists. A comprehensive history and examination aid in diagnosing the severity and type of ankle sprain. Based on the diagnosis and an understanding of ligament healing properties, a progressive treatment regimen can be developed. During the acute inflammatory phase, the goal of care is to reduce inflammation and pain and to protect the ligament from further injury. During the reparative and remodeling phase, the goal is to progress the rehabilitation appropriately to facilitate healing and restore the mechanical strength and proprioception. Radiographic imaging techniques may need to be used to rule out fractures, complete ligament tears, or instability of the ankle mortise. A period of immobilization and ambulating with crutches in a nonweightbearing gait may be necessary to allow for proper ligament healing before commencing a more active treatment approach. Surgery should be considered in the case of grade 3 syndesmotic sprain injuries or those ankle sprains that are recalcitrant to conservative care.
An accurate diagnosis and prompt treatment can minimize an athlete's time lost from sport and prevent future reinjury. Most ankle sprains can be successfully managed using a nonsurgical approach.
本文旨在回顾探讨足踝正常解剖结构与生物力学、可能导致外侧踝关节扭伤或下胫腓联合损伤的机制以及评估和诊断程序的文献，并基于正常韧带愈合原则提出一种治疗方案。
在PubMed和CINAHL数据库中检索2000年至2010年的文献。关键检索词包括踝关节扭伤、踝关节损伤、内翻损伤、本体感觉、康复、物理治疗、距腓前韧带、下胫腓联合、下胫腓联合损伤以及韧带愈合。
大多数踝关节扭伤对非手术治疗反应良好，例如物理治疗师、整脊医生和康复专家提供的治疗。全面的病史和检查有助于诊断踝关节扭伤的严重程度和类型。基于诊断结果并了解韧带愈合特性，可制定逐步的治疗方案。在急性炎症期，护理目标是减轻炎症和疼痛，并保护韧带免受进一步损伤。在修复和重塑期，目标是适当推进康复进程，以促进愈合并恢复机械强度和本体感觉。可能需要使用放射成像技术来排除骨折、韧带完全撕裂或踝关节榫眼不稳定的情况。在开始更积极的治疗方法之前，可能需要一段时间进行固定，并使用拐杖以非负重步态行走，以便韧带能够正确愈合。对于3级下胫腓联合扭伤或对保守治疗无效的踝关节扭伤，应考虑手术治疗。
准确的诊断和及时的治疗可以最大限度地减少运动员因伤缺赛的时间，并预防未来再次受伤。大多数踝关节扭伤可以通过非手术方法成功治疗。
