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[中药三期保守外治法治疗急性外侧踝关节韧带损伤的早期临床疗效研究]

[Early clinical efficacy study on the efficacy of a three-stage conservative Chinese medicine external treatment for acute lateral ankle ligament injuries].

作者信息

Han Qing-Xin, Zhang Lei, Wu Jun-Ying, Liu Xiao-Hua, Li Yan, Chen Tian-Xin, Yi Yu, Yu Mei-Qi

机构信息

Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102, China.

出版信息

Zhongguo Gu Shang. 2024 Oct 25;37(10):997-1002. doi: 10.12200/j.issn.1003-0034.20240730.

Abstract

OBJECTIVE

To evaluate the clinical effect of a new three-phase Chinese medicine (CM) external treatment for acute lateral ankle ligament injuries.

METHODS

From July to December 2023, 64 patients with acute lateral ankle ligament injuries were randomly assigned to receive either the new three-phase CM external treatment combined with the POLICE(protect, optimal loading, ice, compression, elevation) treatment (observation group) or the POLICE treatment (control group), with 32 cases in each group. The observation group consisted of 17 males and 15 females, with an average age of(30.59±3.10) years old ranging from 25 to 36 years old, while the control group included 14 males and 18 females, with an average age of(30.03±3.19) years old ranging from 24 to 37 years old. Visual analogue scale (VAS) evaluation and Figure of 8 measurement were used to evaluate the degree of ankle joint pain and swelling of the subjects at the initial enrollment and after 1 week and sixth weeks of treatment. At the same time, the American Orthopaedic Foot and Ankle Society (AOFAS) and Karlsson Ankle Function Score System were used to evaluate the improvement of ankle joint function in patients at all stages. MRI imaging was employed to observe the degree of biological healing of the anterior talofibular ligament, with the signal to noise ratio(SNR) indicating the level of healing. A lower SNR suggests better ligament healing, as it represents lower water content in the ligament.

RESULTS

All patients completed a 6-week follow-up. There was no significant difference in VAS, AOFAS score and Karlsson score between the two groups before treatment (>0.05). After 1 week and 6 weeks of treatment, the VAS, AOFAS score and Karlsson score of the two groups were significantly improved (<0.05). After 1 week of treatment, the VAS score of the observation group (3.21±0.87) was lower than that of the control group (4.21±1.50), and the difference was statistically significant (<0.05). After 1 weeks of treatment, the AOFAS and Karlsson scores [(50.84±4.70) points, (49.97±4.00) points] of the observation group were higher than those [(46.91±5.56) points, (46.66±5.36) points]of the control group (<0.05). MRI images showed that after 6 weeks of treatment, the SNR value of the observation group was significantly lower than that of the control group, and the difference was statistically significant(SNR of the observation group was 75.25±16.59, the contral gruop was 85.81±15.55), (<0.05).

CONCLUSION

Compared with the control group, the new three-phase CM external treatment is significantly effective in reducing pain and swelling, enhancing ligament repair quality, and promoting functional recovery of the ankle joint in patients with acute lateral malleolar ligament injuries.

摘要

目的

评估一种新型三期中药外用疗法治疗急性外侧踝关节韧带损伤的临床效果。

方法

2023年7月至12月,将64例急性外侧踝关节韧带损伤患者随机分为两组,分别接受新型三期中药外用联合POLICE(保护、适度负重、冰敷、加压、抬高)疗法(观察组)或POLICE疗法(对照组),每组32例。观察组男17例,女15例,平均年龄(30.59±3.10)岁,年龄范围为25至36岁;对照组男14例,女18例,平均年龄(30.03±3.19)岁,年龄范围为24至37岁。采用视觉模拟评分法(VAS)评估及8字绷带测量,分别于初诊时、治疗1周及6周后对受试者踝关节疼痛及肿胀程度进行评估。同时,采用美国矫形足踝协会(AOFAS)评分及卡尔森踝关节功能评分系统对各阶段患者踝关节功能改善情况进行评估。采用MRI成像观察距腓前韧带生物愈合程度,以信噪比(SNR)表示愈合水平。SNR越低表明韧带愈合越好,因为这代表韧带中含水量越低。

结果

所有患者均完成6周随访。治疗前两组VAS、AOFAS评分及卡尔森评分比较,差异无统计学意义(>0.05)。治疗1周及6周后,两组VAS、AOFAS评分及卡尔森评分均显著改善(<0.05)。治疗1周后,观察组VAS评分(3.21±0.87)低于对照组(4.21±1.50),差异有统计学意义(<0.05)。治疗1周后,观察组AOFAS及卡尔森评分[(50.84±4.70)分、(49.97±4.00)分]高于对照组[(46.91±5.56)分、(46.66±5.36)分],差异有统计学意义(<0.05)。MRI图像显示,治疗6周后,观察组SNR值显著低于对照组,差异有统计学意义(观察组SNR为75.25±16.59,对照组为85.81±15.55),(<0.05)。

结论

与对照组相比,新型三期中药外用疗法在减轻急性外侧踝韧带损伤患者疼痛和肿胀、提高韧带修复质量及促进踝关节功能恢复方面效果显著。

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