發(fā)布時間：2018-04-26 22:15

  本文選題：新型支具 + 急性踝關(guān)節(jié)扭傷　； 參考：《廣州中醫(yī)藥大學》2017年碩士論文

【摘要】：目的:對比支具和石膏固定在急性踝關(guān)節(jié)扭傷治療中的運用,基于POLICE原則探討新型支具對急性踝關(guān)節(jié)扭傷的短期臨床療效。方法:采用前瞻性對照研究方法。收集受傷在24小時內(nèi)的急性踝關(guān)節(jié)扭傷的患者,將患者分為試驗組(A)、對照組(B)和空白組(C)三組。試驗組(A):就診后,繃帶包扎后予新型支具固定踝關(guān)節(jié)2～3周,受傷后24小時內(nèi)予冰敷(每次15～20min,每2小時一次,持續(xù)冰敷48～72小時),受傷后3d內(nèi)以休息、抬高患肢、主動活動腳趾消腫為主,3d后患者可部分負重行走。在疼痛可忍情況下,可室內(nèi)行走,如疼痛難以忍受,可用拐杖輔助。對照組(B):繃帶包扎后予石膏固定踝關(guān)節(jié)2～3周。受傷后24小時內(nèi)予冰敷(每次15～20min,每2小時一次,持續(xù)冰敷48～72小時),受傷后3d內(nèi)以抬高患肢、主動活動腳趾消腫為主,石膏固定期間避免負重。固定期間功能鍛煉與觀察組相同。拆除石膏后在疼痛可忍情況下,可室內(nèi)行走,如疼痛難以忍受,可用拐杖輔助。空白組(C):繃帶包扎后不予其余固定。受傷后24小時內(nèi)予冰敷(每次15～20min,每2小時一次,持續(xù)冰敷48～72小時),受傷后3d內(nèi)以休息、抬高患肢、主動活動腳趾消腫為主,3d后患者可部分負重行走。在疼痛可忍情況下,可室內(nèi)行走,如疼痛難以忍受,可用拐杖輔助。接受治療后3天、1周、2周、4周后分別對各組進行Povacz外側(cè)副韌帶療效評分、Kofoed評分、VAS評分、臨床癥狀體征積分。治療4周后記錄改善率、恢復工作時間及滿意度,進行臨床療效綜合評價。治療12周末統(tǒng)計每組并發(fā)癥發(fā)生率。結(jié)果:1.治療1周、2周后,支具組的Povacz外側(cè)副韌帶療效評分、Kofoed評分顯著高于石膏組和空白組(P0.01),且支具組臨床癥狀、體征積分顯著低于石膏組和空白組(P0.01)。2.在治療4周后,支具組和石膏組Povacz外側(cè)副韌帶療效評分、Kofoed評分,臨床癥狀體征積分、VAS評分及好轉(zhuǎn)率、治愈率指標無顯著統(tǒng)計學差異(P0.05)。但支具組治療滿意度顯著高于石膏組和空白組(P0.01),其恢復工作時間明短于石膏組(P0.01),并發(fā)癥發(fā)生率顯著低于石膏組和空白組(P0.01)。3.支具組和石膏組在治療1、2、4周后的相關(guān)隨訪指標普遍優(yōu)于空白組(P0.05),且空白組3個月內(nèi)并發(fā)癥發(fā)生率顯著高于支具和石膏組(P0.01)。結(jié)論:1.基于POLICE原則使用新型支具治療急性踝關(guān)節(jié)扭傷,可比石膏固定能更快緩解疼痛、腫脹、改善踝關(guān)節(jié)功能。2.固定治療在急性踝關(guān)節(jié)扭傷治療中具有積極意義。新型支具的短期臨床療效與石膏相當,但新型支具固定比石膏固定具有更高的治療滿意度,且能縮短病程、降低并發(fā)癥發(fā)生率,新型支具值得臨床推廣運用。
[Abstract]:Objective: to compare the application of brace and plaster fixation in the treatment of acute ankle sprain, and to explore the short-term clinical effect of new brace on acute ankle sprain based on POLICE principle. Methods: a prospective controlled study was used. The patients with acute ankle sprain within 24 hours were divided into three groups: test group, control group (B) and blank group (C). In the test group, after treatment, bandage bandages were used to fix ankle joint for 2 weeks, ice compress was given within 24 hours after injury (1520min, once every 2 hours, continuous ice compress 4872 hours, rest within 3 days after injury), The patients could walk with partial load after 3 days of active toe detumescence. In the case of pain tolerance, can walk indoors, if the pain is unbearable, can be aided by crutches. In the control group, the ankle joint was fixed with plaster for 2 weeks after bandage. Ice compress was given within 24 hours after injury (15 minutes 20 minutes, once every 2 hours, continuous ice compress 48472 hours, 3 days after the injury by raising the affected limb, active movement of toes to reduce swelling, gypsum fixation period to avoid weight bearing. The functional exercise during the fixed period was the same as that in the observation group. After removing gypsum, you can walk indoors in case of pain. If the pain is unbearable, it can be aided by crutches. Blank group: bandage bandage is not to be fixed after the rest. Ice compress was given within 24 hours after injury (15 minutes, 20 minutes, once every 2 hours, continuous ice compress for 4872 hours). After 3 days of injury, the patients could walk with partial load after rest, raising the affected limbs and removing swelling of the toes. In the case of pain tolerance, can walk indoors, if the pain is unbearable, can be aided by crutches. After 3 days, 1 week and 2 weeks and 4 weeks after treatment, the clinical symptoms and signs of each group were evaluated with Kofoed score and Kofoed score. After 4 weeks of treatment, the improvement rate, working time and satisfaction were recorded, and the clinical efficacy was evaluated. The incidence of complications in each group was calculated at the end of 12 weeks. The result is 1: 1. After 1 week and 2 weeks of treatment, the score of Povacz lateral collateral ligament therapeutic effect in the support group was significantly higher than that in the gypsum group and the blank group (P 0.01), and the clinical symptom and physical sign score in the support group was significantly lower than that in the plaster group and the blank group. After 4 weeks of treatment, there was no significant difference in curative effect score of Povacz lateral collateral ligament and Kofoed score, clinical symptom and sign score, improvement rate and cure rate between support group and gypsum group (P 0.05). However, the treatment satisfaction of the support group was significantly higher than that of the gypsum group and the blank group, and the recovery time was shorter than that of the gypsum group, and the incidence of complications was significantly lower than that of the gypsum group and the blank group. The related follow-up indexes of the two groups were higher than that of the blank group after 4 weeks treatment (P 0.05), and the incidence of complications in the blank group was significantly higher than that in the plaster group and the abutment group within 3 months (P 0.01). Conclusion 1. The treatment of acute ankle sprain with new brace based on POLICE principle can relieve pain and swelling more quickly than plaster fixation and improve ankle function. 2. Fixation therapy has positive significance in the treatment of acute ankle sprain. The short-term clinical efficacy of the new brace is equal to that of gypsum, but the new brace fixation has higher therapeutic satisfaction than gypsum fixation, and can shorten the course of disease and reduce the incidence of complications.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R274.3

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