本文選題：陳舊性踝關節(jié)扭傷 + 外踝理筋手法　； 參考：《北京中醫(yī)藥大學》2017年碩士論文

【摘要】：研究目的:科學地觀察中醫(yī)正骨手法中外踩理筋手法治療陳舊性踝關節(jié)扭傷的臨床療效,較為客觀地評估、驗證外踝理筋手法的有效性,以期為陳舊性踝關節(jié)扭傷的臨床治療提供參考依據(jù)。研究方法:2015年9月至2016年12月,臨床收集內(nèi)收型單側(cè)踝關節(jié)扭傷患者74例,最終由66例符合標準并資料完整,其中左側(cè)33例,右側(cè)33例。其中男性29例,女性37例,年齡16～64歲,平均36歲。扭傷到治療時間最短者4周,最長者14個月,平均6.8個月。所有病例采用單盲法,隨機分配至手法治療組(治療組)與功能鍛煉組(對照組)。治療組進行外踝理筋手法治療,具體手法要點是:1,手摸心會,尋找點按筋結(jié);2,手法理筋,行搖、拔、戳手法;3,捋順脈絡,輕捋收工。對照組行功能鍛煉治療,具體包括:1,足背身鍛煉;足跖屈鍛煉;3,踝關節(jié)內(nèi)翻、外翻鍛煉;4,提踵鍛煉等。對兩組患者治療前后對疼痛學VAS評分、踝關節(jié)腫脹程度、A0FAS的Baird-Jackson踝關節(jié)評分、距骨傾斜角測量、PANAS-X具體情緒量表等指標進行監(jiān)測。研究結(jié)果:1.74例患者中66例得到隨訪,隨訪時間最短者1個月,最長者6個月,平均4.2個月。2.VAS評分情況:治療前兩組VAS評分差異無統(tǒng)計學意義,具有可比性(p0.05)。治療后,治療組組內(nèi)比較,治療后較治療前VAS評分下降,差異有統(tǒng)計學意義(p0.01),對照組組內(nèi)比較治療后較治療前VAS評分下降,差異有統(tǒng)計學意義(p0.01);組間比較治療組VAS評分降低程度明顯優(yōu)于比對照組(p0.01),差異有統(tǒng)計學意義。3.踝關節(jié)腫脹情況:治療前兩組患者的患側(cè)踩關節(jié)腫脹情況無統(tǒng)計學差異(p0.05),具有可比性;治療后兩組患者的患側(cè)踝關節(jié)腫脹情況無統(tǒng)計學差異(p0.05)。4.A0FAS評分情況:治療前兩組患者的A0FAS評分情況無統(tǒng)計學差異(p0.05);治療后兩組患者組內(nèi)比較A0FAS評分均較治療前有升高趨勢且均有統(tǒng)計學差異(p0.05),治療后兩組患者組間比較A0FAS評分發(fā)現(xiàn)治療組評分顯著高于對照組,差異有統(tǒng)計學意義(p0.05)。5.距骨傾斜角變化情況:治療前兩組患者患側(cè)距骨傾斜角無統(tǒng)計學差異,具有可比性(p0.05);治療后,治療組組間治療前后距骨傾斜角變化無統(tǒng)計學差異(p0.05),對照組組間治療前后距骨傾斜角變化無統(tǒng)計學差異(p0.05),兩組組內(nèi)比較同樣無統(tǒng)計學差異(p0.05)。6.PANAS-X具體情緒量表評分情況:治療前,兩組患者的該評分無統(tǒng)計學差異,具有可比性(p0.05);治療組組內(nèi)比較治療前后發(fā)現(xiàn),正性情緒評分升高,負性情緒評分下降,與治療前相比有統(tǒng)計學差異(p0.05);對照組組內(nèi)比較治療前后發(fā)現(xiàn),正性情緒評分升高,負性情緒評分下降,與治療前相比有統(tǒng)計學差異(p0.05);組間比較,治療后對照組正性情緒評分升高較對照組明顯,負性情緒評分下降較對照組明顯,差異有統(tǒng)計學意義(p0.05)。研究結(jié)論:1.外踝理筋手法治療陳舊性踝關節(jié)扭傷在緩解疼痛、改善患者踝關節(jié)功能方面臨床療效明顯,并且優(yōu)于目前西醫(yī)常用的踝關節(jié)單純功能療法鍛煉組。2.外踩理筋手法和踝關節(jié)功能療法鍛煉均不能改善踝關節(jié)的解剖關系,所以對于功能性踝關節(jié)不穩(wěn)定療效明顯,對于機械性踩關節(jié)不穩(wěn)定治療效果一般。3.治療組和對照組對改善踝關節(jié)腫脹程度無顯著性差異。4.外踝理筋手法和功能鍛煉治療陳舊性踝關節(jié)扭傷再改善癥狀的同時,均對患者的情緒有積極作用,但是中醫(yī)手法治療組效果明顯優(yōu)于功能鍛煉對照組。
[Abstract]:Objective: To observe the clinical effect of traditional Chinese medicine Orthopedic manipulation on old ankle sprain in the treatment of old ankle sprain, objectively evaluate and verify the effectiveness of the external malleolus manipulation in order to provide reference for the clinical treatment of old ankle sprains. Research methods: from September 2015 to December 2016, the clinical collection was collected. There were 74 cases of unilateral ankle sprain in 66 cases, of which 33 were in the left and 33 in the right, including 29 men, 37 women, 16~64 years old and 36 years. The shortest treatment time was 4 weeks, the longest was 14 months, averaging 6.8 months. The treatment group and the functional exercise group (control group). The treatment group was treated with the external malleolus manipulation, the main points were as follows: 1, hand touch the heart, looking for the points according to the tendons; 2, the manipulation of tendons, shaking, pulling, stamping techniques; 3, smoothing the chores, smoothing the work. The control group was treated with functional exercise treatment, including 1, foot back exercise, foot flexion exercise; 3, ankle varus valgus, valgus ankle joint varus, ankle joint varus, valgus Exercise; 4, heel exercise, and so on. Before and after treatment, the VAS score of pain learning, the degree of swelling of the ankle joint, the Baird-Jackson ankle joint score of A0FAS, the measurement of the talus inclination angle and the PANAS-X specific emotional scale were monitored. The results of the study were that 66 cases of the 1.74 patients were followed up for 1 months and the longest was 6 months. All 4.2 months.2.VAS score: before treatment, there was no statistical difference between the two groups before treatment (P0.05). After treatment, the treatment group was compared with the VAS score before treatment, and the difference was statistically significant (P0.01), compared with the VAS score before treatment in the control group, the difference was statistically significant (P0.01). The degree of VAS score reduction in the comparison group was significantly better than that of the control group (P0.01), and the difference was statistically significant.3. swelling of the ankle joint: there was no statistical difference between the two groups of patients before the treatment (P0.05), and the swelling of the ankle joint was not statistically different (P0.05).4.A0FAS after treatment. Score: the A0FAS score of the two groups before treatment was not statistically significant (P0.05); after treatment, the A0FAS scores in the two groups were all higher than before the treatment and were statistically different (P0.05). After the treatment, the two groups of patients compared with the A0FAS score found that the treatment group was significantly higher than the control group, the difference was statistically significant (P 0.05) the change of the talus inclination angle of.5.: there was no statistical difference between the two groups before treatment, and the talus angle was comparable (P0.05). After treatment, there was no statistical difference between the treatment group before and after treatment (P0.05), and there was no statistical difference between the control group before and after treatment (P0.05), and the same in the two groups was the same. There was no statistical difference (P0.05).6.PANAS-X specific emotional scale score: before treatment, there was no statistical difference between the two groups, and there was a comparability (P0.05). In the treatment group, the positive emotion score increased and the negative emotion score decreased before and after the treatment in the treatment group. Compared with the pre treatment group, there was a statistically significant difference (P0.05), and the comparison group was compared with the control group. Compared with the control group, the positive emotion score of the control group was significantly higher than that of the control group, and the negative emotion score was significantly lower than the control group, and the difference was statistically significant (P0.05). The study conclusion: 1. the 1. lateral malleolus manipulation method. The treatment of old ankle sprain in alleviating pain and improving the function of ankle joint is obvious, and it is superior to the common ankle joint function therapy exercise group in western medicine, which can not improve the anatomical relationship between the ankle joint and the ankle joint function exercise.2., so it is unstable for the functional ankle joint. The curative effect is obvious. There is no significant difference between the.3. treatment group and the control group for the improvement of the ankle joint swelling. The effect of the external malleolus manipulation and the functional exercise treatment on the old ankle sprains and the symptoms can be improved, while the symptoms have positive effects on the mood of the patients, but the effect of traditional Chinese medicine treatment group is effective. It was obviously better than the functional exercise control group.
【學位授予單位】：北京中醫(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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