摘要
目的:观察平乐正骨轻推滑皮走手法用于踝关节骨折术后早期肿痛治疗的临床疗效和安全性,探讨其可能的作用机制。方法:选取踝关节骨折术后早期患者68例,随机分为手法组和对照组,每组各34例。2组患者均在入组后第1天开始治疗,共治疗7 d。对照组采用包括药物治疗、物理治疗、康复锻炼在内的常规治疗,手法组在常规治疗的基础上采用平乐正骨轻推滑皮走手法治疗。比较2组患者患侧踝关节疼痛视觉模拟量表(visual analogue scale,VAS)评分、踝关节肿胀值、踝关节主动活动度,以及外周血中白细胞介素-6(interleukin-6,IL-6)、C-反应蛋白、血浆纤维蛋白原和D-二聚体水平。观察并记录2组患者切口感染、骨折端再移位等并发症发生情况。结果:治疗结束后,2组患者患侧踝关节疼痛VAS评分、踝关节肿胀值均低于治疗前[(4.81±1.98)分,(2.46±0.71)分,t=33.496,P=0.000;(4.92±1.81)分,(2.97±0.82)分,t=30.207,P=0.000;(14.87±5.12)mm,(8.02±2.78)mm,t=27.532,P=0.000;(15.11±6.67)mm,(9.45±3.02)mm,t=23.114,P=0.000],踝关节主动活动度均大于治疗前(20.17°±5.23°,32.76°±8.18°,t=16.893,P=0.000;18.92°±6.12°,28.45°±7.64°,t=15.622,P=0.000);且手法组患侧踝关节疼痛VAS评分、踝关节肿胀值均低于对照组(t=2.742,P=0.008;t=2.031,P=0.046),患侧踝关节主动活动度大于对照组(t=2.245,P=0.028)。治疗结束后,2组患者外周血中IL-6、C-反应蛋白、血浆纤维蛋白原和D-二聚体水平均低于治疗前[(7.11±0.78)pg·mL^(-1),(5.59±0.49)pg·mL^(-1),t=43.453,P=0.000;(7.43±0.82)pg·mL^(-1),(6.01±0.58)pg·mL^(-1),t=40.369,P=0.000;(12.07±4.11)mg·L^(-1),(8.18±2.92)mg·L^(-1),t=22.164,P=0.000;(12.41±4.45)mg·L^(-1),(9.87±3.01)mg·L^(-1),t=20.628,P=0.000;(5.14±1.09)μg·L^(-1),(2.07±0.31)μg·L^(-1),t=32.723,P=0.000;(5.21±1.22)μg·L^(-1),(2.61±0.82)μg·L^(-1),t=28.129,P=0.000;(2.34±0.79)mg·L^(-1),(1.05±0.26)mg·L^(-1),t=25.601,P=0.000;(2.56±0.87)mg·L^(-1),(1.28±0.34)mg·L^(-1),t=21.114,P=0.000],且手法组均低于对照组(t=3.225,P=0.002;t=2.350,P=0.022;t=3.592,P=0.001;t=3.133,P=0.003)。2组患者均未发生切口感染、骨折端再移位等并发症。结论:平乐正骨轻推滑皮走手法用于踝关节骨折术后早期肿痛的治疗,可有效缓解关节疼痛,减轻关节肿胀,改善关节活动度,且安全性高;作用机制可能与其可降低患者外周血中IL-6、C-反应蛋白、血浆纤维蛋白原和D-二聚体水平有关。
Objective:To observe the clinical outcomes and safety of Pingle Zhenggu(平乐正骨,PLZG)gently-pushing&sliding-on-skin manipulation for treatment of early swelling and pain after the surgery of ankle fracture,and to explore its underlying mechanism.Methods:Sixty-eight patients who just underwent surgery for ankle fracture were selected and randomized into manipulation group and control group,34 ones in each group.All patients in the 2 groups were treated with the conventional treatment including drug therapy,physical therapy and rehabilitation exercises;while the ones in manipulation group were further treated with PLZG gently-pushing&sliding-on-skin manipulation.All patients were treated from the first day after enrollment for consecutive 7 days.The affected ankle pain visual analogue scale(VAS)score,ankle swelling value,ankle active range of motion(ROM),and the levels of interleukin-6(IL-6),C-reactive protein(CRP),plasma fibrinogen(FIB)and D-dimer in peripheral blood were compared between the 2 groups.Furthermore,the complications,such as incision infection and re-displacement of the fractured end,in the 2 groups were observed and recorded.Results:The affected ankle pain VAS score was lower,the ankle swelling value was smaller,and the ankle active ROM was greater after the end of the treatment compared to pre-treatment(4.81±1.98 vs 2.46±0.71 points,t=33.496,P=0.000;4.92±1.81 vs 2.97±0.82 points,t=30.207,P=0.000;14.87±5.12 vs 8.02±2.78 mm,t=27.532,P=0.000;15.11±6.67 vs 9.45±3.02 mm,t=23.114,P=0.000;20.17±5.23 vs 32.76±8.18 degrees,t=16.893,P=0.000;18.92±6.12 vs 28.45±7.64 degrees,t=15.622,P=0.000);and the affected ankle pain VAS score was lower,the ankle swelling value was smaller,and the affected ankle active ROM was greater in manipulation group compared to control group(t=2.742,P=0.008;t=2.031,P=0.046;t=2.245,P=0.028).The levels of IL-6,CRP,plasma FIB and D-dimer in peripheral blood decreased in the 2 groups after the end of the treatment compared to pre-treatment(7.11±0.78 vs 5.59±0.49 pg/mL,t=43.453,P=0.000;7.43±0.82 vs 6.01±0.58 pg/mL,t=40.369,P=0.000;12.07±4.11 vs 8.18±2.92 mg/L,t=22.164,P=0.000;12.41±4.45 vs 9.87±3.01 mg/L,t=20.628,P=0.000;5.14±1.09 vs 2.07±0.31μg/L,t=32.723,P=0.000;5.21±1.22 vs 2.61±0.82μg/L,t=28.129,P=0.000;2.34±0.79 vs 1.05±0.26 mg/L,t=25.601,P=0.000;2.56±0.87 vs 1.28±0.34 mg/L,t=21.114,P=0.000),and they were lower in manipulation group compared to control group(t=3.225,P=0.002;t=2.350,P=0.022;t=3.592,P=0.001;t=3.133,P=0.003).No patients in the 2 groups suffered from complications,such as incision infection and re-displacement of the fractured end.Conclusion:PLZG gently-pushing&sliding-on-skin manipulation can effectively relieve joint pain,alleviate joint swelling,and improve joint ROM in treatment of early swelling and pain followed the surgery of ankle fracture,and it exhibits high safety.It may exert the effects by reducing the levels of IL-6,CRP,plasma FIB and D-dimer in peripheral blood.
作者
蒋拥军
汪伟
邵开超
艾怡然
陈佳旭
何梦凡
严翔
JIANG Yongjun;WANG Wei;SHAO Kaichao;AI Yiran;CHEN Jiaxu;HE Mengfan;YAN Xiang(Shenzhen Pingle Orthopedic Hospital(Shenzhen Pingshan District Hospital of Traditional Chinese medicine),Shenzhen 518010,Guangdong,China)
出处
《中医正骨》
2024年第5期26-31,共6页
The Journal of Traditional Chinese Orthopedics and Traumatology
基金
广东省中医药局中医药科研项目(20221333)。
关键词
踝部骨折
疼痛
手术后
肿
推拿疗法
ankle fractures
pain,postoperative
swelling
tui na therapy
