正骨理筋手法配合弹力绷带外固定对踝关节撞击综合征关节镜术后关节功能恢复及SAS的病例对照研究

摘要

Objectives To evaluate the clinical efficacy of joint function recovery after arthroscopy of ankle soft-tissue impingement syndrome (ASTIS) by the method of manipulation combined elastic bandage external fix-ation, and to observe the impact on the self-rating anxiety scale (SAS). Methods Seventy cases of ASTIS from January 2015 to December 2016 in our hospital were randomly divided into manipulation treatment group and control group (each n=35). Patients in manipulation treatment group accepted bone-setting manipulation combined with elastic bandage external fixation after arthroscopy, meanwhile the control group were given regu-lar manipulation technique combined with elastic bandage external fixation. All patients were treated for two courses (7 days as a course), and followed for 3 months. The clinical efficacy was evaluated using ogilvis-harris ankle score, AOFAS score and SAS. Results The total efficiency was 91.4%(32/35) in the manipulation treat-ment group and 80.0%(28/35) in the control group with significant difference between two groups (Z=-1.987, P=0.047). The Ogilvie-Harris and AOFAS scores of manipulation treatment group were higher than those of the control group (P<0.05) after treatment for two weeks and 3 months. The levels of anxiety were relieved, while the SAS had no difference in two groups (χ2=0.753, P=0.861). Conclusion Manipulation combined with elas-tic bandage external fixation can be used to treat ASTIS after arthroscopy, and can significantly improve the an-kle function.%目的:评价正骨理筋手法配合弹力绷带外固定对踝关节撞击综合征(ASTIS)关节镜术后关节功能恢复的临床疗效,及对焦虑自评量表(SAS)的影响.方法:符合入选标准的70例ASTIS关节镜术后患者分为正骨手法组和对照组各35例,正骨手法组在踝关节镜术后给予正骨手法及弹力绷带外固定;对照组在踝关节镜术后给予常规理筋手法及弹力绷带外固定.两组治疗时间均为2疗程,每疗程7 d,2疗程结束后继续随访3个月.采用Ogilvie-Harris踝关节评分、AOFAS评分及SAS量表评价临床疗效.结果:正骨手法组总有效率为91.4%(32/35),对照组为80.0%(28/35),2组差异有统计学意义(Z=-1.987,P=0.047).治疗后2周正骨手法组Ogilvie-Harris评分为(10.88±1.35)分、治疗后3个月为(13.24±1.63)分,均高于对照组(P<0.05).治疗后2周正骨手法组AOFAS评分(80.30±7.01)分,治疗后3个月为(89.27±4.32)分,均高于对照组(P<0.05).正骨手法组与对照组治疗后焦虑情绪均得到缓解,差异均有统计学意义;两组治疗后SAS比较,差异无明显统计学意义(χ2=0.753,P=0.861).结论:ASTIS关节镜术后运用正骨理筋手法配合弹力绷带外固定是将微创关节镜技术与传统中医正骨手法、弹性外固定相结合,临床疗效超过简单叠加的效果,能够显著改善踝关节功能,降低焦虑情绪,是一种简便、有效的综合治疗方案.