急性踝关节外侧韧带损伤的临床研究
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摘要
目的：观察功能疗法对急性踝关节外侧韧带损伤的治疗效果并探讨其作用机制。方法：将吉林省中医院骨科门诊和急诊的83例患者随机分为治疗组38例和对照组45例，治疗组采用功能治疗法治疗，对照组应用石膏固定。比较治疗前后两组患者在肿胀、距骨倾斜角(talar tilt，简称TT)，踝关节活动范围等指标方面的差异。结果：功能疗法能减轻踝关节肿胀的发生，有利于踝关节关节活动的恢复。结论：对于急性踝关节外侧韧带损伤的治疗，功能疗法要明显好于单纯石膏固定。
Objective: To observe the clinical effect of acute injury of lateral ligament of the ankle with functional therapeutics. Method: All 83 cases were collected from orthopaedics of Affiliated Hospital of Changchun University of TCM, and were randomly divided into testing group(38 cases) and controlling group(45 cases).The testing group was treated with functional therapeutics, and the other was treated with U-figure cast. The difference on marker of swell, talar tilt and the ankle range of motion. Result: functional therapeutics is better in reliving swell and regaining better ankle range of motion. Conclusion: Functional therapeutics is better than U-figure cast in treatment of acute injury of lateral ligament of the ankle.
Objective: To observe the clinical effect of acute injury of lateral ligament of the ankle with functional therapeutics. Method: All 83 cases were collected from orthopaedics of Affiliated Hospital of Changchun University of TCM, and were randomly divided into testing group(38 cases) and controlling group(45 cases).The testing group was treated with functional therapeutics, and the other was treated with U-figure cast. The difference on marker of swell, talar tilt and the ankle range of motion. Result: functional therapeutics is better in reliving swell and regaining better ankle range of motion. Conclusion: Functional therapeutics is better than U-figure cast in treatment of acute injury of lateral ligament of the ankle.
引文
[1] 王亦璁．黄家驷外科学，人民卫生出版社，1992：2211．
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[4] Karlsson J, Brandsson S, Jerre R, et al. Ligment injuries of the ankle joint. Ankle and Foot,1999,10(3):179～185.
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[8] Burks RT, Morgan J. Anatomy of the lateral ankle ligaments. Am J Sports Med. 1994, 22(I):72～77.
[9] Delfaut EM, Demondion X, Boutry N, et al. Multi-fasciculated anterior talo-fibular ligament: reassessment of normal findings. Eur Radiol, 2003, 13:1836～1842.
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[45] 朱建斌，薛亮．内外关配合交经刺治疗踝关节扭伤132例．辽宁中医杂志，2004，31(3)：250．
[46] 王铁刚，公维志．针刺加微波疗法治疗踝关节扭伤31例．针灸临床杂志，2004，20(9)：11．
[47] 梁守义．活血化瘀丸治疗踝关节扭伤210例．辽宁中医杂志，2004，31(5)：294．
[48] 罗玉梅．活血汤治疗踝关节扭伤200例．中医药信息，2003，20(5)：39．
[49] Pijnenburg ACM, VanDijk CN, Bossuyt MM, et al. Treanment of ruptures of the lateral ankle ligaments: A meta-analysis[J].J Bone Joint Surg(Am), 2000, 82: 761～773.
[50] Takebayashi T, Yamashita T, Minaki Y, et al.Mcchanosenstive afferent units in lateral ligament of the ankle[J].J Bone Joint Surg(Br)1997, 79: 490～493.
[51] Hazanas S, Galvez L, Cepes JA.Functional stabilization versus orthopedic immobility in grade Ⅰ-Ⅱ ankle spain[J].Aten Primaria, 1999, 23(7): 452～458
[52] Kaikkonen A, Hyppanen E, Kannus P, et al. Long-term functional outcome after primary repair of the lateral ligaments of the ankle[J].Am J Sports Med, 1997, 25: 150～155.
[53] Colville MR. Recontruction of the lateral ankle ligament[J].J Bone Joint Surg(Am), 1994, 76: 1092～1102.
[54] Beeker HP, Rosenbaurn D, Zeithammel G, et al. Tenodesis versus cargon fiber repair of the ankleIigament[J]. Clin Orthop, 1996, 325: 194～202.
[55] Karlsson J, Eriksson BI, Bergsten T, et al. Comparison of two reconstructions for chronic lateral instability of the anklejoint[J].Am J Sports Med, 1997, 25: 46～53.
[56] Becker HP, Rosenbaurn D Chronic recurent ligament instability on the lateral ankle[J].Orthopede, 1999, 28(60): 483～492.
[57] Ishii T, Miyagawa S, Fukubayashi T, et al. Subtalar stress radiography using forced dorsiflexion and supination[J]. J Bone Joint Surg(Br), 1996, 78: 56～60
[58] Mabit C, Boncoeur MP, Chaudrue JM, et al Anatomic and MRI study of the subtalar ligamentous support[J]. Surg Radiol Anat, 1997, 19: 111～117.
[59] 国家中医药管理局．中医病症诊断疗效标准．南京：南京大学出版社，1994，第一版：130．
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[61] Hopkinson WZ St, Pierre P, Ryan JB, et al.Syndesmosis sprains of the ankle .Foot and Ankle,1990, 10:325～330.
[62] 现代骨科学．James H．Beaty主编．戴魁戎主译．北京：科学技术文献出版社，2003，2：10．
[63] Eiff MP, Smith AT, Smith GE. Early mobilization versus immobilization in the treatment oflateral ankle sprains. Am J Sprots Med.1994, 22(1):83～88.
[64] Karlsson J, Eriksson BI. Early functional treatment for acute ligament injuries of the ankle joint. Scan J Med Sci Sports.1996, 6(6):341～345.
[65] 祖晓水，戴尅戎，侯筱魁．踝关节外侧副韧带损伤的研究现状．中华创伤杂志．1995，11(1)：54～57．
[66] Hazanas S, Galvez L, Cepes JA. Functional stabilization versus orthopedic immobility in grade Ⅰ Ⅱ ankle sprain. Aten Primaria, 1999,23 (7):452～455.
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[2] 吴先国．人体解剖学[M]，第四版，北京：人民卫生出版社，2001：56～58．
[3] Schneck CD,Mesgarzadeh M,Bonakdarpour A, Ross et al.MR Imaging of the most commonly injured ankle ligaments, part Ⅰ Normal anatomy.Radiology, 1992,184:499～506.
[4] Karlsson J, Brandsson S, Jerre R, et al. Ligment injuries of the ankle joint. Ankle and Foot,1999,10(3):179～185.
[5] Rosenbaum D, Becker HP, Wilke HJ, et al. Tenodeses destroy the kinematic coupling of the ankle joint complex: A Three-Dimensional In Vitro Analysis of Joint Movement.J Bone Joint Surg, 1998, 80-B(1): 162～168.
[6] Safran MR, Benedetti RS, Bartolozzi AR 3rd, et al. Lateral ankle sprains: an comprehensive review Part 1 :etiology, pathoanatomy, histopathogenesis and diagnosis. Medicine science in sports exercise 1999, 31(7):429-437.
[7] McDermott JE, Scranton PE Jr, Rogers JV. Variations in fibular position, talar length, and anterior talofibular ligament length. Foot Ankle Int, 2004, 25(9):625～629.
[8] Burks RT, Morgan J. Anatomy of the lateral ankle ligaments. Am J Sports Med. 1994, 22(I):72～77.
[9] Delfaut EM, Demondion X, Boutry N, et al. Multi-fasciculated anterior talo-fibular ligament: reassessment of normal findings. Eur Radiol, 2003, 13:1836～1842.
[10] Boruta PM, Bishop JO, Braly WG et al. Acute lateral ankle ligament injuries: a literature review. Foot and ankle, 1990,11 : 107～113.
[11] Marder RA. Current methods for the evaluation of ankle ligament injuries. J Bone joint Surg, 1994, 76:1103～1111.
[12] 燕晓宇，俞光荣．踝关节不稳定的生物力学研究现状．国外医学骨科学分册，2003，24(4)：230～233．
[13] Milner CE, SoamesAnatomy of the collateral ligaments of the human ankle point. Foot Ankle Int, 1998, 19:757～760.
[14] Bahr R, Pena F, Shine J, et al. Mechanics of the anterior drawer and talar tilt tests. Foot&Ankle International, 1998, 19(11):782～783.
[15] Rule J, Yao L, Seeger LL. Spring ligament of the ankle: Normal MR anatomy. AM J Roentgenol, 1993, 161 : 1241.
[16] Mitchell A, Kaein M. MR Imaging of the ankle: Normal and abnormal findings in the medial collateral ligament. AJR, 1994, 162:377～383.
[17] Michelson JD, Varner KE, Checcone M. Diagnosing Deltoid Injury in Ankle Fractures: The Gravity Stress View. Clinical Orthopaedics Related Research, 2001, 387:178～182.
[18] Michelson JD, Hamel AJ, Buczek FL, et al. J Bone Joint Surg Am,2002, 84(11): 2029～2038.
[19] Rosenberg ZS, Cheung YY, Beltran J, et al. Posterior intermalleolar ligament of the ankle: normal anatomy and MR imaging features.Am J Roentgenol, 1995, 165(2):387～390.
[20] Lee SH, Jacobson J, Trudell D, et al. Ligaments of the ankle: Normal anatomy with MR arthrography, 1998, 22(5):807～813.
[21] Cox JS. Surgical and nonsurgical treatment of acute ankle sprains.Clin Orthop, 1985, 198:118～126.
[22] Hamilton WG Surgical anatomy of the foot and ankle. Clin Symp, 1985, 37(3):1～32.
[23] 施祀，王和鸣．骨伤科学．北京：人民卫生出版社，2001，1：903～945，1068～1071．
[24] 胡继功，陈家平，李遵梦．从肝论治急性踝关节扭伤98例．辽宁中医志，2000，27(12)：553．
[25] Hopkinsm WZSt, Piere P, Ryan JB, et al. Syndesmosis sprains of the ankle [J]. Foot and Ankle, 1990, 10: 325～330.
[26] Lee MS,Hofbauer MH. EvMuation and management of laterl ankle injuries [J]. Clin Podiatr Med Surg, 1999, 16(4): 659～678.
[27] Jarde O, Havet E, Gabrion A, et al Long-term outcome following surgical of ruptures of the fibular collateral ligament of the ankle[J].Acta Orthop Belg,1999,65(3): 340～345.
[28] Ozeki S,Yasumura K Ligament injuries in the ankle joint[J].Current Opinion in Orthopedics, 1998, 9(3): 24～29.
[29] Karlsson J,Jerry R,Brandsson S.Ligament injuries of the ankle joint [J]. Curent Opinion in Orthopedics, 1998, 9(3): 1～8.
[30] Leith JM, McConkey JP, Masri B. Valgus streas radiography in normal ankle [J].Foot Ankle Int, 1997, 18: 654～657.
[31] Xenos MJS, Hopkinson WJ.The tibiofibular syndesmosis[J].J Bone Joint Surg(Am), 1995, 77: 847～856.
[32] Black HM, Brand RL.Eichelberger MR. An improved technique for the evaluation of ligamentous injury in severe ankle sprains[J] Am J Sports Med, 1978, 6: 276～282.
[33] Frey C, Bell J, Teresi L, et al.A comparison of MRI and clinical examination of acute lateral ankle sprains[J].Foot Ankle Int, 1996, 17: 533～537.
[34] Gaebler C, Kukla C, Breitenseher M J, et al. Diagnosis of lateral ankle ligament injuries: comparison between talar tilt, MRI and operative in 112 athletes[J].Acta Orthop Scand, 1997, 68: 286～290.
[35] Zanetti M , De Simoni C, Wetz HH, et al.Magnetic resonance imaging injuries to the ankle joint: can it predict clinical outcome[J]? Skeletal Radiol, 1997, 26: 82～88.
[36] Akseki D, Pinar H, Bozkurt M,et al. The distal fascicle of the anterior inferior tibio-ribular ligament as a cause of anterolateral ankle impingement: results of arthroscopic resection[J].Acta Orthop Scand, 1999, 70: 478～482.
[37] Maryrnont JV, Lynch MA, Henning CE.Actue ligamentous diastasis of the ankle without fracture: Evaluation by radionuclide imaging[J].Am J Sports Med, 1986, 14: 407～409.
[38] Bahr R,Lian O, Bahr IA.A twofold reduction in the incidence ofactue ankle speains in volleyball after the introduction of an injury prevention program[J] Scand J MedSci Sports, 1997, 7: 168～171.
[39] Sheth P, Yu B, Laskowskl ER. et aI.Ankle disk training influences reaction times of selected muscles in a simulated ankle sprain [J].Am J Sports Med, 1997, 25: 538～544.
[40] Manfroy PP, Ashton JA, Wojtys EM.The effect of exercise, prewrap, and athletic tape on the maximal active and passive ankle resistance to ankle inversbn [J]. Am J Sports Med, 1997, 25: 156～163.
[41] 高建，张雷迎．消肿止痛膏在踝关节扭伤中的应用．中医外治杂志，2004，13(3)：53．
[42] 李照民，赵丹江．自制消瘀膏外敷治疗急性踝关节扭伤73例．中医药学报，2003，31(2)，48．
[43] 余洁，刘秀清．中药熏洗治疗踝关节扭伤．河南中医，2004，24(8)：43～44．
[44] 李金宝．挤压手法治疗急性踝关节扭伤30例疗效观察．中华实用中西医杂志，2003， 3(16)：857-852．
[45] 朱建斌，薛亮．内外关配合交经刺治疗踝关节扭伤132例．辽宁中医杂志，2004，31(3)：250．
[46] 王铁刚，公维志．针刺加微波疗法治疗踝关节扭伤31例．针灸临床杂志，2004，20(9)：11．
[47] 梁守义．活血化瘀丸治疗踝关节扭伤210例．辽宁中医杂志，2004，31(5)：294．
[48] 罗玉梅．活血汤治疗踝关节扭伤200例．中医药信息，2003，20(5)：39．
[49] Pijnenburg ACM, VanDijk CN, Bossuyt MM, et al. Treanment of ruptures of the lateral ankle ligaments: A meta-analysis[J].J Bone Joint Surg(Am), 2000, 82: 761～773.
[50] Takebayashi T, Yamashita T, Minaki Y, et al.Mcchanosenstive afferent units in lateral ligament of the ankle[J].J Bone Joint Surg(Br)1997, 79: 490～493.
[51] Hazanas S, Galvez L, Cepes JA.Functional stabilization versus orthopedic immobility in grade Ⅰ-Ⅱ ankle spain[J].Aten Primaria, 1999, 23(7): 452～458
[52] Kaikkonen A, Hyppanen E, Kannus P, et al. Long-term functional outcome after primary repair of the lateral ligaments of the ankle[J].Am J Sports Med, 1997, 25: 150～155.
[53] Colville MR. Recontruction of the lateral ankle ligament[J].J Bone Joint Surg(Am), 1994, 76: 1092～1102.
[54] Beeker HP, Rosenbaurn D, Zeithammel G, et al. Tenodesis versus cargon fiber repair of the ankleIigament[J]. Clin Orthop, 1996, 325: 194～202.
[55] Karlsson J, Eriksson BI, Bergsten T, et al. Comparison of two reconstructions for chronic lateral instability of the anklejoint[J].Am J Sports Med, 1997, 25: 46～53.
[56] Becker HP, Rosenbaurn D Chronic recurent ligament instability on the lateral ankle[J].Orthopede, 1999, 28(60): 483～492.
[57] Ishii T, Miyagawa S, Fukubayashi T, et al. Subtalar stress radiography using forced dorsiflexion and supination[J]. J Bone Joint Surg(Br), 1996, 78: 56～60
[58] Mabit C, Boncoeur MP, Chaudrue JM, et al Anatomic and MRI study of the subtalar ligamentous support[J]. Surg Radiol Anat, 1997, 19: 111～117.
[59] 国家中医药管理局．中医病症诊断疗效标准．南京：南京大学出版社，1994，第一版：130．
[60] 陆宸照．踝关节损伤的诊断和治疗．上海：上海科学技术文献出版社，2000，第一版：125．
[61] Hopkinson WZ St, Pierre P, Ryan JB, et al.Syndesmosis sprains of the ankle .Foot and Ankle,1990, 10:325～330.
[62] 现代骨科学．James H．Beaty主编．戴魁戎主译．北京：科学技术文献出版社，2003，2：10．
[63] Eiff MP, Smith AT, Smith GE. Early mobilization versus immobilization in the treatment oflateral ankle sprains. Am J Sprots Med.1994, 22(1):83～88.
[64] Karlsson J, Eriksson BI. Early functional treatment for acute ligament injuries of the ankle joint. Scan J Med Sci Sports.1996, 6(6):341～345.
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