The Clinical Observation And Discussion On Mechanism Of Sunshi’s Manipulation In Treating Chronic Ankle Sprain

Background:Ankle sprains are common in clinic. In anterior dislocation of pure ankle sprains, fractures, is often neglected, which would evolve into chronic ankle sprain. Chronic ankle sprains can lead to chronic pain around the ankle and ankle instability, the last may also lead to severe ankle osteoarthritis, that must be joint fusion or joint replacement, causing serious social and economic burden. Professor shu-chun sun’s bonesetting method is very effective. This study is divided into four parts. The first part is the review. Including the professor shu-chun sun biographies and bonesetting qing academic origin and traumatology understanding of ankle sprains and treatment, the current understanding of ankle sprains and modern medicine treatmen. The second part is the academic thoughts and clinical experience of professor shu-chun sun. This part of a total of seven aspects. Mainly includes shu-chun sun professor of orthopedics muscle injury disease the understanding and treatment of diseases of the first heavy technique, dialectical and combined disease, technique combined with medication, and academic characteristic and the origin and characteristics of ankle external ankle manage reinforcement technique. The third and the fourth part for our use the professor shu-chun sun external ankle qing manage reinforcement technique to treat clinical common disease clinical observation and the mechanism of chronic ankle sprain.Objectives:1 Jo observe and evaluate the clinical curative effect of external ankle qing manage reinforcement technique.Objectively evaluate and validate the effectiveness of the technique in the treatment of clinical common disease of traditional Chinese medicine.To improve the clinical curative effect of chronic ankle injury(CAS).2.Through musculoskeletal ultrasound(MUSU) and foot pressure measurement(FPM) system to explore external ankle qing reinforcement technique for the treatment of chronic ankle injury mechanism.Methods:1.Clinical observation:Select 110 cases accordance with the inclusive criteria, Eventually 89 cases conform to the standard and have complete information. A random, single-blind parallel study was conducted.89 cases were randomly divided into treatment group and control group. The treatment group of 52 cases (13 males and 39 females), control group of 37 cases (14 males and 23 females). Patients were unilateral ankle injury, all is the internal injury, has a different degree of external ankle pain. The right side of the 66 cases,23 cases of the left. History of the shortest is 3 weeks, the longest history is 11 months, an average of 4.7 months. The minimum age 18, maximum age 62 years old. The treatment group specific implementation points:①With the hand massage, feel with heart:In external ankle place to find and soft light point "tendons knot".② Handle the reinforcement: Wait until" tendonsknot" become soft.treat ing with "Shake、Pull、Fbke". ③Brush to close work:Walked along the tendon ligament line direction last sequence channels. In the control group, patients were treated with Functional exercise. Includes the following several aspects. ①Dorsalis pedis stretching exerc.②Foot plantar flexion exercise.③Inside and outside the ankle exercise.④Lift heel exercise. Two groups of patients before and after treatment for Visual Analogue Score(VAS), Baird-Jackson ankle American Orthopedic Foot Andankle Society(AOFAS) score, talus slope Angle measurement.2.Discuss the pathogenesis:A total of 36 patients with history of six months or more (14 males and 22 females). For external ankle qing manage reinforcement technique as compared before and after treatment. The average follow-up of 6.3 months. Sudy 1:Musculoskeletal ultrasound ankle joint lateral collateral ligament. For before and after treatment of ankle talofibular ligaments, before with after ligament and talofibular ligaments to high frequency ultrasound. To observe:① Record the thickness of the ankle joint lateral collateral ligament.② Observe the continuity of ligament fiber. ③ Ankle ligament tension in the process of movement.④ The lateral collateral ligament around hematoma area.⑤ In the amount of fluid in the ankle. Study 2:Were observed before and after treatment in patients with plantar focus distribution and the walking gait changes.Results:1.Clinical outcome:Minimum 3 months follow-up time, the longest follow-up for two years。An average of 13.6 months. Visual analogue scale:Intra-group comparison:Two groups of patients after treatment and final statistics Visual analogue scale were lower than before treatment. The difference have statistically significant(P<0.05, P<0.01); Two groups of patients with final statistics Visual analogue scale shows the following results:The treatment group showed a trend of rise and the control group showed a trend of reduce, The difference have statistical sense (P<0.05). Comparison between the two groups:No statistical difference was found between two groups of patients before treatment(P>0.05), After treatment and at the end of the time, the treatment group pain score lower than the control group.The difference have statistical sense(P<0.05, P<0.01). AOFASscore situation: AOFAS score after treatment in both groups compared with before treatment showed a trend of rise The difference have statistical sense(P<0.05, P<0.01). Before the treatment, There was no statistically significant difference in treatment group and control group(P>0.05). After treatment, Treatment group is higher than the control group in AOFASscore, the difference have statistically significant (P<0.05) An X-ray stress the talus slope:The treatment group and control group in the aspect of the talus slope do not have statistically significant (P>0.05)2.Pathogenesis of discussion result:36 patients were followed up, For outpatient follow-up way. The last follow-up to injury time averaged 6.3 months. Number of manipulation treatment with an average of 7.8 times. Treatment time not more than 10 minutes at a time. Musculoskeletal ultrasound:Incidence of ankle part of the lateral collateral ligament rupture or part of a relaxation of the patients.36 cases before and after treatment the average follow-up of 6.3 months. Found the anterior talofibular ligament is the most common injuries. It is the most difficult to cure. It always injuries combined injuries of anterior talofibular ligament and calcaneofibular ligament. Calcaneofibular ligament can be cured by manipulation treatment. This group of patients can be divided into contusion and part of the fracture. All good continuity ligament before treatment. Ligament tension perfor-mance for relaxation. Ligament with different area around the hematoma. Ligament around has obvious effusion. In the treatment of after a period of time, using the ultrasonic industry recognized comprehensive curative effect evaluation ofcura-tive effect evaluation standard. Its effectiveness is 97.2% for anterior talo-fibular ligaments.88.9%for calcaneofibular ligament.83.3%for posterior talo-fibular ligament. To various ligament thickness values measured by ultrasound and statistical analysis. Treatment group of thickness of ankle recovered before the treatment. There are significant differences (P<0.05). Foot focus distribution and walking gait:Chronic ankle injury in patients with plantar lateral pressure increased significantly. Plantar pressure center offshoring appear. With suff-icient distance with foot-massage center of pressure oscillation significantly bigger. After manipulation treatment in patients with plantar pressure center and center of gravity swing quickly restored to health side level distance.Conclusions:1.Sun-style external ankle qing manage reinforcement technique treatment of chronic ankle sprain in pain relief and improve the function of ankle joint clinical curative effect is distinct, treatment and curative effect is superior to the simple function.2.Because external ankle qing reinforcement technique and ankle function exercise therapy can improve the ankle anatomy relationship, so this technique has a good effect for functional ankle instability, curative effect for mechanical ankle instability.3.Musculoskeletal ultrasound confirmed:technique improved ligament tension and thickness, the function of eliminating surrounding hematoma and effusion. Sun-style technique improved sole focus displacement and the effect of gait. Use modern technology to prove the clinical curative effect mechanism of the old style of traditional Chinese medicine...