急性踝关节扭挫伤的处理与预防

<正>发生急性踝关节扭挫伤后,局部肌肉、韧带及肌腱等软组织会有不同程度的撕裂和毛细血管破裂出血,导致局部出现淤血斑、肿胀、疼痛、功能障碍等。此时切记不要     

Syndesmotic ankle sprain

Ankle sprain injuries are the most common type of joint sprain. The prevalence of ankle joint sprains accounts for 21% of joint injuries in the body. Although somewhat rare, high-ankle or syndesmotic ankle sprains occur in up to 15% of ankle trauma. This article will present the pathomechanics of the high-ankle or syndesmotic sprain.     

Valdecoxib provides effective pain relief following acute ankle sprain

We sought to determine whether valdecoxib is as effective as diclofenac in treating acute ankle sprain. Patients (n=202) with acute first- and second-degree ankle sprain were randomized to valdecoxib (40 mg twice daily on day 1 followed by 40 mg once daily on days 2-7) or diclofenac (75 mg twice daily). The primary efficacy end-point was the Patient's Assessment of Ankle Pain visual analogue scale (VAS, 0-100 mm) value on day 4. Valdecoxib was as efficacious as diclofenac in treating the signs and symptoms of acute ankle sprain. The mean VAS reduction in ankle pain on day 4 was not different between groups; the two-sided 95% confidence interval for the between-group difference was within the prespecified limit for non-inferiority (10 mm). There were no significant differences between groups for all secondary efficacy end-points. The two treatments were similarly effective and well tolerated for treatment of acute ankle sprain.     

History of ankle sprain as a risk factor of future lateral ankle sprain in athletes

Despite the attention and focus lateral ankle sprains receive in athletic training practice and research, they remain the most common injury in many sports. Whereas the functional limitations and time loss from lateral ankle sprains are apparent, consistently reducing their incidence is less certain. One important step in preventing lateral ankle sprains is identifying their risk factors. Although previous literature summaries suggest that specific risk factors are inconclusive in predicting lateral ankle sprains, recent literature investigating the predictors of ankle sprains should be included as evidence. Determining the primary risk factors for lateral ankle sprains may lead to good prevention programs, which in turn may decrease time lost because of injury.     

运动贴扎技术对急性踝关节外侧韧带损伤患者早期康复的影响

目的:探讨运动贴扎技术对急性踝外侧韧带损伤后患者踝关节早期康复的影响.方法:将符合入选标准的90例踝关节扭伤患者按随机数字表法分为实验组(A组)、安慰剂组(B组)、对照组(C组),每组30例.C组接受常规治疗(1次/d,30min/次,5d/周,共2周);A组、B组除常规治疗外(1次/d,30min/次,5d/周,共2...     

康复护理在急性腰扭伤患者中的应用效果

目的探讨康复护理在急性腰扭伤患者中的应用效果。方法选取80例急性腰扭伤患者随机分为2组,对照组给予常规护理,实验组加施康复护理干预,比较2组患者康复效果、疼痛与功能障碍、生活质量与护理满意度。结果实验组患者康复总有效率高于对照组,差异有统计学意义(P0.05);实验组患者干预后VAS与RMDQ评分显著低于对照组,差异有统计学意义(P0.01);实验组患者干预后生理机能、生理职能、躯体疼痛、健康状况、精力、社会功能、情感职能与精神健康评分显著高于对照组,差异有统计学意义(P0.01);实验组患者护理满意度评价优于对照组,差异有统计学意义(P0.05)。结论康复护理在急性腰扭伤患者中的应用效果显著,可提高满意度,具有借鉴性。     

Postural control strategies during single limb stance following acute lateral ankle sprain

Background

Single-limb stance is maintained via the integration of visual, vestibular and somatosensory afferents. Musculoskeletal injury challenges the somatosensory system to reweight distorted sensory afferents. This investigation supplements kinetic analysis of eyes-open and eyes-closed single-limb stance tasks with a kinematic profile of lower limb postural orientation in an acute lateral ankle sprain group to assess the adaptive capacity of the sensorimotor system to injury.

Methods

Sixty-six participants with first-time acute lateral ankle sprain completed a 20 second eyes-open single-limb stance task on their injured and non-injured limbs (task 1). Twenty-three of these participants successfully completed the same 20 second single-limb stance task with their eyes closed (task 2). A non-injured control group of 19 participants completed task 1, with 16 completing task 2. 3-dimensional kinematics of the hip, knee and ankle joints, as well as associated fractal dimension of the center-of-pressure path were determined for each limb during these tasks.

Findings

Between trial analyses revealed significant differences in stance limb kinematics and fractal dimension of the center-of-pressure path for task 2 only. The control group bilaterally assumed a position of greater hip flexion compared to injured participants on their side-matched “involved”(7.41 [6.1°] vs 1.44 [4.8]°; η² = .34) and “uninvolved” (9.59 [8.5°] vs 2.16 [5.6°]; η² = .31) limbs, with a greater fractal dimension of the center-of-pressure path (involved limb = 1.39 [0.16°] vs 1.25 [0.14°]; uninvolved limb = 1.37 [0.21°] vs 1.23 [0.14°]).

Interpretation

Bilateral impairment in postural control strategies present following a first time acute lateral ankle sprain.     

Treatment options for ankle ligament sprain

There is a wealth of literature on the management of ankle sprains, but the quality of evidence is variable and conclusions diverge. Practice in emergency departments (EDs) also varies and in some cases does not reflect the evidence base. This article reviews some of the most recent research on the subject and suggests air-stirrup ankle braces can be used in EDs for management of moderate and severe ankle sprains.     

Acute ankle sprain: an update

Acute ankle injury, a common musculoskeletal injury, can cause ankle sprains. Some evidence suggests that previous injuries or limited joint flexibility may contribute to ankle sprains. The initial assessment of an acute ankle injury should include questions about the timing and mechanism of the injury. The Ottawa Ankle and Foot Rules provide clinical guidelines for excluding a fracture in adults and children and determining if radiography is indicated at the time of injury. Reexamination three to five days after injury, when pain and swelling have improved, may help with the diagnosis. Therapy for ankle sprains focuses on controlling pain and swelling. PRICE (Protection, Rest, Ice, Compression, and Elevation) is a well-established protocol for the treatment of ankle injury. There is some evidence that applying ice and using nonsteroidal antiinflammatory drugs improves healing and speeds recovery. Functional rehabilitation (e.g., motion restoration and strengthening exercises) is preferred over immobilization. Superiority of surgical repair versus functional rehabilitation for severe lateral ligament rupture is controversial. Treatment using semirigid supports is superior to using elastic bandages. Support devices provide some protection against future ankle sprains, particularly in persons with a history of recurrent sprains. Ankle disk or proprioceptive neuromuscular facilitation exercise regimens also may be helpful, although the literature supporting this is limited.     

Diagnosis and management options of ankle sprain injury

Ankle sprain is a common injury that accounts for a significant proportion of attendances at A&E. This article describes the anatomy and physiology of the ankle and discusses options for the diagnosis and management of ankle sprain injuries using a case study approach.     

Immediate effects of anterior to posterior talocrural joint mobilizations following acute lateral ankle sprain

Restrictions in ankle dorsiflexion range of motion (ROM) have been associated with decreased posterior talar glide in individuals with an acute lateral ankle sprain. Talocrural joint mobilizations may be used to restore joint arthrokinematics. Our purpose was to examine the effects of a single bout of anterior to posterior (AP) talocrural joint mobilization on self-reported function, dorsiflexion ROM, and posterior talar translation in individuals with an acute lateral ankle sprain. This single-blinded, randomized controlled trial utilized 17 volunteers (nine treatment and eight control) with an acute lateral ankle sprain (grade I/II) who were immobilized for a period of 1–7 days. The treatment group received a single 30-second bout of grade III AP talocrural joint mobilization the day their immobilization device was removed, while the control group did not receive any intervention. Active dorsiflexion ROM and posterior talar translation were assessed before, immediately after, and 24 hours after receipt of the treatment or control interventions. Self-reported function and pain were assessed before and 24 hours after the receipt of the treatment or control interventions using the foot and ankle disability index. Collectively all groups demonstrated improved dorsiflexion ROM and self-reported function. There was a significant decrease in pain perception at 24-hour follow-up for the treatment group. A single bout of AP talocrural joint mobilizations may not have an immediate effect on ankle dorsiflexion ROM, posterior talar translation, or self-reported function; however, they may have an immediate effect on pain perception in individuals with an acute lateral ankle sprain.     

气针加手法治疗急性踝关节扭挫伤90例

BACKGROUND：Airacupuncturetherapyistomakeuseoftimeandspacestimuliofairinacupointandpromotebloodcircu－lationtoremovebloodstasis，relieveswellingandpainthroughin－terstitialosmosisandabsorption．Manipulationtoacutesprainandbruisingofanklejointcanachieveanatomicreductionassoonaspossible，clearincarcerationofsynovium，promotecirculationofqiandrelievepainandincreasebloodcirculationofaffectedtissue．OBJECTIVE：Toobservetheeffectsofairacupuncturetherapycombinedwithmanipulationonacutesprainand…     

Effect of neuromuscular electrical stimulation on ankle swelling in the early period after ankle sprain

BACKGROUND AND PURPOSE: Neuromuscular electrical stimulation (NMES) is frequently used to decrease swelling in the early period after ankle sprain. The purpose of this study was to evaluate its effectiveness in this treatment. SUBJECTS: Thirty-four subjects (11 female, 23 male; mean age=30.2 years) who were recovering from ankle sprain participated. METHODS: Outcome measures were ankle-foot volume, ankle girth, and self-assessed ankle function. Three testing raining sessions occurred within 5 days of injury. Subjects were randomly assigned to 1 of 3 groups: a group that received NMES treatment, a group that received submotor ES treatment (designed to act as a control group), and a group that received sham treatment. RESULTS: There were no statistically significant differences among the groups for ankle-foot volume and self-assessed ankle function. The statistically significant differences for ankle girth may have been compromised due to the significantly different values among groups at baseline. Ankle girth measurements were shown to be statistically significant from session 1 to session 3 for the NMES group but not for the other 2 groups. DISCUSSION AND CONCLUSION: The results indicate that NMES, as designed and used in this study, is not effective in decreasing ankle-foot volume or increasing self-assessed ankle function in the early period after ankle sprain.     

Compression stockings in ankle sprain: a multicenter randomized study

Objectives

Ankle sprain is a frequently encountered traumatic injury in emergency departments and is associated with important health expenses. However, the appropriate care of this traumatic injury remains a matter of debate. We tested the hypothesis that compression stockings speed up recovery from ankle sprain.

Methods

Recent (<48 hours) cases of ankle sprain without other traumatic injury in patients aged between 18 and 55 years were included. Patients were randomly allocated to placebo Jersey or class II compression stockings (Venoflex; Thuasne, Levallois-Perret, France). The primary end point was the time to recovery of normal painless walking without requirement for analgesic drug. Secondary end points were time to return to sport activity, pain, analgesic consumption, and ankle edema (bimalleolar and midfoot circumferences).

Results

We randomized 126 patients and analyzed 117 patients (60 in the placebo group and 57 in the compression group). The median time to normal painless walking was not significantly decreased (P = .16). No significant differences were observed in pain, analgesic consumption, and bimalleloar and midfoot circumferences. No safety issue was reported. In the subgroup of patients with regular sport activity, the time to return to sport activity was shorter in patients treated with compression stockings (P = .02).

Conclusions

Compression stockings failed to significantly modify the time to return to normal painless walking in ankle sprain. A beneficial effect was observed only in a subgroup of patients, as compression stockings significantly decreased the time to return to sport activity.