基于筋束骨理论逆移位复位手法对尸体模型旋后-外旋型踝关节骨折的作用  

Reverse displacement manipulative reduction of the supination external rotation type ankle joint fracture based on tendon and bone theory:A cadaveric study

作　　者：陈奕历 黄晓宇 成永忠[1] 陈洋 许晶晶 张琪 程灏[1] 史长龙[1] 温建民[1] CHEN Yi-li;HUANG Xiao-yu;CHENG Yong-zhong;CHEN Yang;XU Jing-jing;ZHANG Qi;CHENG Hao;SHI Chang-long;WEN Jian-min(Wanging Hospital of China Academy of Chinese Medical Sciences,Beijing 100102,China:;Beijing University of Chinesc Medicine,Beijing 100029,China)

机构地区：[1]中国中医科学院望京医院,北京100102 [2]北京中医药大学,北京100029

出　　处：《中华中医药杂志》2022年第5期2764-2768,共5页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：中国中医科学院科技创新工程项目(No.CI2021A02008)

摘　　要：目的:验证筋束骨理论逆移位复位手法对旋后-外旋型Ⅳ度骨折尸体模型复位有效性。方法:研究采用6对完整足踝尸体模型暴力制备成旋后-外旋型Ⅳ度骨折模型。将同一对左右足进行配对,随机选一足先采用逆移位复位手法,再次施加暴力造模后进行传统逆损伤手法复位;而另一配对足则相反。将模型分为骨折模型组、逆移位手法复位组和传统逆损伤手法复位组,对比组间作用力,X线检测内外踝移位、胫距间隙、下胫腓联合间隙,距骨倾斜角度与距骨前移位,以评估其复位优良率和复位效果。结果:与骨折模型组比较,两种手法组的正侧位内外踝位移、胫距间隙宽度和距骨倾斜角均显著减小(P<0.01)。与传统逆损伤手法组比较,逆移位复位手法组的平均最大牵引力较大,内外踝平均最大叩挤力小,差异有统计学意义(P<0.05);而逆移位复位手法在外踝和胫距间隙宽度的复位优率高、内踝优率低,差异具有统计学意义(P<0.05)。结论:逆移位复位手法能对旋后-外旋型Ⅳ度骨折进行有效复位,优良率高,但对内踝复位效果差;与传统逆损伤复位手法相比,逆移位复位手法对外踝和距骨复位具有优势。Objective: To verify the effectiveness of tendon and bone theory reverse displacement manipulation in the reduction of supination external rotation degree Ⅳ fracture cadaver model. Methods: Six pairs of complete ankle cadaveric models were used to prepare the supination external rotation degree Ⅳ fracture model. In the experiment, the same pair of left and right feet were paired, and one foot was randomly selected. First, the reverse displacement technique was used for reduction,and then the traditional reverse injury technique was used for reduction after violent modeling;The other pair of feet was the opposite. The models were divided into fracture model group, reverse displacement manual reduction group and traditional reverse injury manual reduction group. The force between the groups, X-ray displacement of upper and outer malleolus, tibiotalar space,lower tibiofibular joint space, talus inclination angle and anterior talus displacement were compared to evaluate the excellent rate and effect of reduction. Results: Compared with the fracture model group, the displacement of medial and lateral malleolus,tibiotalar space and talus inclination angle in the two manipulation groups were significantly reduced(P<0.01). Compared with the traditional reverse injury manipulation, the displacement of medial and lateral malleolus, tibiotalar space and talus inclination angle in the two manipulation groups were significantly reduced(P<0.05);The excellent rate of reverse displacement manipulation in the width of lateral malleolus and tibiotalar space was high, and the excellent rate of medial malleolus was low(P<0.01).Conclusion: The reverse displacement manipulation can effectively reduce supination external rotation Ⅳ fracture, with high excellent rate, but poor effect on medial malleolus. Compared with the traditional reverse injury reduction method, the reverse displacement method has advantages in the reduction of lateral malleolus and talus.

关 键 词：踝关节骨折 筋束骨 旋后-外旋型 手法复位 尸体研究 逆移位复位手法 

分 类 号：R274.1[医药卫生—中医骨伤科学]