目的 探究外踝摇拔戳手法联合支具固定“动静结合”治疗Hepple I—Ⅲ型距骨骨软骨损伤（OLT）的临床疗效。 方法 选取2022年6月至2023年12月在4家医院就诊的OLT患者82例，两组患者治疗均佩戴踝关节支具固定的基础上，对照组采用外用扶他林乳胶剂，每日外用使用2次（早晚各1次），30 d为1个疗程，共治疗1个疗程；试验组在对照组的基础上加用摇拔戳手法治疗，手法治疗2次/周，治疗天数及疗程同对照组。两组治疗前、治疗2周后、4周后及疗程结束后2个月随访，治疗与随访期间均佩戴踝关节支具固定。观察并记录相关疗效指标疼痛评定指数（PRI）、疼痛视觉模拟评分（VAS）、现在疼痛状况（PPI）、美国足踝外科协会踝与后足评分（AOFAS）、本体感觉、OLT病损面积等指标。 结果 治疗后第2周、4周、随访时，试验组PRI评分、PPI评分、AOFAS评分较对照组明显降低（P < 0.05）；治疗后第4周、随访时，试验组VAS评分较对照组明显降低（P < 0.05）；治疗后试验组患侧主、被动复位误差角度明显降低，差异有统计学意义（P < 0.05），其余组别治疗前后无明显统计学意义（P > 0.05）。试验组随访时OLT病损面积较治疗前明显降低（P < 0.05），对照组踝关节核磁OLT病损面积与治疗前无明显变化，差异无统计学意义（P > 0.05）。 结论 基于动静结合理念指导之下，摇拔戳手法联合西医常规疗法保守治疗OLT，在缓解疼痛、改善足踝功能、恢复本体感觉、修复病损面积、提高生活质量等方面具有更明显的优势。

Objective To investigate the clinical efficacy of the "dynamic and static combination" approach in the treatment of Hepple Ⅰ-Ⅲ type osteochondral lesions of the talus（OLT）， utilizing external ankle shaking， pulling， and poking manipulations in conjunction with ankle brace fixation. Methods A total of 82 patients diagnosed with OLT， who sought treatment at four hospitals between June 2022 and December 2023， were included in the study. Both the experimental and control groups received ankle immobilization using braces throughout the treatment period. The control group was administered Voltaren Emulgel topically twice daily （morning and evening）， with each treatment course lasting 30 days， for a total of one course. The experimental group received additional therapeutic intervention involving shaking， pulling， and poking manipulations， conducted twice weekly， with the same duration and number of treatment courses as the control group. Follow-up assessments were scheduled at 2 weeks， 4 weeks， and 2 months post-treatment. Outcome measures included the pain rating index （PRI）， visual analogue scale （VAS） for pain intensity， current pain intensity （PPI）， American Orthopaedic Foot & Ankle Society （AOFAS） ankle and hindfoot scores， proprioceptive function， and the size of OLT. Results During the longitudinal assessment conducted at 2-week， 4-week， and follow-up intervals， the experimental group exhibited superior clinical outcomes compared to the control group， with statistically significant decreases in PRI， PPI， and AOFAS scores （all P < 0.05）. VAS scores showed progressive improvement over time， with significant intergroup differences observed at both the 4-week and follow-up assessments （P < 0.05）. Biomechanical analysis performed post-intervention indicated improved kinematic repositioning accuracy in the experimental group， as reflected by significantly reduced active-passive error angles （P < 0.05）. Importantly， measurements of OLT area revealed notable therapeutic effects in the experimental group （P < 0.05）， whereas no statistically significant changes were observed in the control group throughout the study period （all P > 0.05）. Conclusions Under the guidance of the "dynamic and static combination" concept， the integration of shaking， pulling， and poking manipulation with conventional Western medicine-based conservative treatment for OLT demonstrates more pronounced advantages in alleviating pain， improving ankle joint function， restoring proprioception， facilitating lesion recovery， and enhancing overall quality of life.