外踝摇拔戳手法联合支具固定“动静结合”治疗Hepple Ⅰ—Ⅲ型距骨骨软骨损伤的临床疗效

doi:10.3969/j.issn.1006-5725.2025.14.013

Abstract

Abstract:

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.

Key words: osteochondral lesion of the talus, shaking， pulling and poking manipulation, dynamic and static combination

CLC Number:

Shulong WANG,Dongxiao LI,Huan LIANG,Ruizheng ZHU,Junde WU,Xuyue PAN,Zhanhua MA,Yinze QI,Feng ZHAO,Ayong HUANG,Zhimin YANG,Zhaojun. CHEN. To evaluate the clinical efficacy of "dynamic and static combination" of shaking， pulling and poking manipulation of lateral malleolus combined with brace fixation in the treatment of Hepple type Ⅰ-Ⅲ OLT[J]. The Journal of Practical Medicine, 2025, 41(14): 2210-2216.

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References 30

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变量	试验组	对照组	t/Z/χ² 值	P值
年龄［M（P₂₅，P₇₅ ）］/岁	35.50（31.00，42.50）	37.50（28.50，47.00）	0.302	0.763
病程（x ± s）/月	5.75 ± 1.55	5.35 ± 1.75	1.111	0.270
BMI（x ± s）/（kg/m²）	23.92 ± 4.09	22.85 ± 3.95	1.199	0.234
性别
男	21（50.00）	20（50.00）	0.000	1.000
女	21（50.00）	20（50.00）	0.000	1.000
左右踝
左	14（33.33）	15（37.50）	0.156	0.693
右	28（66.67）	25（62.50）	0.156	0.693
Hepple分级
Ⅰ	9（21.43）	6（15.00）	0.720	0.698
Ⅱ	20（47.62）	19（47.50）
Ⅲ	13（30.95）	15（37.50）

组别	治疗前	第2周	第4周	随访
试验组	18.12 ± 4.55	11.12 ± 3.34	6.24 ± 1.43	3.14 ± 2.36
对照组	17.68 ± 3.51	12.33 ± 3.12	8.15 ± 2.15	5.55 ± 2.24
t值	0.489	1.693	4.758	4.738
P值	0.627	0.094	< 0.001	< 0.001

组别	治疗前	第2周	第4周	随访
试验组	6.12 ± 1.35	3.95 ± 1.34	1.57 ± 1.06	2.07 ± 1.13
对照组	5.95 ± 1.21	4.26 ± 1.09	2.20 ± 1.09	3.13 ± 1.24
t值	0.599	1.146	2.653	4.050
P值	0.551	0.255	0.010	< 0.001

组别	治疗前	第2周	第4周	随访
试验组	3.04 ±1.29	2.17 ± 1.12	1.33 ± 0.48	1.12 ± 0.33
对照组	3.18 ± 1.35	2.68 ± 1.07	1.55 ± 0.60	1.53 ± 0.51
t值	0.480	2.106	1.838	4.343
P值	0.632	0.038	0.070	< 0.001

组别	治疗前	第2周	第4周	随访
试验组	65.21 ± 7.67	73.24 ± 5.54	80.64 ± 8.61	85.12 ± 6.28
对照组	65.43 ± 7.94	70.45 ± 6.34	75.15 ± 9.78	77.45 ± 5.56
t值	0.128	2.125	2.701	5.845
P值	0.900	0.037	0.008	< 0.001

To evaluate the clinical efficacy of "dynamic and static combination" of shaking， pulling and poking manipulation of lateral malleolus combined with brace fixation in the treatment of Hepple type Ⅰ-Ⅲ OLT

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组别	治疗前	治疗后	t值	P值
试验组（患侧）	5.05 ± 1.78	4.28 ± 0.53	2.545	0.015
对照组（患侧）	5.34 ± 1.56	4.98 ± 1.48	0.976	0.335
试验组（健侧）	3.98 ± 1.21	4.01 ± 1.30	0.084	0.933
对照组（健侧）	4.02 ± 1.08	3.97 ± 0.98	0.183	0.855

组别	治疗前	治疗后	t值	P值
试验组（患侧）	5.14 ± 1.49	4.36 ± 0.89	2.932	0.005
对照组（患侧）	5.23 ± 1.63	4.99 ± 1.65	0.657	0.515
试验组（健侧）	4.03 ± 1.11	3.99 ± 1.28	0.109	0.914
对照组（健侧）	3.97 ± 1.34	3.95 ± 1.04	0.135	0.893

组别	例数	OLT病损面积		t值	P值
组别	例数	治疗前	治疗后2个月	t值	P值
试验组	42	1.73 ± 0.64	1.05 ± 0.45	5.360	0.000
对照组	40	1.69 ± 0.83	1.38 ± 0.93	1.514	0.138
t值		0.282	2.114
P值		0.779	0.038

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