CN105686899A - Method for treating supination-external rotation and pronation-external rotation anklebone fracture - Google Patents

Abstract

The invention provides a method for treating supination-external rotation and pronation-external rotation anklebone fracture by adopting a traditional Chinese medicine. According to the method, U-shaped gypsum is adopted for fixing, wherein the fixing range enables the gypsum to be fixed to the malleolus medialis, the lateral malleolus and the posterior malleolus, and the movements of internal rotation, internal turning and dorsal extension are guaranteed; after the fixing by adopting gypsum is carried out for 4 weeks, the ultra-ankle splint fixation is carried out for 3-6 weeks at the neutral position. Traditional Chinese medicine fumigation is carried out till the fracture is healed clinically, and then traditional Chinese medicine fumigation and washing are carried out, wherein the traditional Chinese medicine is composed of the following traditional Chinese medicinal materials by weight: 30g of lycopodium clavatum, 30g of tuberculate speranskia herb, 30g of suberect spatholobus stem, 30g of caulis tinosporae, 15g of peach kernels, 15g of safflower carthamus, 15g of radix angelica sinensis, 15g of rhizoma ligustici wallichii, 15g of myrrh, 15g of lignum sappan, 15g of rhizoma drynariae, 15g of radix dipsaci, 15g of the root of bidentate achyranthes, and 15g of cassia twig. In use, the traditional Chinese medicinal materials are placed in a cloth bag, the cloth bag is soaked for 30min in a basin, then the cloth bag is boiled in water till a boiled state is reached, the affected limb is placed above the basin, the ankle is fumigated for 20min, and after the liquid medicine is cooled gradually, the affected limb is soaked in the liquid medicine for 30min; fumigation and soaking are carried out for 1-2 times each day, one dose is used for 3 days, and 15 days is one course of treatment.

Description

The Therapeutic Method of outward turning type ankle joint fracture before supination outward turning and rotation

Technical field

The present invention relates to a kind of with the Therapeutic Method of outward turning type ankle joint fracture before Chinese medicine supination outward turning and rotation, specifically with the Therapeutic Method of outward turning type ankle joint fracture before Chinese medicine supination outward turning and rotation。

Background technology

Currently known ankle joint fracture, sprained ankle sorting technique has multiple, we adopt Lauge Hansen classification method, mainly because of the relation between posture when this method can give expression to injured clearly, the direction of external force and ligament injury and fracture, manual reduction in clinic is fixed with concrete directive significance。(1) supination outward turning type: for modal type of impairment。Foot on supinator position, astragalus is subject to external force or shank inward turning and astragalus is subject to the external force of relative outward turning, astragalus in ankle cave with inner side for axially outer rear rotation, impact external malleolus is backward。First it is ligament rapture or avulsion fracture of the tibial tubercle before lower tibiofibula;Fibula generation oblique fracture, fracture line is gone up backward by front lower, the further outward turning of astragalus, and rearward displacement causes the damage of rear combined ligament and back ankle fracture, astragalus backward dislocation, the damage of inside structure deltoid ligament or fracture of medial malleolus。(2) outward turning type before rotation: foot is in pronator position when injured, deltoid ligament involves and nervous, and when astragalus is subject to outward turning external force in external malleolus, first ankle joint inside structure damages and lose stability, astragalus with outside for rotation displacement outside axially front。Inside structure is first impaired, shows as deltoid ligament fracture or internal malleolus avulsion fracture;The medial wall of such astragalus just can shift forward, astragalus outward turning, forces fibula rotation twist along its longitudinal axis, causes that front combined ligament ruptures, and followed by the fracture of ligamenta interossea, causes the fracture that on ankle joint, 6～10cm place fibula is dry。Now, the astragalus of rotation departs from the tibia being positioned at inner side, and tibiofibula separates, and finally results in the avulsion fracture of ankle after the damage of rear combined ligament can occur。Patient all should carry out according to the position of its damage mechanisms, ankle when manual reduction is fixing。Therefore, understand sprained ankle mechanism and typing judge the treatment of ankle joint will be brought many facilities, it is possible to raising manual reduction treating level。

Summary of the invention

Diagnostic criteria:

Object of study: observe case totally 39 example, male 26 examples, female 13 example;20～65 years old age, average 45.5 years old;Fracture reason: getting out of a predicament or an embarrassing situation and cycle to fall and sprain 25 examples, 12 examples, Falling Injury 2 example are hindered in traffic accident。By Lauge Hansen typing: supination outward turning type 28 example, wherein III degree of 17 example, IV 11 examples;Outward turning 11 example before rotation, wherein III degree of 7 example, IV degree of 4 example。All cases is closed fracture。After wound to the time of examining be 1h～7d, average 3.2d。Diagnostic criteria: efficacy assessment standard: excellent: painless, without deformity, function is normal or close to normal, x-ray is taken the photograph sheet and shown union of fracture。Good: after fatigue, ankle joint mild pain or discomfort, dorsiflexion or plantar flexion are limited in 10 °～15 °, x-ray is taken the photograph sheet and is shown that union of fracture is without deformity。Can: time sense ankle joint unable, limited 16 °～20 ° of dorsiflexion plantar flexion, x-ray take the photograph sheet display mild malformation。Difference: namely ankle joint bears a heavy burden bitterly, need to hold up and turn walking, and limited 30 ° of dorsiflexion plantar flexion, outward appearance and x-ray are substantially lopsided。Efficacy evaluation: after reduction, x-ray is taken the photograph sheet and shown, the 39 whole good appositions of example fracture end;Set time is 6～11 weeks, average out to 8 weeks;Fracture all heals, and the clinical healing time is 53～84d。Efficacy evaluation result: excellent 28 examples, good 6 examples, can 3 examples, differ from 2 examples, acceptance rate reaches 87.2%。

Goal of the invention: in order to overcome existing treatment ankle joint fracture, I have invented a kind of Chinese medicine supination outward turning and the Therapeutic Method of the front outward turning type ankle joint fracture of rotation。Treatment to Inferior tibiofibular syndesmosis split and back ankle fracture block, from dissecting, articular surface of ankle is less than hip and knee face, its body weight born is more than hip and knee, and ankle joint is close to ground, the bearing capacity acting on ankle joint cannot be cushioned, and therefore requires higher to the treatment of ankle joint fracture;Ankle joint fracture companion's dislocation of ankle joint belongs to complicated intractable case, and treatment requires anatomical reduction, only proper reset, just can have good curative effect and reduce the generation of traumatic arthritis。We are according to classification of fracture, in conjunction with x-ray situation, Correct Analysis judges whether Inferior tibiofibular joint horizontal plane interosseous membrane or ligamenta interossea degree of impairment, Inferior tibiofibular joint are kept completely separate and the size of back ankle fracture block, payes attention to the anatomical reduction of Inferior tibiofibular syndesmosis split and back ankle fracture block, obtains good effect。

Technical scheme: 1. reset maneuver: after damage, clients need not be anaesthetized at once, swelling is serious, the obvious person of displacement fracture, adopts sciatic nerve anesthesia。For supination outward turning type, patient lies supine, go down on one's knees, two assistants grip fracture near-end and far-end respectively, first take advantage of a situation traction by fracture deformity direction, after deformity disappears, assistant holds sufficient inward turning, correct its outward turning deformity, patient's both hands thumb is placed in outer fracture of ankle far-end, fracture near-end embraced by four finger rings of Yuing, push away far-end to the inside, further end laterally, varus dorsiflexion ankle joint simultaneously, correct external malleolus and astragalus displacement, ankle inward turning is suffered from maintenance, varus, dorsiflexion position, patient upwards pushes internal malleolus backward with thumb makes it reset, then patient withstands back ankle fracture far-end with both hands thumb, four refer to fixing fracture near-end, double, two thumbs are pushed and are far rolled over end, push-and-pull foot forward on rear side of calcaneus, and tibia lower end is rearward elapsed, begin to reach the reset of back ankle fracture, then patient's both hands palm root is firmly encircled, opposing compression corrects Inferior tibiofibular syndesmosis split displacement, maintained the inward turning of ankle by assistant after reset, varus, dorsiflexion position。Outward turning type before rotation, carries out manual reduction round about also according to damage mechanisms。2. fixing means: measure suffering limb Gypsum Fibrosum length (from capitulum fibulae down to inner side average length), adopt " U " font plaster fixing, fixed range is enough to make plaster fixing to ankle inside and outside, rear and keep inward turning, varus, dorsiflexion position, regularly give film making check, whether close observation suffering limb blood circulation, swelling situation and Gypsum Fibrosum loosen, as the displacement of fractured ends should be corrected in time, retighten。According to union of fracture situation, plaster fixing changes the super ankle Boards wall of neutral position 3～6 weeks after 4 weeks。3. functional exercise: instruct patient to carry out the functional exercise of specification, be first the recovery of muscular strength, practises ankle joint dorsiflexion, plantar flexion when non-fully bearing a heavy burden, and one stretches that to bend be 1 time, every day 100～300 times;After Myodynamia recovery, exercise is bent and stretched, is rotated completely, now focuses on muscular strength and taking exercise and the exercise of correct gait equilibrium function;It is finally that suffering limb is stood with one foot to the knee and carried out the exercise of heavy sensation in the foot power function, but should be incremental, should not take exercise by force, excessively bear a heavy burden。4. herbal fumigation: after clinical union of bone, gives Chinese medicine fumigation and washing, medicinal Herba Lycopodii, Herba speranskiae tuberculatae, Caulis Spatholobi, each 30g of Herba Lycopodii, Semen Persicae, Flos Carthami, Radix Angelicae Sinensis, Rhizoma Chuanxiong, Myrrha, Lignum Sappan, Rhizoma Drynariae, Radix Dipsaci, Radix Achyranthis Bidentatae, each 15g of Ramulus Cinnamomi。Medicine is put cloth bag soaks 30min in basin, add water boil, prevent steam from scalding suffering limb frame stifling ankle 20min(on basin), after medicinal liquid gradually temperature, suffering limb is soaked 30min。Stifling immersion 1～2 time every day, every dose of 3d, 15d are 1 course for the treatment of。

Invention beneficial effect: this organizes 39 examples, after reduction, x-ray is taken the photograph sheet and is shown, fracture end good apposition, and ankle cave relation recovers normal 28 examples;6～11 weeks set times, average out to 8 weeks;Fracture all heals, and the clinical healing time is 53～84d, average 58d。By above standard rating, excellent 28 examples, account for 71.8%;Good 6 examples, account for 15.4%;Can 3 examples, account for 7.7%;Differ from 2 examples, account for 5.1%；Acceptance rate reaches 87.2%。

Preferred forms: use Chinese medicine and western medicine to combine treatment。

Innovation: this novel patent of invention relates to a kind of with the Therapeutic Method of outward turning type ankle joint fracture before Chinese medicine supination outward turning and rotation, treatment to Inferior tibiofibular syndesmosis split and back ankle fracture block, from dissecting, articular surface of ankle is less than hip and knee face, its body weight born is more than hip and knee, and ankle joint is close to ground, the bearing capacity acting on ankle joint cannot be cushioned, and therefore requires higher to the treatment of ankle joint fracture;Ankle joint fracture companion's dislocation of ankle joint belongs to complicated intractable case, and treatment requires anatomical reduction, only proper reset, just can have good curative effect and reduce the generation of traumatic arthritis。We are according to classification of fracture, in conjunction with x-ray situation, Correct Analysis judges whether Inferior tibiofibular joint horizontal plane interosseous membrane or ligamenta interossea degree of impairment, Inferior tibiofibular joint are kept completely separate and the size of back ankle fracture block, payes attention to the anatomical reduction of Inferior tibiofibular syndesmosis split and back ankle fracture block, obtains good effect。

Claims (3)

1. a Therapeutic Method for outward turning type ankle joint fracture, reset maneuver: after damage, clients need not be anaesthetized at once before novel Chinese medicine supination outward turning and rotation, swelling is serious, the obvious person of displacement fracture, adopts sciatic nerve anesthesia;Four refer to fixing fracture near-end, double, two thumbs are pushed and are far rolled over end, push-and-pull foot forward on rear side of calcaneus, and tibia lower end is rearward elapsed, begin to reach the reset of back ankle fracture, then patient's both hands palm root is firmly encircled, opposing compression corrects Inferior tibiofibular syndesmosis split displacement, fixing means: measure suffering limb Gypsum Fibrosum length (from capitulum fibulae down to inner side average length), adopt " U " font plaster fixing, in fixed range is enough to make plaster fixing arrive, outward, rear ankle also keeps inward turning, varus, dorsiflexion position, regularly give film making check, plaster fixing changes the super ankle Boards wall of neutral position 3～6 weeks after 4 weeks;Functional exercise: instruct patient to carry out the functional exercise of specification, one stretches that to bend be 1 time, every day 100～300 times;After Myodynamia recovery, temper the exercise with correct gait;It is finally that suffering limb is stood with one foot to the knee and carried out the exercise of heavy sensation in the foot power function, excessively bears a heavy burden;Herbal fumigation；After clinical union of bone, give Chinese medicine fumigation and washing, medicinal Herba Lycopodii, Herba speranskiae tuberculatae, Caulis Spatholobi, each 30g of Herba Lycopodii, Semen Persicae, Flos Carthami, Radix Angelicae Sinensis, Rhizoma Chuanxiong, Myrrha, Lignum Sappan, Rhizoma Drynariae, Radix Dipsaci, Radix Achyranthis Bidentatae, each 15g of Ramulus Cinnamomi;Medicine is put cloth bag soaks 30min in basin, add water boil, prevent steam from scalding suffering limb frame stifling ankle 20min(on basin), after medicinal liquid gradually temperature, suffering limb is soaked 30min;Stifling immersion 1～2 time every day, every dose of 3d, 15d are 1 course for the treatment of。

2. method according to claim 1, is characterized in that: fixed range is enough to make plaster fixing to ankle inside and outside, rear and keep inward turning, varus, dorsiflexion position, regularly gives film making check, and plaster fixing changes the super ankle Boards wall of neutral position 3～6 weeks after 4 weeks;Functional exercise: instruct patient to carry out the functional exercise of specification, one stretches that to bend be 1 time, every day 100～300 times;After Myodynamia recovery, temper the exercise with correct gait;It is finally that suffering limb is stood with one foot to the knee and carried out the exercise of heavy sensation in the foot power function, excessively bears a heavy burden;Herbal fumigation；After clinical union of bone, give Chinese medicine fumigation and washing, medicinal Herba Lycopodii, Herba speranskiae tuberculatae, Caulis Spatholobi, each 30g of Herba Lycopodii, Semen Persicae, Flos Carthami, Radix Angelicae Sinensis, Rhizoma Chuanxiong, Myrrha, Lignum Sappan, Rhizoma Drynariae, Radix Dipsaci, Radix Achyranthis Bidentatae, each 15g of Ramulus Cinnamomi;Medicine is put cloth bag soaks 30min in basin, add water boil, prevent steam from scalding suffering limb frame stifling ankle 20min(on basin), after medicinal liquid gradually temperature, suffering limb is soaked 30min;Stifling immersion 1～2 time every day, every dose of 3d, 15d are 1 course for the treatment of。

3. method according to claim 1, is characterized in that: herbal fumigation；After clinical union of bone, give Chinese medicine fumigation and washing, medicinal Herba Lycopodii, Herba speranskiae tuberculatae, Caulis Spatholobi, each 30g of Herba Lycopodii, Semen Persicae, Flos Carthami, Radix Angelicae Sinensis, Rhizoma Chuanxiong, Myrrha, Lignum Sappan, Rhizoma Drynariae, Radix Dipsaci, Radix Achyranthis Bidentatae, each 15g of Ramulus Cinnamomi;Medicine is put cloth bag soaks 30min in basin, add water boil, prevent steam from scalding suffering limb frame stifling ankle 20min(on basin), after medicinal liquid gradually temperature, suffering limb is soaked 30min;Stifling immersion 1～2 time every day, every dose of 3d, 15d are 1 course for the treatment of。