雷火灸联合主动疼痛管理在踝关节骨折术后的临床应用研究

Clinical application of Thunder-Fire Moxibustion combined with active pain management after ankle fracture surgery

摘要:

目的 探讨雷火灸联合主动疼痛管理在踝关节骨折术后疼痛患者中的应用效果。方法 选取2022年1月—2024年1月无锡市第九人民医院收治的82例踝关节骨折患者作为研究对象。根据随机数字表法将患者分为对照组和观察组，各41例。两组均在术后次日接受常规康复训练，对照组在常规康复训练的基础上联合主动疼痛管理，观察组在对照组基础上接受雷火灸治疗。记录患者治疗前、治疗1周和治疗4周后的疼痛评分和踝关节肿胀程度，比较两组治疗前和治疗4周后的炎症因子水平、踝关节活动度，并通过美国足踝外科协会（AOFAS）评分比较两组患者手术前后的踝关节功能。结果 两组患者治疗前、治疗1周后、治疗4个月后的视觉模拟评分法（VAS）评分、关节肿胀值比较，结果 ①不同时间点VAS评分、关节肿胀值比较，差异均有统计学意义（F =362.094、1 512.463，均P <0.05）；②两组患者VAS评分、关节肿胀值比较，差异均有统计学意义（F =11.054、34.932，均P <0.05），观察组治疗后VAS评分、关节肿胀值较低；③两组患者VAS评分、关节肿胀值变化趋势比较，差异均有统计学意义（F =3.302、12.971，均P <0.05）。两组患者治疗前白细胞介素-6（IL-6）、C反应蛋白（CRP）比较，差异均无统计学意义（P >0.05）。观察组治疗后IL-6、CRP均低于对照组（P <0.05）。两组治疗后IL-6、CRP均较治疗前低（P <0.05）。观察组治疗前后IL-6、CRP的差值均高于对照组（P <0.05）。两组患者治疗前背伸、跖屈、内翻、外翻活动度比较，差异均无统计学意义（P >0.05）。观察组治疗后背伸、跖屈、内翻、外翻活动度均大于对照组（P <0.05）。两组治疗后背伸、跖屈、内翻、外翻活动度均较治疗前大（P <0.05）。观察组治疗前后背伸、跖屈、内翻、外翻活动度的差值均大于对照组（P <0.05）。两组患者治疗前疼痛、功能、足部对线评分比较，差异均无统计学意义（P >0.05）。观察组治疗后疼痛程度、踝关节功能、足部对线评分均高于对照组（P <0.05）。观察组治疗后疼痛程度、踝关节功能、足部对线评分均高于对照组（P <0.05）。观察组治疗前后疼痛程度、踝关节功能、足部对线评分的差值均高于对照组（P <0.05）。结论 雷火灸联合主动疼痛管理有助于降低踝关节骨折患者术后疼痛，改善关节功能。

Abstract:

Objective To investigate the effectiveness of Thunder-Fire Moxibustion combined with active pain management in patients experiencing postoperative pain after ankle fracture surgery.Methods A total of 82 patients with ankle fractures admitted to our hospital from January 2022 to January 2024 were selected and divided into a control group and an observation group (each n = 41) by the random number table method. Both groups received conventional rehabilitation training starting one day after surgery. The control group received active pain management in addition to conventional rehabilitation, while the observation group underwent Thunder-Fire Moxibustion combined with the regimen in the control group. Pain scores and ankle swelling were recorded before and 1 week and 4 weeks after treatment. The levels of inflammatory factors, ankle range of motion (ROM), and ankle function assessed by the American Orthopaedic Foot & Ankle Society (AOFAS) scores were compared between the two groups before treatment and 4 weeks after treatment.Results A comparison was made between the observation group and the control group regarding Visual Analog Scale (VAS) scores and joint swelling severity before treatment, one week after treatment, and four weeks after treatment, which demonstrated that they were different across the time points (F = 362.094 and 1 512.463, both P < 0.05) and between the groups (F = 11.054 and 34.932, both P < 0.05), with lower VAS scores and joint swelling severity in the observation group. The change trends of VAS scores and joint swelling severity were also different between the two groups (F = 3.302 and 12.971, both P < 0.05). There was no difference in interleukin-6 (IL-6) and C-reactive protein (CRP) levels before treatment between the two groups (P > 0.05). After treatment, the observation group exhibited significantly lower levels of IL-6 and CRP compared with the control group (P < 0.05). Both groups showed a significant decrease in IL-6 and CRP levels after treatment compared with baseline (P < 0.05), with the magnitude of change in the observation group being greater than that in the control group (P < 0.05). Before treatment, there were no significant differences between the two groups in dorsiflexion, plantarflexion, inversion, or eversion angles (P > 0.05). After treatment, the observation group showed significantly greater improvements in all these ankle range-of-motion parameters compared with the control group (P < 0.05). Both groups experienced significant increases in dorsiflexion, plantarflexion, inversion, and eversion angles after treatment compared with baseline (P < 0.05), with the changes in the observation group exceeding those in the control group (P < 0.05). Similarly, pre-treatment scores for pain, function, and alignment did not differ significantly between the two groups (P > 0.05). After treatment, the observation group had significantly higher scores in pain, function, and alignment compared with the control group (P < 0.05). Both groups showed significant improvements after treatment relative to baseline (P < 0.05), with the magnitude of improvement in the observation group being greater than that in the control group (P < 0.05).Conclusions Thunder-Fire Moxibustion combined with active pain management effectively reduces postoperative pain and improves joint function in patients with ankle fractures.