Abstract:

Objective　To observe the effect of thumbtack needles combined with Bingxiao San for patients with ankle fractures during perioperative period. Methods　From December 2021 to March 2023, 60 patients with ankle fractures treated at Department of Orthopedics and Traumatology, Lianyungang Hospital of Traditional Chinese Medicine were selected for the randomized controlled trial. The patients were divided into a treatment group and a control group by the random number table method, with 30 cases in each group. In the treatment group, there were 15 males and 15 females who were (50.70 ± 17.57) years old; there were 16 cases of left ankle fractures and 14 cases of right ankle fractures; there were 2 cases of medial malleolus fractures, 6 cases of lateral malleolar fractures, 14 cases of bimalleolar fractures, and 8 cases of trimalleolus fractures. In the control group, there were 14 males and 16 females who were (51.87±19.43) years old; there were 14 cases of left ankle fractures and 16 cases of right ankle fractures; there were 2 cases of medial malleolus fractures, 5 cases of lateral malleolar fractures, 16 cases of bimalleolar fractures, and 7 cases of trimalleolus fractures. Open reduction and internal fixation of ankle fractures was given to all the patients, and they were treated routinely after the surgery. In addition to the above-mentioned treatments, the treatment group were acupunctured Neiguan and Hegu by thumbtack needles and took Bingxiao San for a course of 1 week. The number of days to be operated on was recorded. The patients' score of Visual Analogue Scale (VAS), ankle circumference, score of traditional Chinese medicine syndromes, local skin temperature, ankle mobility, and the number of episodes of nausea and vomiting were measured 1 and 7 days after the surgery. χ², t, and Wilcoxon rank-sum tests were used. Results　The number of days to undergo surgery in the treatment group was less than that in the control group [(3.57±2.14) d vs. (5.00±2.08) d], with a statistical difference (P<0.05). One day after the surgery, the VAS score, ankle circumference, skin temperature, plantar flexion angle, dorsiflexion angle, and score of traditional Chinese medicine symptoms in the treatment group were (6.70±0.84), (59.23±2.06) cm, (36.34±0.14) ℃, (11.30±1.12)°, (9.03±1.13)°, and (16.03±2.61), and those in the control group were (6.67±0.96), (59.17±1.93) cm, (36.30±0.10) ℃, (11.53±1.33)°, (9.40±1.07)°, and (15.77±2.27), respectively, with no statistical differences (all P>0.05). Seven days after the surgery, the VAS score, ankle circumference, skin temperature, and score of traditional Chinese medicine symptoms in the treatment group were lower than those in the control group [(2.30±0.75) vs. (3.03±0.89), (56.23±1.74) cm vs. (57.33±1.97) cm, (36.07±0.08) ℃ vs. (36.13±0.09) ℃, and (7.30±2.37) vs. (9.07±2.15)], and the plantar flexion angle and dorsiflexion angle in the treatment group were higher than those in the control group [(28.77±1.07)° vs. (25.40±1.40)° and (18.30±1.95)° vs. (15.67±1.40)°], with statistical differences (all P<0.05). The effective rate of the treatment group was higher than that of the control group [93.3% (28/30) vs. 80.0% (24/30)], with a statistical difference (P<0.05). Nausea and vomiting occurred twice in the treatment group, and 4 times in the control group, with no statistical difference (P>0.05). Conclusion　Thumbtack needles combined with Bingxiao San for patients with ankle fractures after surgery can effectively reduce the occurrence of ankle pain and local heating, and improve their activity function, clinical symptoms, postoperative recovery, and quality of life.

Key words:

Ankle fractures, Thumbtack needles, Bingxiao San, Perioperative period, Traditional Chinese medicine nursing

摘要：

目的　观察揿针联合冰硝散在踝关节骨折患者围手术期中的应用效果。方法　选取2021年12月至2023年3月连云港市中医院骨伤科踝关节骨折住院手术患者60例进行随机对照试验。采用随机数字表法将患者分为治疗组和对照组，各30例。治疗组男15例，女15例，年龄（50.70±17.57）岁；患侧左16例，右14例；内踝骨折2例，外踝骨折6例，双踝骨折14例，三踝骨折8例。对照组男14例，女16例，年龄（51.87±19.43）岁；患侧左14例，右16例；内踝骨折2例，外踝骨折5例，双踝骨折16例，三踝骨折7例。所有患者均予踝关节骨折切开复位内固定术，术后常规治疗。治疗组除上述治疗外，另予揿针针刺内关、合谷穴结合冰硝散外敷，疗程1周。记录待手术天数，术后第1、7天测定患者视觉模拟量表（Visual Analogue Scale，VAS）评分、踝围、中医证候积分、局部皮肤温度、踝关节活动度及恶心呕吐发生次数。采用χ²检验、t检验和Wilcoxon秩和检验。结果　治疗组待手术天数少于对照组［（3.57±2.14）d比（5.00±2.08）d］，差异有统计学意义（P<0.05）。术后第1天，治疗组VAS评分、踝围、肤温、跖屈角度、背屈角度、中医证候评分分别为（6.70±0.84）分、（59.23±2.06）cm、（36.34±0.14）℃、（11.30±1.12）°、（9.03±1.13）°、（16.03±2.61）分，对照组分别为（6.67±0.96）分、（59.17±1.93）cm、（36.30±0.10）℃、（11.53±1.33）°、（9.40±1.07）°、（15.77±2.27）分，差异均无统计学意义（均P>0.05）。术后第7天，治疗组VAS评分、踝围、肤温、中医证候评分均低于对照组［（2.30±0.75）分比（3.03±0.89）分、（56.23±1.74）cm比（57.33±1.97）cm、（36.07±0.08）℃比（36.13±0.09）℃、（7.30±2.37）分比（9.07±2.15）分］，跖屈角度、背屈角度均高于对照组［（28.77±1.07）°比（25.40±1.40）°、（18.30±1.95）°比（15.67±1.40）°］，差异均有统计学意义（均P<0.05）。治疗组有效率高于对照组［93.3%（28/30）比80.0%（24/30）］，差异有统计学意义（P<0.05）。治疗组患者恶心呕吐次数2次，对照组4次，差异无统计学意义（P>0.05）。结论　揿针联合冰硝散能够有效减轻踝关节骨折患者术后踝部肿痛、发热症状，改善活动功能及临床症状，促进患者术后恢复，提高患者生活质量。

关键词:

踝关节骨折, 揿针, 冰硝散, 围手术期, 中医护理