足踝扭傷中西醫證治綜論

A Literature Review of Ankle Sprain with Western Medicine Therapy and Chinese Medicine Treatment

10.6516/TJTCM.201909_22(2).0004

張維修(Wei-Hsiu Chang)；陳建霖(Chien-Lin Chen)；黃建榮(Chien-Jung Huang)；黃蕙棻(Hui-Fen Huang)

足踝扭傷 ； 傳統中醫療法 ； 傷科手法治療 ； Ankle sprain ； Traditional Chinese medicine ； Traumatological Manipulation

中醫藥研究論叢

22卷2期（2019 / 09 / 30）

31 - 43

繁體中文

足踝扭傷是常見的下肢疾病之一，特別常發生在運動員與女性族群之中。醫師在治療上除恢復足踝結構外，也需注重後續功能復健。足踝扭傷西醫根據臨床分級而分別做不同的治療，而中醫師則依循中醫理論，以理筋正骨、固定、內治法外敷法與針灸放血等治療方式於臨床上互相搭配使用，其中足踝傷科手法也是目前醫學上較認可的處理方式之一。本文主要闡述足踝扭傷的原理機轉、診斷、治療，並藉由回顧以往中醫與西醫針對足踝扭傷治療的文獻與實證，除說明中西醫各自的優勢外，也提出未來中醫能研究發展的目標供臨床醫師參考。

Ankle sprain is one of the most common musculoskeletal injuries in lower extremities, and occurs mostly in athletic population and women. Clinicians should focus on not only recovering anomalies of ankle structure, but also remodeling functional rehabilitation program for the patient. According to clinical classification, there are several types of treatment for ankle sprain in western medicine. On the other hand, according to traditional Chinese theory, clinicians use Chinese manipulative therapy, immobilization, Chinese herbal therapy, acupuncture, and bleeding therapy for the injury. In this article, we put our emphasis on elaborating the mechanism, diagnosis, and treatment of ankle sprain, narrating the advantages between Chinese and Western therapy in evidence-based medicine, and enlightening methods of modern research for Chinese traumatological doctor in this subject in the future.

1. Bachmann, LM,Kolb, E,Koller, MT,Steurer, J,ter Riet, G(2003).Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review.Bmj,326,417.
2. Bilgic, S,Durusu, M,Aliyev, B,Akpancar, S,Ersen, O,Yasar, SM,Ardic, S(2015).Comparison of two main treatment modalities for acute ankle sprain.Pakistan journal of medical sciences,31,1496.
3. Bleakley, CM,O’Connor, SR,Tully, MA,Rocke, LG,MacAuley, DC,Bradbury, I,Keegan, S,McDonough, SM(2010).Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial.Bmj.,340,c1964.
4. Curr, S,Xyrichis, A(2015).Does nurse-led initiation of Ottawa ankle rules reduce ED length of stay?.International emergency nursing,23,317-322.
5. David, S,Gray, K,Russell, JA,Starkey, C(2016).Validation of the Ottawa Ankle Rules for acute foot and ankle injuries.Journal of sport rehabilitation,25,48-51.
6. Doherty, C,Bleakley, C,Delahunt, E,Holden, S(2017).Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis.Br J Sports Med,51,113-125.
7. Doherty, C,Delahunt, E,Caulfield, B,Hertel, J,Ryan, J,Bleakley, C(2014).The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies.Sports medicine.,44,123-140.
8. Feger, MA,Herb, CC,Fraser, JJ,Glaviano, N,Hertel, J(2015).Supervised rehabilitation versus home exercise in the treatment of acute ankle sprains: a systematic review.Clinics in sports medicine,34,329-346.
9. Ferran, NA,Maffulli, N(2006).Epidemiology of sprains of the lateral ankle ligament complex.Foot and ankle clinics,11,659-662.
10. Fessell, D.,vanHolsbeeck, MT(2001).Sonography of the ankle and foot. Musculoskeletal ultrasound.St Louis:Mosby.
11. Fong, DT-P,Hong, Y,Chan, L-K,Yung, PS-H,Chan, K-M(2007).A systematic review on. Ankle injury and ankle sprain in sports.Sports medicine,37,73-94.
12. Großterlinden, LG,Hartel, M,Yamamura, J,Schoennagel, B,Bürger, N,Krause, M,Spiro, A,Hoffmann, M,Lehmann, W,Rueger, JM(2016).Isolated syndesmotic injuries in acute ankle sprains: diagnostic significance of clinical examination and MRI.Knee Surgery, Sports Traumatology, Arthroscopy,24,1180-1186.
13. Hall, EA,Docherty, CL,Simon, J,Kingma, JJ,Klossner, JC(2015).Strength-training protocols to improve deficits in participants with chronic ankle instability: a randomized controlled trial.Journal of athletic training,50,36-44.
14. Holden, S,Delahunt, E,Doherty, C(2015).14 A systematic review and quality assessment of systematic reviews on ankle sprain injury prevention and treatment.BMJ,49(1)
15. Kim, TH,Lee, MS,Kim, KH,Kang, JW,Choi, TY,Ernst, E(2014).Acupuncture for treating acute ankle sprains in adults.Cochrane database of systematic reviews,6
16. Kristianslund, E,Bahr, R,Krosshaug, T(2011).Kinematics and kinetics of an accidental lateral ankle sprain.Journal of biomechanics.,44,2576-2578.
17. Kwak, MK,Kim, MW,Jeong, SJ,Kim, SA,Jeong, MY,Kim, JH(2018).Systematic Review of Chuna Manipulative Treatment for Ankle Sprain.Journal of Acupuncture Research,35,61-68.
18. Lamb, S,Marsh, J,Hutton, J,Nakash, R,Cooke, M,Trial, CAS(2009).Mechanical supports for acute, severe ankle sprain: a pragmatic, multicentre, randomised controlled trial.The Lancet.,373,575-581.
19. Linens, SW,Ross, SE,Arnold, BL(2016).Wobble board rehabilitation for improving balance in ankles with chronic instability.Clinical Journal of Sport Medicine,26,76-82.
20. Melzack, R,Stillwell, DM,Fox, EJ(1977).Trigger points and acupuncture points for pain: correlations and implications.Pain.,3,3-23.
21. Nikken, JJ,Oei, EH,Ginai, AZ,Krestin, GP,Verhaar, JA,van Vugt, AB,Hunink, MM(2005).Acute ankle trauma: value of a short dedicated extremity MR imaging examination in prediction of need for treatment.Radiology,234,134-142.
22. Park, J,Hahn, S,Park, J-Y,Park, H-J,Lee, H(2013).Acupuncture for ankle sprain: systematic review and meta-analysis.BMC complementary and alternative medicine,13,55.
23. Rao, MS,Vemali, D(2015).Effectiveness of ice pack versus cold water immersion on static and dynamic balance in ankle sprain.Int J Physiother Res,3,1239-1243.
24. Schiftan, GS,Ross, LA,Hahne, AJ(2015).The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: a systematic review and meta-analysis.Journal of science and medicine in sport,18,238-244.
25. Serinken, M,Eken, C,Elicabuk, H(2016).Topical Ketoprofen versus placebo in treatment of acute ankle sprain in the emergency department..Foot & ankle international,37,989-993.
26. van den Bekerom, MP,Sjer, A,Somford, MP,Bulstra, GH,Struijs, PA,Kerkhoffs, GM(2015).Non-steroidal anti-inflammatory drugs (NSAIDs) for treating acute ankle sprains in adults: benefits outweigh adverse events.Knee Surgery, Sports Traumatology, Arthroscopy.,23,2390-2399.
27. Van Reijen, M,Vriend, I,van Mechelen, W,Verhagen, E(2018).Preventing recurrent ankle sprains: Is the use of an App more cost-effective than a printed Booklet? Results of a RCT.Scandinavian journal of medicine & science in sports,28,641-648.
28. Vuurberg, G,Hoorntje, A,Wink, LM,van der Doelen, BF,van den Bekerom, MP,Dekker, R,van Dijk, CN,Krips, R,Loogman, MC,Ridderikhof, ML(2018).Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline.Br J Sports Med.
29. Waterman, BR,Belmont, PJ, Jr,Cameron, KL,Svoboda, SJ,Alitz, CJ,Owens, BD(2011).Risk factors for syndesmotic and medial ankle sprain: role of sex, sport, and level of competition.The American journal of sports medicine,39,992-998.
30. Waterman, BR,Owens, BD,Davey, S,Zacchilli, MA,Belmont, Jr, PJ(2010).The epidemiology of ankle sprains in the United States.JBJS.,92,2279-2284.
31. Yeung, M,Chan, K-M,So, C,Yuan, W(1994).An epidemiological survey on ankle sprain.British journal of sports medicine,28,112-116.
32. 王和鳴,施杞(2001).踝及足部筋傷.北京:人民衛生出版社.
33. 何新芳,胥海斌(2006)。針刺陽陵泉治療外踝關節扭傷療效觀察。中國針灸，26(8)，569-570。
34. 黃新家,楊宗憲,林恆右,李科宏(2009)。踝關節扭傷的治療一病例報告。中醫骨傷科醫學雜誌，75-82。
35. 劉靜,劉超(2015)。李永峰圍刺放血配合推拿治療急性踝關節扭傷療效觀察。湖北中醫雜誌，37，62-63。
36. 戴有志,黃慧君(2007)。傷科手法治療踝關節扭傷及後遺關節黏連。中醫骨傷科醫學雜誌，11-15。
37. 謝冬明,黎穎賢,賀振泉(2016)。淺析踝關節扭傷的診斷及針灸推拿對其的治療。中醫臨床研究，8，42-43。

1. 陳中奎,林慶芳,何宗融(2022)。足背痛之經脈音療治療案例報告。中醫藥研究論叢，25(3)，53-63。