踝關(guān)節(jié)扭傷的患者的指南

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1、踝關(guān)節(jié)扭傷患者指南勝利油田中心醫(yī)院 手外科、足踝外科姜?jiǎng)?踝關(guān)節(jié)扭傷患者指南 Ankle Sprain 踝關(guān)節(jié)扭傷踝關(guān)節(jié)扭傷 A Patients Guide to Ankle Sprain 踝關(guān)節(jié)扭傷患者指南踝關(guān)節(jié)扭傷患者指南 Introduction 簡(jiǎn)介簡(jiǎn)介 An ankle sprain is a common injury and usually results when the ankle is twisted,or turned in(inverted).The term sprain signifies injury to the soft tissues,usually t

2、he ligaments,of the ankle.踝關(guān)節(jié)扭傷是生活中很常見的損傷，通常是由于踝關(guān)節(jié)內(nèi)翻損傷所導(dǎo)致。術(shù)語“扭傷”一般指的是軟組織的損傷，在踝關(guān)節(jié)，通常指的是韌帶損傷。This guide will help you understand how an ankle sprain occurs how doctors diagnose the condition what can be done to treat a sprain 本指南旨在幫助你了解本指南旨在幫助你了解 踝關(guān)節(jié)扭傷是怎樣發(fā)生的 如何診斷踝關(guān)節(jié)扭傷 如何治療踝關(guān)節(jié)扭傷 Anatomy 解剖解剖 What part

3、of the ankle is involved?踝關(guān)節(jié)包括哪些結(jié)構(gòu)？踝關(guān)節(jié)包括哪些結(jié)構(gòu)？Anatomy解剖解剖What part of the ankle is involved?踝關(guān)節(jié)包括哪些結(jié)構(gòu)？踝關(guān)節(jié)包括哪些結(jié)構(gòu)？Ligaments are tough bands of tissue that help connect bones together.Three ligaments make up the lateral ligament complex on the side of the ankle farthest from the other ankle.They are the

4、anterior talofibular ligament(ATFL),the calcaneofibular ligament(CFL),and the posterior talofibular ligament(PTFL).The common inversion injury to the ankle usually involves two ligaments,the ATFL and CFL.Normally,the ATFL keeps the ankle from sliding forward,and the CFL keeps the ankle from rolling

5、inward on its side.韌帶是一種致密的帶狀組織，它把相鄰骨關(guān)節(jié)連接在一起。踝關(guān)節(jié)外側(cè)韌帶復(fù)合體由三條韌帶組成：距腓前韌帶、跟腓韌帶、距腓后韌帶。踝關(guān)節(jié)內(nèi)翻扭傷通常累及其中兩條韌帶：距腓前韌帶和跟腓韌帶。距腓前韌帶防止踝關(guān)節(jié)前移，跟腓韌帶防止踝關(guān)節(jié)過度內(nèi)收。A ligament is made up of multiple strands of connective tissue,similar to a nylon rope.A sprain results in stretching or tearing of the ligaments.Minor sprains only

6、 stretch the ligament.A tear may be either a complete tear of all the strands of the ligament or a partial tear of only some of the strands.The ligament is weakened by the injury;how much it is weakened depends on the degree of the sprain.韌帶是由多股束帶狀結(jié)締組織組成，很像是一股尼龍繩。扭傷會(huì)導(dǎo)致韌帶的拉傷或撕裂。輕微扭傷僅僅導(dǎo)致韌帶的拉傷。嚴(yán)重扭傷會(huì)導(dǎo)致韌

7、帶撕裂，而韌帶撕裂既可能是韌帶內(nèi)全部束帶的斷裂，也可能是部分束帶的斷裂。韌帶損傷后，其力量會(huì)減弱，具體減弱的程度取決于扭傷的程度。The lateral ligaments are by far the most commonly injured ligaments in a typical inversion injury of the ankle.In an inversion injury the ankle tilts inward,meaning the bottom of the foot angles toward the other foot.This forces all t

8、he pressure of your body weight onto the outside edge of the ankle.As a result,the ligaments on the outside of the ankle are stretched and possibly torn.踝關(guān)節(jié)外側(cè)韌帶損傷最常見于踝關(guān)節(jié)內(nèi)翻損傷。何謂踝關(guān)節(jié)內(nèi)翻損傷？就是發(fā)生扭傷時(shí)，扭傷的這只腳的足底朝向另外一只腳，這樣全身的重量都集中于踝關(guān)節(jié)的外側(cè)，結(jié)果導(dǎo)致了踝關(guān)節(jié)外側(cè)韌帶的拉傷或撕裂。A severe form of ankle sprain,called an ankle syndesmo

9、sis injury,involves damage to other supportive ligaments in the ankle.This type of injury is sometimes called a high ankle sprain because it involves the ligaments above theankle joint.In an ankle syndesmosis injury,at least one of the ligaments connecting the tibia and fibula bones(the lower leg bo

10、nes)is sprained.Recovering from even mild injuries of this type takes at least twice as long as from a typical ankle sprain.有一種嚴(yán)重的踝關(guān)節(jié)扭傷，又稱踝關(guān)節(jié)下脛腓聯(lián)合損傷，累及踝關(guān)節(jié)的其他支持韌帶。這種類型的踝關(guān)節(jié)扭傷又稱高位踝關(guān)節(jié)扭傷，因?yàn)樗奂暗捻g帶位于踝關(guān)節(jié)上方。踝關(guān)節(jié)下脛腓聯(lián)合損傷發(fā)生時(shí)，至少有一條連接脛腓骨遠(yuǎn)端的韌帶發(fā)生拉傷或撕裂，即使是輕微的下脛腓聯(lián)合損傷，其恢復(fù)時(shí)間至少是普通踝關(guān)節(jié)扭傷的兩倍。Symptoms 癥狀癥狀 What does an ankle

11、 sprain feel like?踝關(guān)節(jié)扭傷后有哪些表現(xiàn)？踝關(guān)節(jié)扭傷后有哪些表現(xiàn)？Initially the ankle is swollen,painful,and may turnecchymotic(bruised).The bruising and swelling are due to ruptured blood vessels from the tearing of the soft tissues.Most of the initial swelling is actually bleeding into the surrounding tissues.The ankle s

12、wells as extra fluid continues to leak into the tissues over the 24 hours following the sprain.踝關(guān)節(jié)扭傷發(fā)生后，最初的癥狀是腫脹、疼痛、淤青，這是由于撕裂的軟組織內(nèi)血管發(fā)生破裂，進(jìn)而血液滲出到踝關(guān)節(jié)周圍所致。隨著扭傷后24小時(shí)或更長(zhǎng)時(shí)間，額外的液體不斷滲漏入組織，踝關(guān)節(jié)發(fā)生腫脹。People who have sprained an ankle often end up spraining the ankle again.If the ankle keeps turning in with acti

13、vity,the condition is called ankle instability.Patients who have ankle instability lose confidence in their ankle to support them,especially on uneven ground.They often have swelling around the ankle that doesnt go away.Pain and swelling in a joint can cause a reflex where the body turns off the mus

14、cles around the joint.This can cause times when the ankle feels like it is going to give way,meaning it may have a tendency to twist again very easily.一旦踝關(guān)節(jié)發(fā)生過一次扭傷，就很容易再次發(fā)生扭傷。如果踝關(guān)節(jié)反復(fù)多次扭傷，這被稱之為“踝關(guān)節(jié)不穩(wěn)”，這種情況會(huì)導(dǎo)致患者對(duì)他們的踝關(guān)節(jié)的功能失去信心，尤其是在凹凸不平的路面行走時(shí)。這類患者的踝關(guān)節(jié)總是反復(fù)腫脹而不能消退。關(guān)節(jié)的疼痛和腫脹會(huì)反射性地使人們不使用關(guān)節(jié)周圍的肌肉。這會(huì)不時(shí)地讓人們感覺踝關(guān)節(jié)似

15、乎將要垮掉了，也說是說踝關(guān)節(jié)更容易再次扭傷。People who have had several mild ankle sprains or one severe sprain are prone to impingement problems in the ankle.The ligaments that were sprained may become irritated and thickened,causing them to get pinched near the edge of the ankle joint.反復(fù)多次的輕度踝關(guān)節(jié)扭傷或一次嚴(yán)重的踝關(guān)節(jié)扭傷均可導(dǎo)致踝關(guān)節(jié)撞擊綜合

16、征。扭傷韌帶會(huì)發(fā)炎并增厚，導(dǎo)致在踝關(guān)節(jié)邊緣附近出現(xiàn)撞擊。Diagnosis 診斷診斷 How do doctors diagnose the condition?醫(yī)生是如何診斷踝關(guān)節(jié)扭傷的醫(yī)生是如何診斷踝關(guān)節(jié)扭傷的 The diagnosis of an ankle sprain is usually made by examination of the ankle and X-rays to make sure that the ankle is not fractured.A physical examination is used to determine which ligament

17、has been injured.The doctor will move your ankle in different positions in order to check the ligaments and other soft tissues around the ankle.Some tests place stress directly on the ankle ligaments to see if the ankle has become unstable and to find out if one or more ligaments has been partially

18、or completely torn.踝關(guān)節(jié)扭傷的診斷通常是通過體格檢查，然后拍攝X片排除踝關(guān)節(jié)骨折。體格檢查可以判斷哪一根韌帶發(fā)生損傷。你的醫(yī)生會(huì)在不同方向活動(dòng)你的踝關(guān)節(jié)，以檢查踝關(guān)節(jié)韌帶和周圍軟組織。一些特殊的體檢試驗(yàn)，直接把應(yīng)力施加于踝關(guān)節(jié)韌帶，通過踝關(guān)節(jié)的穩(wěn)定程度來判斷是否有韌帶損傷，一根或多跟韌帶損傷，是部分還是全部撕裂。If a complete rupture of the ligaments is suspected,your doctor may order stress X-rays as well.These X-rays are taken while the liga

19、ments are placed in a stretched position.The X-ray will show a slight tilt in the ankle bone if the ligaments have been torn.如果你的醫(yī)生懷疑你的韌帶全部撕裂，他會(huì)建議你去拍攝一個(gè)應(yīng)力位的X片。所謂應(yīng)力位X片即你拍片時(shí)，你的踝關(guān)節(jié)會(huì)被施加一個(gè)外力，以使得韌帶處于張力狀態(tài)。如果存在韌帶撕裂，那么在X片上會(huì)表現(xiàn)出踝關(guān)節(jié)骨頭的輕度傾斜。Treatment治療 What can be done for the problem?如何治療踝關(guān)節(jié)扭傷？Nonsurgical Treat

20、ment 非手術(shù)治療 Nonsurgical treatment options depend on whether your problem is an ankle sprain or ankle instability.非手術(shù)治療的選擇取決于你遭受是踝關(guān)節(jié)扭傷還是踝關(guān)節(jié)不穩(wěn)。Ankle Sprain 踝關(guān)節(jié)扭傷 The best results after an ankle sprain come when treatment is started right away.Treatments are used to stop the swelling,ease pain,and prote

21、ct how much weight is placed on the injured ankle.A simple way to remember these treatments is by the letters in the word RICE.These stand for rest,ice,compression,and elevation.在扭傷發(fā)生后立即開始治療，這有助于取得最好的結(jié)果。治療方法包括：減輕腫脹、緩解疼痛、控制患足的負(fù)重。有一個(gè)簡(jiǎn)單的記住這些治療手段的方法，即單詞“大米”（RICE），它代表著踝關(guān)節(jié)扭傷的治療方法：休息（rest）、冰敷（ice）、加壓包扎（com

22、prssion）、抬高患肢（elevation）Rest:The injured tissues in the ankle need time to heal.Crutches will prevent too much weight from being placed on the ankle.Ice:Applying ice can help ease pain and may reduce swelling.Compression:Gentle compression pushes extra swelling away from the ankle.This is usually ac

23、complished by using an elastic wrap.Elevation:Supporting your ankle above the level of your heart helps control swelling.休息：損傷的組織需要時(shí)間恢復(fù)，使用拐杖有助于減少患足的負(fù)擔(dān)。冰敷：冰敷有助于緩解疼痛、減輕腫脹。加壓包扎：適當(dāng)?shù)募訅喊梢詼p輕踝關(guān)節(jié)的腫脹，通常是使用彈力繃帶進(jìn)行加壓包扎 抬高患肢：將患肢抬高超過心臟水平，可以控制腫脹。Your doctor may also prescribe medications.Mild pain relievers help

24、with the discomfort.Anti-inflammatory medications can help ease pain and swelling and get people back to activity sooner after an ankle sprain.These medications include common over-the-counter drugs such as ibuprofen.But newer anti-inflammatory medicines called COX-2 inhibitors show promising result

25、s and dont seem to cause as much stomach upset and other intestinal problems.你的醫(yī)生也會(huì)給你開一些藥物。一些止痛藥可以緩解不適。消炎鎮(zhèn)痛藥物可以緩解疼痛減輕腫脹，可以讓患者盡快的返回的到日常活動(dòng)中去。這些藥物包括常見的非處方藥如布洛芬（芬必得）。還有一類新型的消炎鎮(zhèn)痛藥，屬于COX-2抑制劑，具有更好的療效，且不會(huì)引起胃部不適及一些其他的消化道問題。As treatment progresses,it is helpful to gradually begin putting weight through the j

26、oint.Casts have fallen out of favor because soft tissues weaken when they are kept immobile.But braces that can be worn to support the ankle,but still allow weight bearing,are the most popular treatment for helping reduce strain on the healing tissues.隨著治療的進(jìn)行，患足逐步負(fù)重是有利于恢復(fù)的。石膏固定會(huì)減弱軟組織的力量，所以一般不建議使用。佩戴

27、踝關(guān)節(jié)支具既可以保護(hù)踝關(guān)節(jié)又可以允許患足負(fù)重，是幫助減少恢復(fù)中的組織扭傷的流行治療方法。Healing of the ligaments usually takes about six weeks,but swelling may be present for several months.Your doctor may suggest that you work with a physical therapist to help you regain full range of ankle motion,improve balance,and maximize strength.韌帶損傷的恢

28、復(fù)通常需要六周時(shí)間，但腫脹可能會(huì)持續(xù)數(shù)月之久。你的醫(yī)生會(huì)建議你與理療師多接觸，以幫助你重獲踝關(guān)節(jié)的活動(dòng)度、提高踝關(guān)節(jié)的平衡性及恢復(fù)踝關(guān)節(jié)的肌力。Ankle Instability 踝關(guān)節(jié)不穩(wěn)定 If the ankle ligaments do not heal adequately,you may end up with ankle instability.This can cause the ankle to give way and feel untrustworthy on uneven terrain.If your ankle ligaments do not heal adequ

29、ately following an ankle sprain,your doctor may suggest several things.如果踝關(guān)節(jié)扭傷沒有得到充分的恢復(fù)，將會(huì)導(dǎo)致踝關(guān)節(jié)不穩(wěn)。這會(huì)造成患者在凹凸不平的路面行走時(shí)，會(huì)感覺踝關(guān)節(jié)崩潰不值得信融賴。如果在踝關(guān)節(jié)扭傷后，踝關(guān)節(jié)韌帶并未充分愈合，你的醫(yī)生會(huì)給你以下幾個(gè)建議：Changes in your footwear may be prescribed to help keep your ankle from turning in.Placing a heel wedge under the outer half of your

30、heel blocks the ankle from rolling,as does a flared heel built into your shoe.In extreme cases,doctors may prescribe a plastic brace,called an orthosis,to firmly hold your ankle from rocking side to side.Some patients feel a sense of steadiness from wearing high-topped shoes.Patients with ankle inst

31、ability should avoid wearing high-heeled shoes.首先是改變你的鞋，以防止你的踝關(guān)節(jié)總是處于內(nèi)翻狀態(tài)。在你足跟底部外側(cè)半放置足跟墊，可以阻止踝關(guān)節(jié)的內(nèi)翻，或穿一雙足跟外展的鞋也可以起到同樣的效果。對(duì)一些嚴(yán)重踝關(guān)節(jié)不穩(wěn)的患者，醫(yī)生可能會(huì)推薦使用塑料支具，即所謂矯正器，它可以牢牢的固定踝關(guān)節(jié)，防止踝關(guān)節(jié)晃動(dòng)。一些患者可以穿高幫鞋，這有助于提高踝關(guān)節(jié)的穩(wěn)定性。踝關(guān)節(jié)不穩(wěn)患者應(yīng)該避免穿高跟鞋。Physical therapy treatments will likely be initiated to help restore joint range of

32、motion,strength,and joint stability.理療有助于恢復(fù)踝關(guān)節(jié)活動(dòng)度，增強(qiáng)踝關(guān)節(jié)肌力及提高踝關(guān)節(jié)穩(wěn)定性。Small nerve sensors inside the ligament are injured when a ligament is stretched or torn.These nerve sensors give your brain information about the position of your joints,a sensation called position sense.For example,nerve sensors in

33、 your arm and hand give you the ability to touch your nose when your eyes are closed.The ligaments in the ankle work the same way.They send information to your nervous system to alert you about the position of your ankle joint.A physical therapist will help you retrain this sensation as a way to ste

34、ady the ankle joint and protect you from spraining your ankle again.當(dāng)踝關(guān)節(jié)韌帶拉傷或撕裂時(shí)，其內(nèi)的一些小的神經(jīng)感受器也會(huì)發(fā)生損傷。這些感受器用來幫助大腦確定關(guān)節(jié)的位置，這叫本體感覺。比如，你胳膊和手里的位置感受器能讓你在閉眼的時(shí)候也能很準(zhǔn)確的摸到自己的鼻子。踝關(guān)節(jié)韌帶里的位置感受器也起著同樣的作用，它們會(huì)告訴大腦踝關(guān)節(jié)的位置。理療師會(huì)幫助你重建本體感覺以穩(wěn)定踝關(guān)節(jié)并防止踝關(guān)節(jié)再次扭傷。Many people who have ankle instability have weakness in the muscles alo

35、ng the outside of the leg and ankle.These are called the peroneal muscles.Strengthening these muscles may help control the ankle joint and improve joint stability.很多踝關(guān)節(jié)不穩(wěn)的患者，其小腿及踝關(guān)節(jié)腓側(cè)肌肉的肌力會(huì)下降，這些肌肉一般指的是腓骨長(zhǎng)短肌。加強(qiáng)這些肌肉的肌力有助于增強(qiáng)患者對(duì)踝關(guān)節(jié)的控制并提高踝關(guān)節(jié)的穩(wěn)定性。Surgery 手術(shù)治療 Surgeons will occasionally do procedures right

36、 away in athletes who tear a lateral ankle ligament.In most other cases of torn ankle ligaments,surgeons will try nonsurgical treatments before doing reconstructive surgery of the ligaments.對(duì)于一些踝關(guān)節(jié)外側(cè)韌帶撕裂的運(yùn)動(dòng)員，外科醫(yī)生會(huì)選擇立即進(jìn)行手術(shù)治療，但對(duì)于其他普通人來說，在進(jìn)行外科手術(shù)治療之前，通常建議首先嘗試非手術(shù)療法。Ligament Tightening Procedure 韌帶緊縮術(shù) Chr

37、onic ankle instability can happen when the lateral ankle ligaments are stretched or torn and the ankle keeps giving way.Surgery can be done to tighten the stretched ligaments and improve the stability of the ankle.The surgery usually involves the ATFL and theCFL.當(dāng)踝關(guān)節(jié)外側(cè)韌帶拉傷或撕裂時(shí)，會(huì)導(dǎo)致慢性踝關(guān)節(jié)不穩(wěn)。可以將拉傷的韌帶進(jìn)行緊

38、縮以提高踝關(guān)節(jié)的穩(wěn)定性。手術(shù)通常是緊縮距腓前韌帶和跟腓韌帶。In this procedure,an incision is made in the skin that lies over the lateral ligaments.Using a scalpel,the surgeon cuts the ATFL and CFL in half.沿著踝關(guān)節(jié)外側(cè)韌帶表面取切口，切開后皮膚后，顯露距腓前韌帶和跟腓韌帶，使用刀片自其中部切斷。Holes are drilled along the lower end of the fibula bone,the small bone of the

39、lower leg.The two ends of the cut ligament are overlapped and sewn together.The surgeon uses the drill holes in the fibula to hold the stitches to the bone.在腓骨（小腿的小骨頭）遠(yuǎn)端鉆孔，將切斷的韌帶兩個(gè)斷端重疊并縫合，通過腓骨遠(yuǎn)端的孔將韌帶固定于腓骨。A large band of connective tissue crosses the front of the ankle just below the lateral ligamen

40、ts.This band,called the ankle retinaculum,holds the tendons in place.The surgeon pulls the top edge of the ankle retinaculum upward and sews it into the fibula.This helps reinforce the reconstructed ligaments.踝關(guān)節(jié)下支持帶，位于踝關(guān)節(jié)前方，恰好走形于踝關(guān)節(jié)外側(cè)韌帶的下方。通常，外科醫(yī)生會(huì)將踝關(guān)節(jié)下支持帶的上半部分縫合于腓骨遠(yuǎn)端，以加強(qiáng)重建韌帶的力量。The following image

41、s show each step of the ligament tightening procedure:下圖將描述韌帶緊縮術(shù)的過程：第一步：自韌帶中部切斷 第二步；腓骨遠(yuǎn)端鉆孔 第三步：韌帶縫合于腓骨 第四步：縫合踝關(guān)節(jié)下支持帶。Tendon Graft Procedure 肌腱移植術(shù) Another type of reconstruction is done using a tendon graft.If your surgeon feels that the stretched and scarred ligaments are not strong enough to simply

42、 repair in a ligament tightening procedure,then the ligaments must be reinforced with a tendon graft.另一種韌帶重建術(shù)需要肌腱移植。如果外科醫(yī)生認(rèn)為將僅僅對(duì)拉傷或疤痕化的韌帶進(jìn)行緊縮重建，依然不夠牢固，這時(shí)就需要移植肌腱來強(qiáng)化韌帶。In this procedure,the surgeon removes a portion of one of the nearby tendons to use as a tendon graft.The tendon most commonly used at

43、taches the peroneus brevis muscle to the outside edge of the small toe.A section of this tendon is put in place of the torn lateral ligaments.在這一手術(shù)過程中，術(shù)者會(huì)切取踝關(guān)節(jié)外側(cè)臨近肌腱的一部分進(jìn)行移植。通常，會(huì)切取腓骨短肌腱的一部分，然后將其縫合于撕裂的外側(cè)韌帶。After making the skin incision,the surgeon drills a hole in the fibula near the attachment of t

44、he original ligament.A second drill hole is made in the area where the ligament attaches on the talus(the anklebone).完成皮膚切口后，術(shù)者在踝關(guān)節(jié)外側(cè)韌帶于腓骨遠(yuǎn)端及距骨的止點(diǎn)附近鉆孔。The tendon graft is then removed(or harvested)and woven between these holes to recreate the ligament complex.然后切取腓骨短肌腱，穿過腓骨與距骨的鉆孔，以重建外側(cè)韌帶復(fù)合體。After su

45、rgery,you will probably be placed in a cast or brace for about six weeks to allow the tendon reconstruction to heal.Following removal of the cast,physical therapy will be required to regain full use of the ankle.術(shù)后，踝關(guān)節(jié)需要使用石膏或支具固定六周，以使重建的韌帶愈合。拆除石膏后，馬上開始理療，以獲得踝關(guān)節(jié)功能完整的恢復(fù)?？祻?fù) What will it take to make my

46、 ankle healthy again?如何使踝關(guān)節(jié)重獲健康。Nonsurgical Rehabilitation 非手術(shù)治療后的康復(fù) Even if you dont need surgery,you may need to follow a program of rehabilitation and exercise.Doctors recommend that their patients work with a physical therapist for two to four weeks.Your therapist can create a program to help yo

47、u regain ankle function.It is very important to improve strength and coordination in the ankle.即使你沒有接受手術(shù)治療，你也需要接受一系列的康復(fù)鍛煉計(jì)劃。醫(yī)生會(huì)推薦你在康復(fù)師的指導(dǎo)下進(jìn)行康復(fù)鍛煉，這一般需要兩到四周的時(shí)間。理療師會(huì)幫你制定康復(fù)計(jì)劃，以恢復(fù)恢復(fù)踝關(guān)節(jié)的功能。其中，最重要的是恢復(fù)踝關(guān)節(jié)的力量及協(xié)調(diào)性。Swelling and pain are treated with ice and electrical stimulation.If swelling in the ankle is se

48、vere,therapists may also apply massage strokes from the ankle toward the knee with your leg kept in an elevated position.This helps get the swelling moving out of the ankle and back into circulation.Your therapist may issue a compression wrap and instruct you to wrap your ankle and lower limb and to

49、 elevate your leg.腫脹和疼痛可以通過冰敷和電刺激療法進(jìn)行治療。如果腫脹很嚴(yán)重，理療師可能還會(huì)采用按摩療法，將你的患肢抬高，然后自踝關(guān)節(jié)向膝關(guān)節(jié)進(jìn)行按摩。這有助于踝關(guān)節(jié)的消腫，并促使?jié)B液返回入循環(huán)系統(tǒng)。理療師會(huì)對(duì)你進(jìn)行加壓包扎，并指導(dǎo)你如何包扎你的踝關(guān)節(jié)和小腿。Therapists also apply specialized hands-on treatment called joint mobilization to improve normal joint motion.These treatments restore the gliding motion within

50、the ankle joint where the lower leg meets the talus bone.This form of treatment speeds healing after an ankle sprain,and it helps return people and players more quickly to their activity or sport.理療師還會(huì)采用特殊手動(dòng)療法，即所謂的關(guān)節(jié)活動(dòng)療法，用來提高踝關(guān)節(jié)的活動(dòng)度。這些療法可以提高脛距關(guān)節(jié)面的滑動(dòng)度，加快踝關(guān)節(jié)扭傷后的康復(fù)速度，并使得普通患者和運(yùn)動(dòng)員更快的返回日常生活和運(yùn)動(dòng)中去。An effect

51、ive treatment for ankle sprains is disc training,which uses a circular platform with a small sphere under it.Patients place their feet on it while they sit or stand and work the ankle by tilting the disc in various positions.This form of exercise strengthens the muscles around the ankle,and it impro

52、ves joint sense(mentioned earlier).還有一種踝關(guān)節(jié)扭傷的鍛煉方式，稱為圓盤訓(xùn)練。使用一個(gè)底部有一個(gè)小球的圓盤，患者可取站立位或坐位，將腳放置于圓盤之上，然后往不同方向旋轉(zhuǎn)圓盤。這種形式的鍛煉可以加強(qiáng)踝關(guān)節(jié)周圍肌肉的肌力，并提高踝關(guān)節(jié)的本體感覺。When you get full ankle movement,your ankle isnt swelling,and your strength is improving,youll be able to gradually get back to your work and sport activities.An

53、 ankle brace may be issued for athletes who intend to return quickly to their sport.當(dāng)你的踝關(guān)節(jié)活動(dòng)度得到完全的恢復(fù)，沒有腫脹且肌力足夠時(shí)，你就能逐步返回你的日常工作和運(yùn)動(dòng)中去。對(duì)于那些想盡快回到運(yùn)動(dòng)中去的運(yùn)動(dòng)員來說，最好穿戴踝關(guān)節(jié)支具。After Surgery 手術(shù)后的康復(fù) Patients usually take part in formal physical therapy after surgery.Rehabilitation after surgery can be a slow process

54、.You will probably need to attend therapy sessions for two to three months,and you should expect full recovery to take up to six months.接受手術(shù)治療的患者術(shù)后通常會(huì)進(jìn)行正式的理療，術(shù)后的康復(fù)鍛煉通常是一個(gè)緩慢的過程。你可能需要進(jìn)行兩到三個(gè)月的康復(fù)鍛煉，而踝關(guān)節(jié)功能得到完全的恢復(fù)則需要半年時(shí)間。Rehabilitation proceeds cautiously after reconstruction of the ankle ligaments.Most p

55、atients are prescribed an ankle brace to wear when they are up and about,and they are strongly advised to follow the recommendations about how much weight can be borne while standing or walking.You may be instructed to put little or no weight on your foot when standing or walking for up to 12 weeks.

56、Your physical therapist will work with you to make sure you are using crutches safely and only bearing the recommended amount of weight on your foot.踝關(guān)節(jié)韌帶重建后的康復(fù)鍛煉需要小心謹(jǐn)慎的進(jìn)行。絕大多數(shù)的患者都需要穿戴踝關(guān)節(jié)支具，并且在站立或行走時(shí)，嚴(yán)格控制患足的負(fù)重量。術(shù)后12周內(nèi)，確保你的患足不負(fù)重或輕微負(fù)重。你的理療師會(huì)一直與你保持聯(lián)系，以確保你能安全的使用拐杖，且患足承受適當(dāng)負(fù)重量。The first few physical thera

57、py treatments are designed to help control pain and swelling from the surgery.Ice and electrical stimulation treatments may be used during your first few therapy sessions to help control pain and swelling.Your therapist may also use massage and other hands-on treatments to ease muscle spasm and pain

58、.首先開始的理療主要是用于控制術(shù)后的疼痛和腫脹，這期間會(huì)采用冰敷和電刺激治療。你的理療師也會(huì)采用按摩或其他手法治療來緩解肌肉痙攣和疼痛。Treatments are also used to help improve ankle range of motion without putting too much strain on the healing ligaments.一些其他的治療方法也會(huì)使用，用于提高踝關(guān)節(jié)活動(dòng)度，并且不會(huì)在重建韌帶上施加太多的外力。After about six weeks you may start doing more active exercise.Exerci

59、ses are used to improve the strength in the peroneal muscles.Your therapist will also help you retrain position sense in the ankle joint to improve the stability of the joint.一般六周后，你就可以開始進(jìn)行適當(dāng)?shù)闹鲃?dòng)鍛煉了，這些鍛煉有助于提高腓側(cè)肌肉的肌力。你的理療師也會(huì)幫助你重建本體感覺以提高踝關(guān)節(jié)的穩(wěn)定性。The physical therapists goal is to help you keep your pain

60、 under control,improve range of motion,and maximize strength and control in your ankle.When you are well under way,regular visits to the therapists office will end.Your therapist will continue to be a resource,but you will be in charge of doing your exercises as part of an ongoing home program.理療師的作

61、用就是幫你控制疼痛、提高踝關(guān)節(jié)活動(dòng)度及增加肌力。如果康復(fù)鍛煉計(jì)劃完成，你就不需要定期去理療師門診隨訪了。但作為家庭康復(fù)計(jì)劃的一部分，你仍然需要堅(jiān)持鍛煉急性運(yùn)動(dòng)損傷處置原則的演變 1978年，Gabe Mirkin醫(yī)生在所著的Sports Medicine Book中，首次提出了急性損傷的處理策略RICE原則，即由R-rest，I-ice,C-compression，E-elevation四大部分組成。多年來，這個(gè)治療原則被世界廣為利用作為運(yùn)動(dòng)員亦或是醫(yī)學(xué)的治療方式。Rest(休息)：停止走動(dòng)，讓受傷部位靜止休息，減少進(jìn)一步損傷；Ice(冰敷)：讓受傷部位溫度降低，減輕炎癥反應(yīng)和肌肉痙攣，緩解疼

62、痛抑制腫脹。每次 10-20 分鐘，每天 3 次以上，注意不要直接將冰塊敷在患處，可用濕毛巾包裹冰塊，以免凍傷。冰敷僅限傷后 48 小時(shí)內(nèi)。Compression(加壓)：使用彈性繃帶包裹受傷的踝關(guān)節(jié)，適當(dāng)加壓，以減輕腫脹。注意不要過度加壓，否則會(huì)加重包裹處以遠(yuǎn)肢體的腫脹、缺血。Elevation(抬高)：將肢抬高，高于心臟位置，增加靜脈和淋巴回流，減輕腫脹，促進(jìn)恢復(fù)。2011年9月7日，英國(guó)運(yùn)動(dòng)醫(yī)學(xué)醫(yī)學(xué)雜志（BJSM）在線的一篇文章“PRICE needs updating,should we call the POLICE?”為沉寂了30多年的急性軟組織損傷的治療原則問題放出一顆炸彈 文章

63、強(qiáng)烈建議將目前踝關(guān)節(jié)損傷治療的 RICE 原則替換為 POLICE：保護(hù) protect 適當(dāng)負(fù)重 optimal loading，冰敷 ice，加壓包扎 compression，抬高患肢 elevation。在評(píng)論文章中作者建議，踝關(guān)節(jié)損傷后休息僅限于踝關(guān)節(jié)損傷初期，休息時(shí)間應(yīng)盡可能短，踝關(guān)節(jié)長(zhǎng)時(shí)間無負(fù)重對(duì)關(guān)節(jié)存在潛在傷害，并可以導(dǎo)致關(guān)節(jié)組織生物力學(xué)和形態(tài)的負(fù)性改變。大家能看得出是把R換成了OL，即把休息（Rest）換成了最佳負(fù)荷（OL，Optimal Loading）。這個(gè)理念的改變是從以往的各種研究的分析得出的。研究發(fā)現(xiàn)，單純的休息可能是對(duì)機(jī)體的一種損傷，而不是良好作用。而用合理的負(fù)荷刺

64、激來代替休息是一種很好的解決方案。該理念的提出，是對(duì)現(xiàn)代康復(fù)理念的一種更新。了解最佳負(fù)荷了解最佳負(fù)荷 功能性康復(fù)得到了力學(xué)療法的原理較好的支持，力學(xué)負(fù)荷能提高全面的反應(yīng)以促進(jìn)組織結(jié)構(gòu)的改變。從動(dòng)物模型中得到了一致的研究結(jié)果，機(jī)械負(fù)荷可以上調(diào)與軟組織修復(fù)相關(guān)的關(guān)鍵蛋白的mRNA的表達(dá)。比較困難的臨床挑戰(zhàn)是找到在組織修復(fù)的過程中施加負(fù)荷和不施加負(fù)荷之間的平衡。如果損傷后機(jī)械刺激過大，它可能導(dǎo)致重新出血或者進(jìn)一步的損傷。保護(hù)脆弱的組織仍然是一個(gè)重要的原則。但是，過多的強(qiáng)調(diào)這一點(diǎn)可能會(huì)使在急性處理時(shí)放棄負(fù)荷的刺激。休息可能是有害的，且可以抑制恢復(fù)。訣竅就是找到所謂的“最佳負(fù)荷”。最佳負(fù)荷意味著用一種平

65、衡的、遞增的康復(fù)方案來取代休息，這種康復(fù)越早進(jìn)行就恢復(fù)越早。強(qiáng)調(diào)早期活動(dòng)而不是休息強(qiáng)調(diào)早期活動(dòng)而不是休息 文章中作者建議，踝關(guān)節(jié)損傷后休息僅限于踝關(guān)節(jié)損傷初期，休息時(shí)間應(yīng)盡可能短，踝關(guān)節(jié)長(zhǎng)時(shí)間無負(fù)重對(duì)關(guān)節(jié)存在潛在傷害，并可以導(dǎo)致關(guān)節(jié)組織生物力學(xué)和形態(tài)的負(fù)性改變。2013年國(guó)家運(yùn)動(dòng)教練員協(xié)會(huì)（NATA）刊登了踝關(guān)節(jié)扭傷處置第一個(gè)官方指南，研究者結(jié)合過去6年的文獻(xiàn)將踝關(guān)節(jié)治療方案由證據(jù)等級(jí)最好至最差分為A、B、C三級(jí)。RICE原則的大部分處置方法評(píng)級(jí)均為C級(jí)，但是遺憾的是目前臨床上的大部分醫(yī)生仍在遵循該原則。NATA的研究者發(fā)現(xiàn)目前有A級(jí)證據(jù)支持踝關(guān)節(jié)損傷I級(jí)（牽拉，韌帶纖維損傷）、II級(jí)（韌帶部

66、分撕裂）后的康復(fù)功能鍛煉。目前并沒有踝關(guān)節(jié)扭傷后即刻負(fù)重行走的直接證據(jù)，但一些隨機(jī)對(duì)照研究發(fā)現(xiàn)踝關(guān)節(jié)扭傷后數(shù)天進(jìn)行關(guān)節(jié)活動(dòng)度鍛煉并組建增加負(fù)重可以使得患者踝關(guān)節(jié)扭傷恢復(fù)更快，有經(jīng)驗(yàn)的物理治療師按摩治療也可以幫助患者踝關(guān)節(jié)盡早恢復(fù)功能。對(duì)III級(jí)踝關(guān)節(jié)扭傷患者（完全性韌帶撕裂），有B級(jí)證據(jù)支持傷后10天內(nèi)早期制動(dòng)，此后開始踝關(guān)節(jié)運(yùn)動(dòng)。但作者同時(shí)強(qiáng)調(diào)對(duì)踝關(guān)節(jié)脛腓聯(lián)合損傷或較嚴(yán)重踝關(guān)節(jié)扭傷的患者更保守的治療策略是較為恰當(dāng)?shù)摹Ｆ胶忮憻捄蚇SAIDs藥物治療是目前證據(jù)A級(jí)的治療措施。通過平衡鍛煉可以改善患者的本體感覺，減少后期患者在損傷的概率。NSAIDs類藥物治療踝關(guān)節(jié)扭傷目前爭(zhēng)議較多。Kaminski等人推薦在傷后48小時(shí)內(nèi)不使用NSAIDs類藥物，因此藥物可能在損傷早期抑制炎癥反應(yīng)的發(fā)生從而對(duì)后期關(guān)節(jié)預(yù)后產(chǎn)生影響Optimal Loading實(shí)質(zhì)實(shí)質(zhì) 平衡、遞增負(fù)荷的康復(fù)訓(xùn)練計(jì)劃來替代PRICE中的制動(dòng)休息(R)；早期康復(fù)中的OL可以通過加力或減力的方式來進(jìn)行控制和調(diào)節(jié)；加力抗阻訓(xùn)練是最典型的調(diào)整和控制OL的加力方式，阻力可以來自器械，還可以來自康復(fù)師的徒手技術(shù)；減力通過休息、制動(dòng)的護(hù)具、