丹参注射液关节腔注射联合Mulligan手法治疗踝关节大骨节病1例

Intra-Articular Injection of Salvia miltiorrhiza Injection Combined with Mulligan Technique for the Treatment of One Case of Ankle Kashin-Beck Disease

摘要: 大骨节病(Kashin-Beck disease, KBD)是一种以关节软骨变性及坏死为主要病理改变的地方性、变形性骨关节病，青少年起病常见，晚期可致关节畸形和功能障碍。现代医学治疗以非甾体抗炎药、关节腔注射透明质酸钠及手术干预为主，但远期疗效仍不稳定。本文报道1例右踝关节KBD (I度)青少年患者，采用丹参注射液关节腔注射联合Mulligan动态关节松动技术的中西医结合方案，治疗12周后疼痛与功能显著改善，炎症因子水平下降，随访3个月未复发。治疗思路依据国医大师段富津“正气运药”学术思想，强调以扶正为先，使活血化瘀之品得以透达病所，并以现代康复手法校正关节力学与运动控制失衡，达到“内外兼治、筋骨并重”的目的。其潜在机制推测为，Mulligan手法通过改善关节内力学环境，可能促进了丹参注射液在病灶局部的渗透与分布，从而协同发挥抗炎与组织保护作用。本案提示，丹参注射联合Mulligan手法治疗踝关节KBD具有良好安全性与可行性，值得进一步临床研究与推广。

Abstract: Kashin-Beck disease (KBD) is an endemic, deforming osteoarthropathy characterized primarily by degeneration and necrosis of articular cartilage. It commonly affects adolescents and may lead to joint deformity and functional impairment in advanced stages. Conventional medical management includes nonsteroidal anti-inflammatory drugs (NSAIDs), intra-articular sodium hyaluronate injections, and surgical interventions, yet long-term efficacy remains suboptimal. This report presents a case of a juvenile patient with grade I KBD affecting the right ankle, who was treated with a combined integrative Chinese and Western medicine approach involving intra-articular injection of Salvia miltiorrhiza injection and Mulligan’s mobilization with movement (MWM) technique. After 12 weeks of treatment, the patient exhibited significant improvement in pain and function, reduced levels of inflammatory markers, and no recurrence during a 3-month follow-up. The therapeutic strategy was guided by the academic principle of “Zheng Qi Yun Yao” (righteous qi facilitating drug action) proposed by Academician Fu-Jin Duan, emphasizing reinforcing the body’s vital energy to enable blood-activating and stasis-resolving agents to reach the pathological site effectively. Concurrently, modern manual therapy was employed to correct joint biomechanical and motor control dysfunctions, achieving the therapeutic goal of “treating both internal and external aspects, and addressing tendons and bones equally”. A potential underlying mechanism is hypothesized that the Mulligan technique, by improving the intra-articular mechanical environment, might facilitate the penetration and distribution of Salvia miltiorrhiza injection at the local lesion site, thereby synergistically exerting anti-inflammatory and tissue-protective effects. This case suggests that the combination of Salvia miltiorrhiza injection and the Mulligan technique for ankle KBD is safe and feasible, warranting further clinical investigation and potential application.