手法复位联合中药外敷治疗TFCC损伤的RCT 研究

Research on a Randomized Controlled Trial of Manual Reduction Combined with External TCM Application for TFCC Injury

摘要: 目的：探讨手法复位联合中药外敷治疗三角纤维软骨复合体(TFCC)损伤的临床疗效及安全性，为优化TFCC损伤保守治疗策略提供循证医学证据。方法：选取2023年1月至2024年6月青州市人民医院收治的68例急性TFCC损伤患者，随机分为观察组(34例)与对照组(34例)。对照组采用西医常规保守治疗(腕关节制动、口服非甾体类抗炎药及康复指导)，观察组采用手法复位联合活血续筋方外敷治疗，两组均治疗4周，随访3个月。比较两组治疗前、治疗2周、4周及随访3个月时的VAS评分、Cooney腕关节功能评分、患侧手握力，记录症状缓解时间，评估临床疗效、影像学修复情况及不良反应。结果：最终完成研究65例(观察组33例，对照组32例)。治疗前两组基线资料可比(P > 0.05)。观察组各时间节点VAS评分显著低于对照组(P > 0.05)，Cooney评分及握力显著高于对照组(P > 0.05)；肿胀消退时间[(7.2 ± 2.1) d vs (10.5 ± 2.6) d]、压痛消失时间[(5.8 ± 1.8) d vs (8.3 ± 2.2) d]均短于对照组(P > 0.05)；治疗4周总有效率(93.94% vs 84.38%)、随访3个月影像学修复优良率(90.91% vs 71.88%)均优于对照组(P > 0.05)。两组不良反应发生率无统计学差异(P > 0.05)。结论：手法复位联合中药外敷治疗TFCC损伤疗效显著，安全性可靠，值得临床推广。

Abstract: Objective: To explore the clinical efficacy and safety of manual reduction combined with external application of traditional Chinese medicine in the treatment of triangular fibrocartilage complex (TFCC) injuries, and to provide evidence-based medicine for optimizing conservative treatment strategies for TFCC injuries. Method: Sixty eight patients with acute TFCC injury admitted to Qingzhou People’s Hospital from January 2023 to June 2024 were randomly divided into an observation group (34 cases) and a control group (34 cases). The control group received conventional conservative treatment in Western medicine (wrist joint immobilization, oral nonsteroidal anti-inflammatory drugs, and rehabilitation guidance), while the observation group received manual reduction combined with external application of the Huoxue Xujin formula. Both groups were treated for 4 weeks and followed up for 3 months. Compare the VAS scores, Cooney wrist joint function scores, and affected hand grip strength between two groups before treatment, at 2 weeks, 4 weeks of treatment, and 3 months of follow-up. Record the time of symptom relief, evaluate clinical efficacy, imaging repair, and adverse reactions. Result: A total of 65 cases were completed in the study (33 in the observation group and 32 in the control group). The baseline data of the two groups before treatment were comparable (P > 0.05). The VAS scores of the observation group at each time point were significantly lower than those of the control group (P > 0.05), while the Cooney score and grip strength were significantly higher than those of the control group (P > 0.05); The time for swelling to subside [(7.2 ± 2.1) d vs (10.5 ± 2.6) d] and the time for tenderness to disappear [(5.8 ± 1.8) d vs (8.3 ± 2.2) d] were both shorter than those in the control group (P > 0.05); The total effective rate after 4 weeks of treatment (93.94% vs 84.38%) and the excellent and good imaging repair rate after 3 months of follow-up (90.91% vs 71.88%) were both better than the control group (P > 0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P > 0.05). Conclusion: The combination of manual reduction and external application of traditional Chinese medicine has significant therapeutic effect and reliable safety in the treatment of TFCC injury, and is worthy of clinical promotion.