针刺联合其他外治法治疗陈旧性踝关节扭伤的研究进展

Research Progress of Acupuncture Combined with Other External Therapies in the Treatment of Chronic Ankle Instability

摘要: 陈旧性踝关节扭伤(CAI)，多因急性踝关节扭伤制动不足、早期康复缺失，迁延超过1个月形成，临床以踝周反复肿痛、关节僵硬、行走酸软、频繁崴脚为典型表现，单纯抗炎、单一针刺远期复发率偏高。针刺可快速疏通经络、即时镇痛，但对深层筋膜粘连、筋骨亏虚、关节力学失衡改善有限，临床常联合中药熏洗、热敏灸、火针、电针、推拿理筋、拔罐、关节松动术、功能锻炼等多类外治法协同干预。本文系统梳理分类归纳各类针刺联合外治法的临床应用、操作方案，总结现有研究短板并提出未来研究方向，为陈旧性踝关节扭伤规范化综合外治提供循证依据。

Abstract: Chronic ankle instability (CAI) mostly develops more than one month after acute ankle sprain due to insufficient immobilization and lack of early rehabilitation. Its typical clinical manifestations include recurrent swelling and pain around the ankle, joint stiffness, soreness and weakness during walking, and frequent recurrent ankle sprains. Simple anti-inflammatory therapy or monotherapy with acupuncture has a relatively high long-term recurrence rate. Acupuncture can quickly dredge meridians and relieve pain instantly, yet it has limited effects on deep fascial adhesion, insufficiency of tendons and bones, and joint mechanical imbalance. Clinically, acupuncture is often combined with various external therapies including Chinese herbal fumigation, heat-sensitive moxibustion, fire needling, electroacupuncture, tendon-regulating tuina, cupping, joint mobilization and functional exercise for synergistic intervention. This paper systematically sorts out and categorizes the clinical applications and operation protocols of different combined regimens of acupuncture and external therapies, summarizes the deficiencies of existing studies, and proposes future research directions, so as to provide evidence-based references for standardized comprehensive external treatment of chronic ankle instability.