中西医结合非手术治疗急性踝关节外侧韧带Ⅲ度损伤的疗效观察及预后相关因素分析OA

Objective This study aims to systematically evaluate the clinical outcomes and prognostic factors associated with an integrated traditional Chinese and Western medicine non-surgical treatment regimen for acute gradeⅢ lateral ankle ligament injuries through a retrospective analysis,so as to provide evidence for optimizing clinical treatment strategies and improving prognosis.Methods A retrospective analysis was conducted on 51 patients with acute lateral ankle sprain(grade Ⅲ)who were treated non-surgically in the outpatient clinic from June 2023 to December 2024.All patients received a three-phase integrated traditional Chinese and Western medicine treatment protocol:Phase Ⅰ,traditional Chinese medicine(TCM)manual tendon manipulation and the POLICE principle(Protection,Optimal Loading,Ice,Compression,Elevation);Phase Ⅱ,protected active ankle mobilization and static balance training are progressively introduced;Phase Ⅲ,involved proprioceptive training,dynamic balance training,and resistive muscle strengthening are performed.During all three stages,depending on the patient's swelling and pain conditions,Erhuang Xinshang Zhitong Ointment or Jiushang Huoluo Ointment may be applied topically based on syndrome differentiation.Anterior drawer tests and talar tilt stress tests were performed at 1,2,and 3 months post-injury,and the Cumberland Ankle Instability Tool(CAIT)was used to assess ankle stability at 5 to 6 months post-injury.Multivariable regression analysis(with Firth-corrected logistic regression)was applied to identify factors associated with poor prognosis,aiming to explore the clinical application of individualized treatment plans in grade Ⅲ lateral ankle ligament injuries.Results Among the 51 patients,the mean age was 32.16±11.29 years,and the mean time from injury to initial visit was 3.65±2.27 days.The CAIT score at 6 months post-injury showed that the functional ankle stability recovery rate of the integrated traditional Chinese and Western medicine non-surgical treatment for acute grade Ⅲ lateral ankle ligament injury was 64.71%.According to the recovery time of ankle stability,the patients were divided into a rapid recovery group n=13(25.49%),a delayed recovery group n=16(31.37%),and a persistent instability group n=22(43.14%).Their CAIT scores were 26.08±1.32,25.13±1.31,and 21.45±2.39,respectively,with a statistically significant difference among the groups(F=31.277,P<0.001).Multivariable Firth-corrected logistic regression analysis showed that time from injury to presentation(OR=1.563,P=0.047)and the anterior drawer test result at 1 month post-injury(OR=9.820,P=0.029)were associated with poor prognosis.Conclusion Among patients with acute grade Ⅲ lateral ankle ligament injuries treated with an integrated traditional Chinese and Western medicine non-surgical regimen,approximately 64.71%achieved the CAIT-defined criteria for ankle stability recovery at 5-6 months post-injury.Prolonged time from injury to presentation and a positive anterior drawer test at 1 month post-injury may indicate a higher risk of poor functional prognosis.Therefore,risk-stratified management should be guided by the association between patients'recovery trajectories and mid-to-long-term ankle functional status,with individualized adjustments to treatment protocols and careful evaluation of surgical indications.