踝关节扭伤患者指南（下）

踝关节扭伤患者指南

What can be done for the problem?

如何治疗踝关节扭伤？

非手术治疗

Nonsurgical treatment options depend on whether your problem is an ankle sprain or ankle instability.

非手术治疗的选择取决于你遭受是踝关节扭伤还是踝关节不稳。

Ankle Sprain

踝关节扭伤

The best results after an ankle sprain come when treatment is started right away. Treatments are used to stop the swelling, ease pain, and protect how much weight is placed on the injured ankle. A simple way to remember these treatments is by the letters in the wordRICE.

These stand for rest, ice, compression, and elevation.

在扭伤发生后立即开始治疗，这有助于取得最好的结果。治疗方法包括：减轻肿胀、缓解疼痛、控制患足的负重。有一个简单的记住这些治疗手段的方法，即单词“大米”（RICE），它代表着踝关节扭伤的治疗方法：休息（rest）、冰敷（ice）、加压包扎（comprssion）、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 accomplished by using an elastic wrap.

Elevation: Supporting your ankle above the level of your heart helps control swelling.

休息：损伤的组织需要时间恢复，使用拐杖有助于减少患足的负担。

冰敷：冰敷有助于缓解疼痛、减轻肿胀。

加压包扎：适当的加压包扎可以减轻踝关节的肿胀，通常是使用弹力绷带进行加压包扎

抬高患肢：将患肢抬高超过心脏水平，可以控制肿胀。

Your doctor may also prescribe medications. Mild pain relievers help 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 calledCOX-2 inhibitorsshow promising results and don’t seem to cause as much stomach upset and other intestinal problems.

你的医生也会给你开一些药物。一些止痛药可以缓解不适。消炎镇痛药物可以缓解疼痛减轻肿胀，可以让患者尽快的返回的到日常活动中去。这些药物包括常见的非处方药如布洛芬（芬必得）。还有一类新型的消炎镇痛药，属于COX-2抑制剂，具有更好的疗效，且不会引起胃部不适及一些其他的消化道问题。

As treatment progresses, it is helpful to gradually begin putting weight through the joint. 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.

随着治疗的进行，患足逐步负重是有利于恢复的。石膏固定会减弱软组织的力量，所以一般不建议使用。佩戴踝关节支具既可以保护踝关节又可以允许患足负重，是帮助减少恢复中的组织扭伤的流行治疗方法。

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.

韧带损伤的恢复通常需要六周时间，但肿胀可能会持续数月之久。你的医生会建议你与理疗师多接触，以帮助你重获踝关节的活动度、提高踝关节的平衡性及恢复踝关节的肌力。

Ankle Instability

踝关节不稳定

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 adequately following an ankle sprain, your doctor may suggest several things.

如果踝关节扭伤没有得到充分的恢复，将会导致踝关节不稳。这会造成患者在凹凸不平的路面行走时，会感觉踝关节崩溃不值得信融赖。如果在踝关节扭伤后，踝关节韧带并未充分愈合，你的医生会给你以下几个建议：

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 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 anorthosis, 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 instability should avoid wearing high-heeled shoes.

首先是改变你的鞋，以防止你的踝关节总是处于内翻状态。在你足跟底部外侧半放置足跟垫，可以阻止踝关节的内翻，或穿一双足跟外展的鞋也可以起到同样的效果。对一些严重踝关节不稳的患者，医生可能会推荐使用塑料支具，即所谓矫正器，它可以牢牢的固定踝关节，防止踝关节晃动。一些患者可以穿高帮鞋，这有助于提高踝关节的稳定性。踝关节不稳患者应该避免穿高跟鞋。

Physical therapy treatments will likely be initiated to help restore joint range of motion, strength, and joint stability.

理疗有助于恢复踝关节活动度，增强踝关节肌力及提高踝关节稳定性。

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 calledposition sense. For example, nerve sensors in your arm andhandgive 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 steady the ankle joint and protect you from spraining your ankle again.

当踝关节韧带拉伤或撕裂时，其内的一些小的神经感受器也会发生损伤。这些感受器用来帮助大脑确定关节的位置，这叫本体感觉。比如，你胳膊和手里的位置感受器能让你在闭眼的时候也能很准确的摸到自己的鼻子。踝关节韧带里的位置感受器也起着同样的作用，它们会告诉大脑踝关节的位置。理疗师会帮助你重建本体感觉以稳定踝关节并防止踝关节再次扭伤。

Many people who have ankle instability have weakness in the muscles along the outside of the leg and ankle. These are called theperoneal muscles. Strengthening these muscles may help control the ankle joint and improve joint stability.

很多踝关节不稳的患者，其小腿及踝关节腓侧肌肉的肌力会下降，这些肌肉一般指的是腓骨长短肌。加强这些肌肉的肌力有助于增强患者对踝关节的控制并提高踝关节的稳定性。

手术治疗

Surgeons will occasionally do procedures right 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.

对于一些踝关节外侧韧带撕裂的运动员，外科医生会选择立即进行手术治疗，但对于其他普通人来说，在进行外科手术治疗之前，通常建议首先尝试非手术疗法。

Ligament Tightening Procedure

韧带紧缩术

Chronic 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 the
CFL.

当踝关节外侧韧带拉伤或撕裂时，会导致慢性踝关节不稳。可以将拉伤的韧带进行紧缩以提高踝关节的稳定性。手术通常是紧缩距腓前韧带和跟腓韧带。

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.

沿着踝关节外侧韧带表面取切口，切开后皮肤后，显露距腓前韧带和跟腓韧带，使用刀片自其中部切断。

Holes are drilled along the lower end of the fibula bone, the small bone of the 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（小腿的小骨头）远端钻孔，将切断的韧带两个断端重叠并缝合，通过腓骨远端的孔将韧带固定于腓骨。

A large band of connective tissue crosses the front of the ankle just below the lateral ligaments. This band, called theankle 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.

踝关节下支持带，位于踝关节前方，恰好走形于踝关节外侧韧带的下方。通常，外科医生会将踝关节下支持带的上半部分缝合于腓骨远端，以加强重建韧带的力量。

The following images show each step of the ligament tightening procedure:

下图将描述韧带紧缩术的过程：

第一步：自韧带中部切断

第二步；腓骨远端钻孔

第三步：韧带缝合于腓骨

第四步：缝合踝关节下支持带。

Step 1

Step 2

Step 3

Step 4

Tendon GraftProcedure

肌腱移植术

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 repair in a ligament tightening procedure, then the ligaments must be reinforced with a tendon graft.

另一种韧带重建术需要肌腱移植。如果外科医生认为将仅仅对拉伤或疤痕化的韧带进行紧缩重建，依然不够牢固，这时就需要移植肌腱来强化韧带。

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 attaches theperoneus brevismuscle to the outside edge of the small toe. A section of this tendon is put in place of the torn lateral ligaments.

在这一手术过程中，术者会切取踝关节外侧临近肌腱的一部分进行移植。通常，会切取腓骨短肌腱的一部分，然后将其缝合于撕裂的外侧韧带。

After making the skin incision, the surgeon drills a hole in the fibula near the attachment of the original ligament. A second drill hole is made in the area where the ligament attaches on the talus (the anklebone).

完成皮肤切口后，术者在踝关节外侧韧带于腓骨远端及距骨的止点附近钻孔。

The tendon graft is then removed (orharvested) and woven between these holes to recreate the ligament complex.

然后切取腓骨短肌腱，穿过腓骨与距骨的钻孔，以重建外侧韧带复合体。

After surgery, you will probably be placed in acastor 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.

术后，踝关节需要使用石膏或支具固定六周，以使重建的韧带愈合。拆除石膏后，马上开始理疗，以获得踝关节功能完整的恢复。

康复

What will it take to make my ankle healthy again?

如何使踝关节重获健康。

非手术治疗后的康复

Even if you don’t 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 you regain ankle function. It is very important to improve strength and coordination in the ankle.

即使你没有接受手术治疗，你也需要接受一系列的康复锻炼计划。医生会推荐你在康复师的指导下进行康复锻炼，这一般需要两到四周的时间。理疗师会帮你制定康复计划，以恢复恢复踝关节的功能。其中，最重要的是恢复踝关节的力量及协调性。

Swelling and pain are treated with ice andelectrical stimulation. If swelling in the ankle is severe, therapists may also apply massage strokes from the ankle toward thekneewith 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 elevate your leg.

肿胀和疼痛可以通过冰敷和电刺激疗法进行治疗。如果肿胀很严重，理疗师可能还会采用按摩疗法，将你的患肢抬高，然后自踝关节向膝关节进行按摩。这有助于踝关节的消肿，并促使渗液返回入循环系统。理疗师会对你进行加压包扎，并指导你如何包扎你的踝关节和小腿。

Therapists also apply specialized hands-on treatment calledjoint mobilizationto improve normal joint motion. These treatments restore the gliding motion within 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.

理疗师还会采用特殊手动疗法，即所谓的关节活动疗法，用来提高踝关节的活动度。这些疗法可以提高胫距关节面的滑动度，加快踝关节扭伤后的康复速度，并使得普通患者和运动员更快的返回日常生活和运动中去。

An effective treatment for ankle sprains isdisc 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 improves joint sense (mentioned earlier).

还有一种踝关节扭伤的锻炼方式，称为圆盘训练。使用一个底部有一个小球的圆盘，患者可取站立位或坐位，将脚放置于圆盘之上，然后往不同方向旋转圆盘。这种形式的锻炼可以加强踝关节周围肌肉的肌力，并提高踝关节的本体感觉。

When you get full ankle movement, your ankle isn’t swelling, and your strength is improving, you’ll be able to gradually get back to your work and sport activities. An ankle brace may be issued for athletes who intend to return quickly to their sport.

当你的踝关节活动度得到完全的恢复，没有肿胀且肌力足够时，你就能逐步返回你的日常工作和运动中去。对于那些想尽快回到运动中去的运动员来说，最好穿戴踝关节支具。

手术后的康复

接受手术治疗的患者术后通常会进行正式的理疗，术后的康复锻炼通常是一个缓慢的过程。你可能需要进行两到三个月的康复锻炼，而踝关节功能得到完全的恢复则需要半年时间。

Rehabilitation proceeds cautiously after reconstruction of the ankle ligaments. Most patients 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. 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.

踝关节韧带重建后的康复锻炼需要小心谨慎的进行。绝大多数的患者都需要穿戴踝关节支具，并且在站立或行走时，严格控制患足的负重量。术后12周内，确保你的患足不负重或轻微负重。你的理疗师会一直与你保持联系，以确保你能安全的使用拐杖，且患足承受适当负重量。

The first few physical therapy 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.

首先开始的理疗主要是用于控制术后的疼痛和肿胀，这期间会采用冰敷和电刺激治疗。你的理疗师也会采用按摩或其他手法治疗来缓解肌肉痉挛和疼痛。

Treatments are also used to help improve ankle range of motion without putting too much strain on the healing ligaments.

一些其他的治疗方法也会使用，用于提高踝关节活动度，并且不会在重建韧带上施加太多的外力。

After about six weeks you may start doing more active exercise. Exercises 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，你就可以开始进行适当的主动锻炼了，这些锻炼有助于提高腓侧肌肉的肌力。你的理疗师也会帮助你重建本体感觉以提高踝关节的稳定性。

The physical therapist’s goal is to help you keep your pain under control, improve range of motion, and maximize strength and control in your ankle. When you are well under way, regular visits to the therapist’s 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.

理疗师的作用就是帮你控制疼痛、提高踝关节活动度及增加肌力。如果康复锻炼计划完成，你就不需要定期去理疗师门诊随访了。但作为家庭康复计划的一部分，你仍然需要坚持锻炼。