【目的】 探究凉血祛瘀法在急性踝关节扭伤早期对肿胀、疼痛症状及关节活动能力恢复进程的作用。【方法】 选取2023年 1月至2024年1月广州中医药大学第八临床医学院（佛山市中医院）收治的88例急性踝关节扭伤早期患者，通过随机分配的方 式（随机数字表法）将患者随机分为观察组和对照组，每组各 44例。对照组采用 PRICE 原则进行治疗，具体措施包括冰敷、 制动以及加压包扎等；观察组在对照组的基础上给予中药汤剂凉血祛瘀方（由毛冬青、赤芍、牡丹皮、生地黄、牛膝、大 枣、甘草组成）口服联合舒筋洗外用颗粒（由威灵仙、苏木、刘寄奴、钩藤、连钱草等组成）外洗治疗，2组患者的治疗周期 均为1周。观察2组患者治疗前后疼痛程度视觉模拟量表（VAS）评分、踝关节肿胀度评分、踝关节活动度（包括跖屈和背伸） 以及美国足踝外科协会（AOFAS）踝-后足功能量表评分的变化情况，并评估2组患者的临床疗效。【结果】（1）疗效方面，治 疗1周后，观察组的总有效率为95.45%（42/44），对照组为86.36%（38/44），组间比较（χ2 检验），观察组的疗效明显优于对照 组（P＜0.05）。（2）疼痛程度和踝关节功能方面，治疗后，2组患者的疼痛程度VAS评分均较治疗前明显降低（P＜0.05），踝关 节功能 AOFAS评分均较治疗前明显升高（P＜0.05），且观察组对疼痛程度 VAS评分的降低作用及对踝关节功能 AOFAS评分 的升高作用均明显优于对照组（P＜0.05或P＜0.01）。（3）踝关节肿胀度和活动度方面，治疗后，2组患者的踝关节肿胀度评分 均较治疗前明显降低（P＜0.05），踝关节活动度均较治疗前明显提高（P＜0.05），且观察组对踝关节肿胀度评分的降低作用及 对踝关节活动度的提高作用均明显优于对照组（P＜0.05 或 P＜0.01）。（4）中医证候评分方面，治疗后，2 组患者的疼痛、瘀 斑、肿胀以及功能障碍等各项中医证候评分均较治疗前明显降低（P＜0.05），且观察组对疼痛、瘀斑、肿胀评分的降低作用 均明显优于对照组（P＜0.01），而在功能障碍评分方面，2组治疗后比较，差异无统计学意义（P＞0.05）。【结论】 凉血祛瘀法 在急性踝关节扭伤早期的治疗中，对肿痛症状的改善具有显著的临床效果，能够有效发挥消肿止痛作用，并有助于促进踝 关节功能的恢复。

Objective To explore the effect of the method of cooling blood and removing stasis on promoting the relief of swelling and pain symptoms and the recovery of joint mobility in the early stage of acute ankle sprains. Methods From January 2023 to January 2024，a total of 88 patients with early-stage acute ankle sprains admitted to the Eighth Clinical Medical School of Guangzhou University of Chinese Medicine（Foshan Hospital of Traditional Chinese Medicine） were selected. The patients were randomly divided into an observation group and a control group using a random allocation method （random number table），with 44 patients in each group. The control group was treated following the PRICE principle for acute sports injury， with the measures such as ice compress， immobilization， and compression. The observation group， in addition to receiving the same treatment as the control group，was given the decoction of Liangxue Quyu Prescription orally （a formula with the actions of cooling blood and removing stasis，and composed of Ilicis Pubescentis Radix，Paeoniae Radix Rubra，Moutan Cortex， Rehmanniae Radix，Achyranthis Bidentatae Radix，Jujubae Fructus，and Glycyrrhizae Radix et Rhizoma），and external washing with Shujin Xi External Washing Granules（mainly composed of Clematidis Radix et Rhizoma， Sappan Lignum， Artemisiae Anomalae Herba， Uncariae Ramulus cum Uncis， and Glechomae Herba， and others. The treatment period for both groups lasted for one week. Before and after treatment，the changes in Visual Analogue Scale（VAS） scores of pain，ankle swelling scores，ankle range of motion （including plantar flexion and dorsiflexion），and the American Orthopedic Foot & Ankle Society（AOFAS） ankle-hindfoot scale scores in the two groups were observed. After treatment，the clinical efficacy of the two groups was evaluated. Results （1）After one week of treatment，the total effective rate in the observation group was 95.45%（42/44），and that in the control group was 86.36%（38/44）. The intergroup comparison by chi-square test showed that the efficacy of the observation group was significantly superior to that of the control group （P＜0.05）.（2）After treatment，the VAS scores for pain in both groups were significantly reduced （P＜0.05） and the AOFAS scores for ankle function were significantly increased（P＜0.05） compared to those before treatment. The observation group showed significant reduction in VAS scores and obvious improvement in AOFAS scores compared to the control group（P＜0.05 or P＜ 0.01）.（3）After treatment，the ankle swelling scores in both groups were significantly reduced（P＜0.05） and the ankle range of motion was significantly improved （P＜0.05） compared to those before treatment. The observation group showed significant reduction in ankle swelling scores and obvious improvement in the range of motion compared to the control group （P＜0.05 or P＜0.01）.（4） After treatment，the scores for TCM symptoms of pain， ecchymosis and swelling，and scores of functional disorders in both groups were significantly reduced（P＜0.05） compared to those before treatment. The observation group showed significant reduction in pain，ecchymosis，and swelling scores compared to the control group（P＜0.01），while there was no significant difference in dysfunction scores between the two groups after treatment （P＞0.05）. Conclusion The method of cooling blood and removing stasis has significant effects on improving swelling and pain symptoms during the early treatment of acute ankle sprains. It is effective on relieving swelling and pain， and is helpful for promoting the recovery of ankle joint function.

R274.9

广东省中医药局科研项目（编号：20221381）