南方医科大学学报

南方医科大学学报 ›› 2018, Vol. 38 ›› Issue (02): 135-.

• • 上一篇    下一篇

气压弹道式放散性冲击波和超声引导下类固醇激素介入治疗足底筋膜炎的预后分析

霍修林，王克涛，张晓莹，杨倚天，曹福羊，杨静，袁维秀，米卫东   

  • 出版日期:2018-02-20 发布日期:2018-02-20

Prognostic analysis of plantar fasciitis treated by pneumatic ballistic extracorporeal shock wave versus ultrasound guided intervention

  • Online:2018-02-20 Published:2018-02-20

HTML

PDF

1725

摘要： 目的比较气压弹道式放散性冲击波和超声引导下类固醇激素治疗足底筋膜炎的中长期疗效。方法选择2015年9月~ 2017年2月就诊于解放军总医院疼痛门诊的足底筋膜炎患者，采用随机数字法分为冲击波组（A组）和超声组（B组）。比较两组 治疗前（T0）与治疗后1周（T1）、1月（T2）、3月（T3）、6月（T4）晨起第1步数字量表疼痛评分（NRS）、美国足踝外科协会（AOFAS）踝- 后足功能评分、超声下足底筋膜的厚度，末次随访时记录2组患者的疗效、复发率和满意度。结果最终A组纳入39人，B组纳入 38人。治疗前两组患者NRS评分相近，治疗后早晨第1步NRS评分均较治疗前降低（P<0.05）；治疗后1周（T1）、1月（T2）B组晨 起第1步NRS评分均低于A组（P<0.01），治疗后3月（T3）、6月（T4）B组晨起第1步NRS评分高于A组（P<0.05）；两组患者末次随 访AOFAS功能评分均较治疗前升高（P<0.05），且A组高于B组（90.44±13.27 vs 75.76±21.40，P<0.05）；A组、B组有效率分别为 92.31%、76.32%，A组高于B组（P<0.05）；A组复发1例（2.56%），B组复发8例（21.05%），B组复发率高（P<0.05）；A组、B组满意 度评分分别为8.13±2.67、6.63±3.75，两组间差异有统计学意义（P=0.048）。结论气压弹道式放散性冲击波中长期疗效和患者 满意度优于超声引导下激素注射组，在疼痛医学、运动医学和康复医学治疗上具有较好的应用价值。

Abstract: Objective To compare the medium- and long-term effect of pneumatic ballistic extracorporeal shock wave versus ultrasound-guided hormone injection in the treatment of plantar fasciitis. Methods The clinical data were collected from patients with plantar fasciitis admitted to PLA General Hospital pain department from September, 2015 to February, 2017. The patients were randomly divided into ultrasound-guided drug injection group and shock wave group. The therapeutic parameters including the numerical rating scale (NRS) scores in the first step pain in the morning, American Orthopedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Scale, and thickness of the plantar fascia were monitored before and at 1 week, 1 month, 3 months, and 6 months after the treatment. The recurrence rate, effectiveness, and patient satisfaction were compared between the two groups at 6 months after the treatment. Results Thirty-nine patients were enrolled in shock wave group and 38 patients in ultrasound group. The NRS scores in the first step pain in the morning were lowered after treatment in both groups (P<0.05), and the scores were significantly lower in ultrasound group than in shock wave group at 1 week and 1 month (P<0.01), but significantly higher in ultrasound group than in shock wave group at 3 and 6 months after treatment (P<0.05). The AOFAS functional scores were increased in both groups (P<0.05) at 6 months after treatment, was significantly lower in ultrasound group than in shock wave group than group B (90.44±13.27 vs 75.76±21.40; P<0.05). The effective rates in shock wave group and ultrasound group were 92.31% and 76.32%, respectively (P<0.05). Recurrence was found in 1 patient (2.56%) in shock wave group and in 8 (21.05%) in ultrasound group (P<0.05). The patient satisfaction scores were significantly higher in shock wave group than in ultrasound group (8.13±2.67 vs 6.63±3.75, P=0.048). Conclusion Pneumatic ballistic extracorporeal shock achieves better medium- and long-term outcomes than ultrasound-guided hormone injection in the treatment of plantar fasciitis.