顽固性跟痛症的手术治疗  

Selection of surgical intervention for intractable calcaneodynia

作　　者：李忠[1] 姜厚森[1] 刘俊华 曹振昊 杨学栋[1] 石林[1] LI Zhong;JIANG Hou-sen;LIU Jun-hua;CAO Zhen-hao;YANG Xue-dong;SHI Lin(Department of Hand and Foot Surgery, People＇s Hospital of Weifang City, Weifang 261051, China;Central Township Hospital of Madian, Shouguang 262700, China)

机构地区：[1]山东省潍坊市人民医院手足骨外科,潍坊261041 [2]山东省潍坊市寿光市马店中心卫生院,262700

出　　处：《中国矫形外科杂志》2018年第10期918-922,共5页Orthopedic Journal of China

基　　金：潍坊市卫生计生委科研计划项目(编号:2016wsjs063)

摘　　要：[目的]探索顽固性跟痛症的手术方式与治疗效果。[方法]回顾性分析2012年4月～2016年12月本科手术治疗的84例顽固性跟痛症患者。根据术前压痛点、局部封闭疗效和跟骨骨刺情况综合判断分析,15例行跟骨钻孔减压术(减压组),29例行骨刺切除并跖腱膜射频消融术(切除组);19例行胫后神经跟骨内侧支松解切断术(松解复合切断组),21例行骨刺切除、跟骨钻孔减压、跖腱膜射频消融和胫后神经跟骨内侧支松解切断术(复合组)。[结果]四组患者的VAS评分随术后时间延长而显著下降,差异均有统计学意义(P<0.05)。而四组患者AOFAS-AH评分随术后时间延长而显著增加,差异均有统计学意义(P<0.01);末次随访时,四组患者临床疗效优良率分别为:减压组93.33%,切除组93.10%,松解复合切除组100%,复合组95.23%,84例患者总体优良率为95.23%。[结论]顽固性跟痛症主要术式有跖腱膜射频消融术,跟骨骨刺切除术,跟骨钻孔减压术,胫后神经跟骨内侧支切断术,经术前充分的评估,根据疼痛的不同原因合理优化组合应用上述手术方式,临床效果满意。[Objective] To explore how to choose the surgical interventions for intractable calcaneodynia.[Methods]A retrospective study was conducted on 84 patients who underwent surgical treatment for refractory heel pain in our department from April 2012 to December 2016.Based on the tender point,consequences of local blocking and calcaneal spur,15 patients received drilling decompression of the calcaneus（the decompression group）,29 patients underwent spur resection and radiofrequency ablation（the resection group）,19 patients got soft tissue release and neurectomy of the medial calcaneal branches of posterior tibial nerve（the neurectomy group）,and the remaining 21 had spur resection,drilling decompression,radiofrequency ablation and neurectomy（the composited group）.[Results]The VAS scores in the 4 groups significantly decreased over time,which at 1,3 months postoperatively and the latest follow up were statistically less than those before operation（P〈0.05）.Conversely,the AOFAS-AH scores in the 4 groups considerably increased as time elapsed,with statistical differences among the time points（P〈0.05）.At the latest follow up,the excellent and good rate of results were marked as 93.33%in the decompression group,93.10%in the resection group,100%in the neurectomy group and 95.23%in composited group,without a statistical difference among them.[Conclusion]The surgical interventions for intractable calcaneodynia include drilling decompression,removal of bone spurs,radiofrequency ablation of plantar fascia and neurectomy of medial calcaneal branch of posterior tibial nerve.All above technique or combinations achieve satisfactory clinical outcomes as long as reasonable selection of these interventions conducted to meet the concrete pathology in each patient

关 键 词：跟痛症 局封 跟骨钻孔减压 骨赘切除 软组织松解 

分 类 号：R687[医药卫生—骨科学]