内侧入路关节镜下三联术式治疗顽固性跟痛症的临床效果  

Clinical effect of treating refractory calcaneodynia with medial approach arthroscopic triple operation

作　　者：鲁林[1] 张汉庆[1] 王智[1] 陈炜[2] 李双蕾[2] LU Lin;ZHANG Hanqing;WANG Zhi;CHEN Wei;LI Shuanglei(Department of Orthopaedics,Wuhan Traditional Chinese Medicine Hospital,Hubei Province,Wuhan430014,China;Department of Neurology,the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine,Guangxi Zhuang Autonomous Region,Nanning530023,China)

机构地区：[1]湖北省武汉市中医院骨科,湖北武汉430014 [2]广西中医药大学附属第一医院神经内科,广西南宁530023

出　　处：《中国医药导报》2020年第33期13-17,共5页China Medical Herald

基　　金：国家自然科学基金资助项目(81860784);湖北省高校人文社会科学重点研究基地中医药发展研究中心项目(ZX2015D03)。

摘　　要：目的探讨内侧入路关节镜下三联术式治疗顽固性跟痛症的临床效果。方法遴选2017年12月—2019年2月湖北省武汉市中医医院对经过系统保守治疗6个月以上仍无效的足跟痛患者20例(21足),在内侧入路关节镜直视下运用三联术式(等离子刀消融汽化松解跖筋膜、跟骨骨赘磨削、跟骨钻孔减压)治疗。采用美国足踝外科协会踝与后足评分(AOFAS-AH)及疼痛视觉模拟评分(VAS)对患者术前及术后6~10个月进行评分,用以观察临床疗效。结果患者术后切口均甲级愈合,无神经、血管损伤及其他并发症,术后患者能早期进行日常活动。中位随访时间为8.7(6.0~10.0)个月,中位手术时间为40.7(30.0~60.0)min。患者术后AOFAS-HA评分显著提高(P<0.01),术后VAS评分显著下降(P<0.01)。结论内侧入路关节镜下三联术式作为顽固性跟痛症的一种治疗方法,具有创伤小、恢复快、操作安全精确的特点,能较全面地处理致痛病因,较好地改善足运动功能,疗效可靠,是值得临床参考及进一步研究推广的治疗方法。[Objective]To investigate the clinical effect of treating refractory calcaneodynia with medial approach arthroscopic triple operation.Methods From December 2017 to February 2019 in Wuhan Hospital of Traditional Chinese Medicine,Hubei Province,20 patients(21 feet)with heel pain who failed to respond to systematic conservative treatment for more than six months were selected.Under the direct vision of the medial approach arthroscopy,the treatment was performed with a triple operation(plasma knife ablation and vaporization of metatarsal fascia,calcaneal osteophyte grinding,calcaneal drilling and decompression).The American Orthopaedic of foot and ankle society ankle hindfoot scale(AOFAS-AH)and visual analogue scale(VAS)were used to evaluate the clinical efficacy of the patients before and 6 to 10 months after surgery.Results All the incisions of the patients were healed at the first grade without nerve,vascular injury or other complications.The patients could carry out daily activities in the early stage after the operation.The median follow-up time was 8.7(6.0-10.0)months,and the median operative time was 40.7(30.0-60.0)min utes.Postoperative AOFAS-HA scores of patients were significantly increased(P<0.01),and postoperative VAS score were significantly decreased(P<0.01).Conclusion Triple-combinative arthroscopic operation with the medial approach is a treatment modality of intractable calcaneodynia.It has features of little trauma,quick recovery,safe and accurate operation.It can treat the cause of pain comprehensively,improve the function of foot movement well,and has reliable curative effect,which is worthy of clinical reference and further research and promotion of treatment.

关 键 词：内侧入路 等离子刀消融汽化松解跖筋膜 跟骨骨赘磨削 跟骨钻孔减压 顽固性跟痛症 关节镜 

分 类 号：R681.8[医药卫生—骨科学]