内镜下三联手术治疗顽固性跟痛症  

Analysis of the curative effect of triple surgery under endoscope in the treatment of intractable heel pain

作　　者：谷成毅 陈明亮 丁松 许涛[1] 周游 GU Cheng-yi;CHEN Ming-liang;DING Song;XU Tao;ZHOU You(Department of Orthopaedics,Affiliated Renhe Hospital of China Three Gorges University,Sports Medicine Institute of China Three Gerges University,Yichang Sports Injury and Rehabilitotion Clinical Medicine Research Center,Yichang443001,Hubei,China)

机构地区：[1]三峡大学附属仁和医院骨科三峡大学运动医学研究所宜昌市运动损伤与修复临床医学中心,湖北宜昌443001

出　　处：《中国骨伤》2023年第2期139-144,共6页China Journal of Orthopaedics and Traumatology

基　　金：湖北省自然科学基金面上项目(编号:2021CFB414)。

摘　　要：目的:探讨内镜下跟骨骨刺切除联合跖筋膜松解和跟骨减压三联手术治疗顽固性跟痛症的疗效。方法:回顾性分析2016年1月至2019年1月50例顽固性跟痛症患者的临床资料,其中男20例,女30例;年龄40~68(50.12±7.35)岁,病史1~4年,所有患者行内镜下跟骨骨刺切除联合足底跖筋膜松解和跟骨减压术,术后随访24~60(42.00±3.28)个月。术前患者均存在明显的足跟疼痛,X线检查多提示存在跟骨骨刺。疗效评估指标除常规足部检查外,还通过X线结果测量足弓高度、内弓角手术前后的改变。采用疼痛视觉模拟评分(visual analogue scale,VAS)系统评估足部疼痛程度;采用美国骨科足踝协会(American Orthopedic Foot and Ankle Society,AOFAS)评分系统,对足部疼痛、自主活动、步态和稳定性进行综合性分析。结果:VAS由术前的(8.75±1.24)分,降为术后3个月的(5.15±2.35)分,术后6个月的(4.07±2.53)分和末次随访的(3.95±2.44)分(P<0.05)。AOFAS评分由术前的(53.46±4.17)分,增加为术后3个月的(92.46±2.53)分,术后6个月的(96.33±2.46)分和末次随访的(97.05±2.37)分(P<0.05)。足弓高度术前为(41.54±1.15)mm,术后(41.49±1.09)mm,差异无统计学意义(P>0.05)。足弓的内弓角度术前为(121±6)°,术后(122±7)°,差异无统计学意义(P>0.05)。结论:内镜下跟骨骨刺切除联合足底跖筋膜松解和跟骨减压三联手术对于治疗顽固性跟痛症,能减轻术后疼痛,足部功能恢复快。Objective To investigate the clinical effect the treatment of arthroscopy-assisted calcaneal spur resection combined with plantar fascia release and calcaneal decompression in the treatment of the patients with intractable calcaneal pain.Methods The clinical data of 50 patients with intractable heel pain from January 2016 to January 2019 were retrospectively analyzed,including 20 males and 30 females;aged from 40 to 68 years old with an average of(50.12±7.35)years old,the medical history ranged from 1 to 4 years.All patients underwent arthroscopy-assisted calcaneal spur resection combined with plantar fascia release and calcaneal decompression,and were followed up,the duration ranged from 24 to 60 months with an average of(42.00±3.28)months.All patients had obvious heel pain before surgery,and X-ray examinations often showed the presence of calcaneal spurs.In addition to the routine foot examination,the changes in the height and angle of the arch of the foot were also measured pre and post-operatively by X-ray,for the evaluation of clinical effect.The VAS system was used to evaluate the degree of foot pain;the AOFAS scoring system was used to comprehensively evaluate the foot pain,voluntary movement,gait and stability.Results The VAS decreased from(8.75±1.24)before surgery to(5.15±2.35)at 3 months after surgery,(4.07±2.53)at 6 months after surgery,and(3.95±2.44)at the last fllow-up(P<0.05).The AOFAS score increased from(53.46±4.17)before surgery to(92.46±2.53)at 3 months after surgery,(96.33±2.46)at 6 months after surgery,and(97.05±2.37)at the last follow-up(P<0.05).The arch height was(41.54±1.15)mm before operation and(41.49±1.09)mm after the operation,the difference was not statistically significant(P>0.05).The internal arch angle of the foot arch was(121±6)°before operation and(122±7)°after operation.The difference was not statistically significant(P>0.05).Conclusion Arthroscopy-assisted calcaneal bone spurs resection combined with plantar fascia release and calcaneal decompression exhibited gr

关 键 词：跟痛症 跖筋膜 骨刺 关节镜 

分 类 号：R686[医药卫生—骨科学]