关节镜治疗顽固性跖筋膜炎伴跟骨骨刺改善足功能和步态的效果研究

Observation on the Effect of Arthroscopic Treatment for Refractory Plantar Fasciitis with Calcaneal Bone Spurs to Improve Foot Function and Gait

目的:探讨关节镜治疗顽固性跖筋膜炎伴跟骨骨刺改善足功能和步态的效果。方法:选取2020年1月—2022年5月远安县人民医院收治的75例顽固性跖筋膜炎伴跟骨骨刺患者作为研究对象,采用随机数表法将患者分为关节镜组和开放组,其中37例患者采用关节镜下手术治疗(关节镜组)、另外38例患者采用传统开放手术治疗(开放组);对比两组手术过程指标、手术前后疼痛程度、足底踝关节功能、患足单支撑相及健足步长/身高比值的变化。结果:关节镜组的出血量、伤口术后渗出时间、住院时间均显著低于开放组,差异有统计学意义(P<0.05);术前,两组的视觉模拟疼痛量表(VAS)评分,差异无统计学意义(P>0.05);在术后1周、1个月时复查,关节镜组的VAS评分低于开放组患者,差异有统计学意义(P<0.05);术后3个月时,两组的VAS评分,差异无统计学意义(P>0.05);术前、术后1周、术后1个月、术后3个月,两组的患足单支撑相及健足步长/身高比值,差异统计学意义(P<0.05);术前,两组的Hawkins评分,差异无统计学意义(P>0.05);术后1周时,关节镜组患者的Hawkins评分高于开放组,差异有统计学意义(P<0.05),术后1个月及术后3个月复查,两组Hawkins评分,差异无统计学意义(P>0.05)。结论:关节镜微创手术治疗顽固性跖筋膜炎伴跟骨骨刺手术效果可靠,手术创伤小、术后早期疼痛程度轻、足踝关节功能恢复好。

Objective:To explore the effect of arthroscopic minimally invasive surgery in the treatment of refractory plantar fasciitis with calcaneal bone spurs.Method:A clinical study was conducted on 75 patients with refractory plantar fasciitis accompanied by calcaneal bone spurs who underwent surgical treatment in the hospital from January 2020 to May 2022.The patients were randomly divided into arthroscopic group and open group by using a random number table method.Among them,37 patients underwent arthroscopic surgery(arthroscopic group),while the other 38 patients underwent traditional open surgery(open group).The changes in surgical process indicators,preoperative and postoperative pain levels,plantar and ankle joint function,single support phase of the affected foot and healthy foot step length/height ratio were compared between the two groups of patients.Result:The bleeding volume,postoperative exudation time,and hospitalization time of the arthroscopy group were significantly lower than those of the open group patients and the difference was statistically significant(P<0.05).Before surgery,the difference in Visual analogue pain scale(VAS)scores between the two groups was not statistically significant(P>0.05).1 week and 1 month after the operation,the VAS score of the arthroscopy group was lower than that of the open group and the difference was statistically significant(P<0.05).3 months after the operation,there was no significant difference in the VAS score(P>0.05).Before operation,1 week after operation,1 month after operation and 3 months after operation,there were differences in the single support phase and the stride length/height ratio of the affected foot between the two groups(P>0.05).Before operation,the Hawkins score of the two groups was not statistically different(P>0.05).1 week after surgery,the Hawkins score of the arthroscopy group was higher than that of the open group(P<0.05).1 month after operation and 3 months after operation,there was no significant difference in Hawkins score between the two groups(P>0.05).Conclusion:Arthroscopic minimally invasive surgery for the treatment of refractory plantar fasciitis with calcaneal spurs is reliable,which also take advantage of small surgical trauma,low pain in the early postoperative period,and good recovery of foot and ankle joint function.