高能体外冲击波治疗慢性足底筋膜炎

High energy shock wave in the treatment of chronic plantar fasciitis

目的:观察高能体外冲击波对慢性足底筋膜炎的临床治疗效果。方法:选择2004-12/2005-12在深圳市第六人民医院疼痛科门诊就诊的足底筋膜炎患者167例,均自愿参加观察。按奇偶序列随机分为2组,治疗组84例,对照组83例。①治疗组采用HKSW-O冲击波治疗机进行标准治疗,工作电压7～10V,冲击波频率60次/min,治疗时间15min。②对照组除机器探头未与治疗部位充分有效接触外,定位及治疗参数设置同治疗组。两组患者均治疗3次,间隔5d治疗1次。①治疗前及治疗结束3个月后对两组患者进行简式McGill疼痛问卷测评:包括感觉类评分(0～33分)、情感类评分(0～12分)、疼痛总分(0～45分)、目测类比疼痛评分(0～10分)及现有疼痛强度评分(0～5分),以上各项分值越高,表示疼痛强度越大。②治疗后3个月对两组患者进行疗效评估:显效为疼痛明显减轻;好转为疼痛略减轻;无效为症状较治疗前无改变或加重。③患者治疗后第3天复诊时进行副作用观察,包括皮肤发红、疼痛、肿胀及其他(如恶心、眩晕、异感等)。结果:167例足底筋膜炎患者全部进入结果分析,无脱落。①两组患者治疗前及治疗3个月后简式McGill疼痛问卷评分比较:治疗3个月后,治疗组感觉类、情感类、疼痛总分、目测类比疼痛评分及现有疼痛强度评分均显著低于治疗前(t=2.639～3.416,P<0.01)。除现有疼痛强度评分外,治疗3个月后治疗组患者的感觉类、情感类、疼痛总分及目测类比疼痛评分均显著低于对照组(t=2.467～3.487,P<0.01)。②治疗3个月后两组患者的临床疗效比较:治疗组患者的显效率显著高于对照组(χ2=112.33,P<0.01)。③治疗后第3天复诊时治疗组患者的副作用发生情况:治疗组患者有少部分病例会出现皮肤发红和局部疼痛,而肿胀和其他副作用几乎不出现。结论:高能体外冲击波对慢性足底筋膜炎的临床治疗效果确切,具有安全、有效、简易和快速等特点。

AIM： To observe the curative effects of high energy shock wave （HESW） on chronic plantar fasciitis. METHODS ： 167 patients with chronic plantar fasciitis between December 2004 and December 2005 ware selected from the Department of Pain Medicine of Shenzhen Sixth People＇s Hospital. All subjects participated in the experiment voluntarily and divided into two groups according to their sequences： treatment group （n =84） and control group （n =83）. ①Patients in the treatment group ware treated with HKSW-O shock wave machine at the operating voltage of 7-10 V and the frequency of 60 times/minutes for totally 15 minutes. ② Patients in the control group ware treated the same as treatment group in location and treatment parameter installation except that the probe of machine did not contact with the treatment part. Patients in both groups ware treated for three times with an interval of 5 days between each two. ③ Short Form McGill Pain Questionnaire （SF-MPQ） was used to evaluate the patients of both groups before treatment and 3 months after the treatment respectively, including evaluation on perception （0-33 points）, evaluation on emotion （0-12 points）, total score of pain （0-45 points）, visual analog evaluation （0-10 points） and evaluation on present intensity of pain （0-5 points）. The higher the scores of above-mentioned items ware, the higher the pain intensity was. ④ The curative effects at 3 months after treatment was compared between the two groups： Effective as obvious amelioration of pain, better as slight amelioration of pain, invalid as no changes or aggravated. ⑤ Three days after the treatment, the side effects on patients ware observed at further consultation, including skin redness, pain, swelling and others （such as nausea, dizzy and so on）. RESULTS： A total of 167 patients with plantar fascUtis ware involved in the analysis of results, and no one withdriew from the study. ①Comparison in SF-MPQ score before treatment and 3 months after treatment between the two groups： At 3 months after the treatment, the scores of feeling, emotion, pain and visual analog as well as present intensity of pain in the treatment group ware significantly lower than those before treatment （t =2.639-3.416,P 〈 0.01 ）. Except the score of present intensity of pain, the scores of other items at 3 months after treatment in the treatment group ware remarkably lower than those in the control group （t =2.467-3.487, P 〈 0.01 ）. ② Comparison in clinical curative effects at 3 months after the treatment between the two groups： the excellent rate was markedly higher in the treatment group than that in the control group （X^2=112.33, P 〈 0.01 ）.③ The side effects on patients in the treatment group at 3 days after the treatment： there ware skin redness and local pain found in few patients, while there was no phenomenon of swelling or others. CONCLUSION： HESW has valid curative effect on chronic plantar fasciitis, which is safe, effective, rapid without side effects.