应用等离子刀生物学特征完成内窥镜下跖筋膜松解术

Radiofrequency in endoscopic plantar fascia release

目的:观察等离子刀在内窥镜下跖筋膜松解中的应用效果及优势。方法:选取2002-01/2005-02南京医科大学附属南京第一医院骨科收治的12例患者,跖筋膜炎7例,先天性高弓仰趾足畸形3例,马蹄内翻足2例。分别在跟骨内外侧建立两个入路,引入关节镜和等离子刀。等离子刀由内向外切开跖筋膜,直到显示跖筋膜下的疏松结缔组织或可见到拇展肌、趾短屈肌等的肌纤维。对于高弓足和马蹄内翻足,在切开处的远端用Saber等离子刀再作数个横行切开,并且用蓝钳切除掉部分跖筋膜组织,也可以用等离子刀进行汽化消融。对于跖筋膜炎,只切开跖筋膜内侧的2/3。在高弓足和马蹄内翻足的病例,同时施行截骨矫形、跟腱延长或肌腱转移等其他手术。记录手术时间并观察足跟局部反应和畸形矫正效果。结果:12例患者均成功完成手术进入结果分析。①手术时间5￣20min。②术后足底肿胀较轻,渗出少,未见皮肤的坏死和感染。③术后随访≥14个月。7例跖筋膜炎的病例,有4例疼痛完全缓解,或仅在走高低不平的路时有不适感;3例疼痛较术前有好转,但仍然有隐痛的感觉,不过能接受,不需要服用止痛药。3例高弓足的病例,术后高弓畸形明显改善,足底和趾背胼胝、疼痛消失,能穿皮鞋行走,其中有1例主诉足趾背伸肌力减弱。马蹄内翻足的病例,术后对外形的矫正都很满意。结论:等离子刀用于内窥镜下跖筋膜松解具有明显的优点:①等离子刀具有止血的作用,术后基本没有什么渗血。②创伤小,损伤反应轻,康复快。③操作简便,手术时间短。④安全性高。

AIM： To study the effectiveness and advantage of radiofrequency applied in endoscopic plantar fascia release. METHODS： This experiment adopted 12 cases from Department of Orthopaedics, Nanjing First Hospital of Nanjing Medical University between January 2002 and February 2005, including 7 cases of plantar fascitis （PF）, 3 of congenital cavus feet, and 2 of equinovarus deformity. Two portals were created along both sides of calcaneus, by which the arthrescopy and radiofrequency wand were introduced, respectively. The plantar fascia was cut open in the direction from inside to outside using radiofrequency. This maneuver didn＇t stop until the loose connective tissues or such muscle fibers as abductor hallucis, flexor hallucis brevis, and so on were visualized underneath the plantar fascia. In both cavus and equinovarus feet, several transverse cutting were routinely added into the distal portion of previous cutting by Saber radiofrequency wand, even further resected partial plantar fascia by either punch or radiofrequency. The total width of plantar fascia was only cut 2/3 in PF. In cavus and equinovarus feet, additional osteotomy, Achilles tendon lengthening, tendon transfer or others were simultaneously performed. Local reaction at the operation site of heel and postoperative deformity correction were observed. RESULTS： All 12 patients completed the operation and entered the result analysis. ①The operation duration was 5-20 minutes.②After operation, the sole of foot swelled gently and exudated lightly, no necrosis or infection of skin was found. ③All cases were followed for over 14 months. And 4 of 7 PF cases had pain totally disappeared or had discomfort only in walking on uneven road; 3 cases were reported to have pain relief compared to the preoperative level, also had occult pain that was tolerable and didn＇t need analgesic medication. In 3 cavus feet cases, the appearances of high arch deformity were significantly improved postoperatively, with the disappearance of both the callus and pain at the insole and dorsal interphalangeal joint. All could resume normal walking while wearing leather shoes, but only one complained the decrease of digital dorsal extension motor strength. All equinovarus feet cases were satisfied with the correction of deformity. CONCLUSION： Radiofrequency has such advantages as： ①less postoperative bleeding and extravasation; ②less trauma and fast rehabilitation; ③simpler maneuverability, shorter operation time; ④higher safety.