微创治疗老年跟骨结节骨赘型跟痛症临床疗效分析

Analysis of clinical curative effect of minimal invasion surgery for heel pain elderly patients with calcaneal tubercle osteophyte

[目的]探讨老年(年龄≥60岁)跟骨结节骨赘型跟痛症微创治疗的临床疗效。[方法]对2000年7月～2010年7月本院治疗的159例(173足)跟骨结节骨赘型跟痛症老年患者的手术方式及疗效进行分析。根据Maryland评分患者均<50分,其中82足(微创组)患者接受了微创骨赘切除、跖腱膜止点松解、滑囊切除手术,91足(开放组)接受开放式手术。[结果]共有93例(104足)获得随访,随访时间6～26个月,平均19个月,其中微创组55足疼痛完全消失,行走无影响;2足明显好转,剧烈活动后,有疼痛感,休息后缓解;开放组45足疼痛完全消失,行走无影响;1足好转,剧烈活动后,有疼痛感,休息后缓解;1足,半年内瘢痕疼痛,半年后瘢痕软化,疼痛消失。[结论]针对跟骨结节骨赘致跟痛症老年患者,微创及开放式手术通过松解跖腱膜止点,切除骨赘及滑囊治疗,效果均令人满意。相比于开放式手术,微创术式因其创伤较小,恢复较快而更容易被患者接受。

[ Objective] To discuss the clinical curative effect of minimal invasion surgery for heel pain in elderly patients （ age ≥60 years） with calc aneal tubercle osteophyte. ~ Methods ] From July 2000 to July 2010, the surgical methods and clini- cal curative effect were analyzed in 159 cases （173 feet） of heel pain with calcaneal tubercle osteophyte. According to the Mary- land scoring system, all the cases were 〈 50 scores before surgery. Minimally invasive removal of osteophytes, the release of plantar fascia insertion and bursa surgery were operated in 57 feet （ minimal invasion group） , while other 47 feet received open surgery （open group） . [ Results] A total of 93 cases （104 feet） obtained a mean of 19 months follow up. In minimal inva- sion group, the pain was completely relieved without walking effect in 55 feet. Other 2 feet also improved pain relief significant- ly, but the pain was residual after severe activity, which can be relieved by rest. In open group, the pain was completely re- lieved without walking effect in 45 feet. One foot improved pain relief significantly, but the pain was residual after severe activi- ty, which can be relieved by rest. One foot suffered from scarring pain for six months, which disappeared after the softening of the scar. [ Conclusion] For the heel pain with calcaneal tubercle osteophyte, it can obtain good clinical curative effect by re- leasing the plantar fascia insertion and removing the osteophytes and bursa both in minimal invasion surgery and open surgery. Compared with the open surgery, the minimal invasion surgery can be acceptable easily for the less invasion and faster recovery.