采用KobeGurd系统行跖腱膜部分切断术治疗顽固性跟痛症的疗效

Heel medial plantar fascia partial amputation with KobeGurd systemHeel systemfor intractable calcaneodyniafor calcaneodynia

背景：跟痛症是足踝外科的常见病，目前临床主要通过保守方法治疗。但对于保守治疗无效或反复发作的病例，手术治疗也许是一种不错的选择。目的：观察足跟内侧小切口KobeGurd系统跖腱膜部分切断术治疗顽固性跟痛症后患者症状改善情况，探讨利用该方法治疗顽固性跟痛症的可能性。方法：2008年8月至2011年3月采用小切口KobyGard系统进行足跟内侧跖腱膜部分切断术治疗顽固性跟痛症患者68例，其中资料完整的56例（84足），男24例（32足）、女32例（52足），体重80 kg以上者46例。年龄28~72岁，平均47.6岁。病史均1年以上，最长者3.6年，平均1.8年。手术前后及末次随访时观察包括疼痛强度（VAS评分系统）、行走距离、站立时间、跟骨筋膜压痛及踝关节、距下关节的活动度等的临床疼痛指数变化，并进行后足疗效评定。结果：本组患者随访时间11~36个月，平均17个月。所有患者跟骨处疼痛完全消失，行走步态恢复正常。疼痛指数：术前平均为8.8，术后4周、8周、4个月、8个月分别为4.89、2.98、1.46和0。根据美国足踝外科协会Maryland后足百分评分法对本组患者进行评定，优66足（78.6%），良16足（19.1%），可2足（2.3%）。未出现跟骨骨折、足弓塌陷等并发症。结论：运用小切口KobeGurd系统跖腱膜部分切断术治疗顽固性跟痛症疗效满意，可作为临床治疗顽固性足跟痛的一种选择。

Background：Calcaneodynia is a common disease in foot and ankle surgery. Conservative treatment has been used mainly at present. However, surgical treatment may be a good choice to the patients with ineffective conservative treatment or repeat-ed relapse. Objective：To explore the clinical outcome of heel medial plantar fascia partial amputation with mini-invasive KobeGurd-system to treat intractable calcaneodynia. Methods：A retrospective analysis was conducted in 68 intractable calcanodynia patients who were treated by heel medial plantar fascia partial amputation with mini-invasive KobeGurd-system in our hospital between August 2008 and March 2011. Complete clinical data were obtained from 56 cases （84 feet）, including 24 males （32 feet） and 32 females （52 feet）. The mean age of them was 47.6 years （range, 28-72 years）. Of them, 46 cases weighed more than 80 kg. Medical history were all more than 1 year （1.8 years on average and the longest was 3.6 years）. The pain indexes, including pain intensity （VAS score system）, walking distance, standing time, calcaneal fascia tenderness, range of motion of ankle and subtalar joints were measured before and after surgery and at the final follow-up. Then curative effect for hindfoot was evaluated. Results：The duration of follow-up was 17 months on average （range, 11-36 months）. Heel pain completely disappeared and all patients resumed normal gait. The pain index was significantly improved. （8.8 before surgery, 4.89 at 4 weeks after sur-gery, 2.98 at 8 weeks after surgery, 1.46 at 4 months after surgery, and zero point at 8 months after surgery. According to the American Association of Foot＆amp;Ankle Surgery Maryland Hindfoot Percentile Score, the clinical outcome was excellent in 66 feet （78.6%）, good in 16 feet （19.1%） and fair in 2 feet （2.3%）. No complications such as calcaneal fracture and arch col-lapse occurred.Conclusions： Plantar fascia partial amputation with mini-invasive KobeGurd-system combined with calcaneal drilling de-compression can achieve satisfactory results in treatment of intractable calcanodynia. It is a suitable surgical method for in-tractable calcanodynia.