体外冲击波治疗跟腱腱病的临床疗效研究

The treatment with extracorporeal shock waves for Achilles tendinopathy

目的探讨体外冲击波治疗跟腱腱病的方法及近期疗效。方法以2012年12月1日至2013年12月1日,该院关节外科门诊诊治的跟腱腱病患者为研究对象。患者主要症状是行走时后踝区域疼痛,休息时可缓解,治疗前常规行踝关节X片正侧位和MRI检查,明确诊断和排除其他引起疼痛的病因。冲击波治疗,2 000脉冲/次,1次/周,共4次。治疗期间避免跑跳剧烈运动,治疗当晚口服1次止痛药。采用VAS评分,患者在治疗前、治疗4次后和治疗3个月时,这3个时间点进行VAS评分和踝-后足AOFAS评分。记录治疗并发症,随访并进行统计学分析VAS和AOFAS评分。结果 32例跟腱肌腱病患者全部均获得随访,其中跟腱止点性腱病22例,非止点性腱病10例。8例双侧病变,24例为单侧病变。5例患者在治疗后出现局部红斑,休息后缓解,1例患者在4次治疗后局部疼痛缓解,但在治疗5个月后下楼时摔伤致跟腱断裂;患者在治疗前、治疗4次后和治疗3个月时,这3个时间点进行VAS评分分别为(8.2±1.5)分、(2.1±0.8)分、(1.3±0.6)分(前两组数据P<0.01,后两组数据P>0.05),AOFAS评分分别为(72.2±5.1)分、(86.3±5.2)分、(91.3±3.5)分(3组数据间P<0.01)。结论在治疗跟腱腱病时,采用体外冲击波治疗后能够改善局部症状,患者满意程度高,该技术具有创伤小、疗效可靠的优势,使部分患者免去或者推迟手术治疗。

Objective The purpose of this study is to investigate extracorporeal shock waves therapy on Achilles tendopathy and evaluate its short-term effectiveness.Methods The subjects were out-patients with Achilles tendopathy who came to center for Joint Surgery,Southwest Hospital,from Dec.1st 2012 to Dec.1st 2013.The main symptom of these patients showed pain at the hock site,while the pain could be released with rest.Before the treatment,routine checkups were performed including X-ray of ankle joint with normal side and MRI,which brought out a definite diagnosis and evacuated other reasons resulting pain.The treatment of blast was 2 000 pulse per time,once a week and four times in total.During the treatment period,patients were suggested to prevent from strenuous exercise and had the anodyne on the evening of the first day when they underwent the shock waves.VAS and AOFAS was used to evaluate the effectiveness with the records,before the treatment,after four-time treatment,after three-month treatment.Patients′complications and follow-ups were recorded and VAS results were assessed with statistical analysis.Results32 patients had full follow-ups.22 of them had insertion tendopathy.10 patients had non-insertion tendopathy.8patients had bilateral lesion and 24 patients had unilateral lesion.Part of erythema appeared in five patients and could be relieved after rest.One patient achieved pain release after four-time treatment,but fell down going downstairs and resulted rupture of tendon.All patients had VAS assessment for three times,with the score 8.2±1.5before the treatment（P〈0.01）,2.1±0.8after four-time treatment（P〈0.01）and 1.3±0.6after 3-month treatment（P〉0.05）.The score of AOFAS were 72.2±5.1,86.3±5.2and 91.3±3.5（P〈0.01）.Conclusion When treating on Achilles tendopathy,extracorporeal shock wave can improve the local symptoms.With minor trauma and reliable outcome,it brings patients benefits that treat tendon disease without surgery or postponing the surgery.