导针定位双外侧入路关节镜下微创治疗跟痛症

Minimally invasive treatment of heel pain by double lateral approach arthroscopy guided by needle

目的观察导针定位、双外侧入路关节镜下微创治疗跟痛症的可行性及手术疗效。方法分析2015年1月至2017年3月收治的17例跟痛症患者,其中10例患者接受了导针定位、经足双外侧入路关节镜下射频消融肥厚/增生的跖筋膜、刨削器清除足底增生滑膜囊、带鞘磨钻切除痛性跟骨骨刺等治疗。采用疼痛视觉模拟评分(VAS)评估患者足部疼痛情况,Maryland足部功能评分评估足部功能。结果全部病例均获随访,随访时间12～38个月,平均18.2个月。术后未发生切口深浅部感染,无血管神经损伤等并发症。术后VAS评分为(1.33±0.82)分显著低于术前的(7.67±0.82)分(P<0.01);术后Maryland评分(88.67±5.54)分,非常显著高于术前的(33.33±8.33)分(P<0.01)。结论导针定位双外侧入路关节镜微创治疗跟痛症临床操作可行、有效,并能有效避免术中多次"C"型臂机定位造成的放射损害,外侧入路还可避免足底血管神经束损伤。

Objective To explore the feasibility and effect of minimally invasive treatment of heel pain by double lateral approach arthroscopy guided needle.Methods From January2015to March2017,17patients with calcanodynia were analyzed.Ten of them underwent guided needle placement,radiofrequency ablation of hypertrophic or hperplastic plantarfascia via bilateral lateral approach of the foot,removal of plantar hyperplastic synovial sac with a planer,and excision of painful calcaneal spurs with a sheathed drill.The pain visual analogue scale(VAS)was used to evaluate heel pain.The foot function was assessed by Maryland foot function score.Results All patients were followed up from12month to38months,with an average of18.2months.No deep wound infection occurred after operation,and no complications occurred.Postoperative VAS score(1.33±0.82)was significantly lower than preoperative(7.67±0.82)(P<0.01),and postoperative Maryland score(88.67±5.54)was significantly higher than preoperative(33.33±8.33)(P<0.01).Conclusion The minimally invasive treatment of heel pain by double lateral approach arthroscopy guided by needle is feasible and effective.It can effectively avoid the radiation damage caused by multiple C arm positioning.Lateral lateral approach can effectively avoid plantar vascular nerve injury.