发散式体外冲击波治疗膝关节鹅足肌腱炎的疗效分析

Radial extracorporeal shockwave therapy for pes anserine tendinitis

[目的]评价发散式体外冲击波治疗膝关节鹅足肌腱炎的临床效果,为进一步推广应用提供参考。[方法]随访2013年3月~2015年4月至本科门诊治疗的膝关节鹅足肌腱炎患者174例。按照治疗方法,采用体外发散式冲击波治疗组78例(冲击波组),采用常规中药消痛贴外用治疗96例(中药组)。比较两组患者治疗前、治疗后3周和3个月的疼痛视觉模拟评分(VAS评分)及膝关节功能评分(Lysholm评分),记录随访过程中并发症,评定临床效果。[结果]两组患者随时间推移VAS评分显著下降,而Lysholm评价显著增加,不同时间点间差异有统计学意义(P<0.05)。治疗后3周,冲击波组的VAS和Lysholm评分显著优于中药组(P<0.05),但治疗后3个月,两组上述评分的差异均无统计学意义(P>0.05)。随访期间,冲击波组出现皮肤红斑4例,外用中药组皮疹28例,冲击波组并发症发生率显著低于中药组(P<0.05)。治疗后3周冲击波组总体有效率为97.44%,而中药组为57.29%,两组间差异有统计学意义(P<0.05)。[结论]发散式冲击波治疗鹅足肌腱炎比外用中药的治疗方法,可以更快地缓解膝关节内侧疼痛,改善膝关节功能,且不良反应发生率低。

[Objective]To evaluate the clinical efficacy of radial extracorporeal shock wave therapy(rESWT)for pes anserine tendinitis.[Methods]A total of 174 patients received outpatient treatment for pes anserine tendinitis in our center from March 2013 to April 2015.Based on treatment applied,78 patients underwent rESWT,while the remaining 96 patients received pain-relieving patch of traditional Chinese medicine(TCM).The visual analogue scale(VAS),Lysholm score,complications and clinical outcome grades were compared between the two groups.[Results]The VAS score significantly decreased,whereas the Lysholm score significantly increased as time went after treatment,with statistically significant differences among time points in both groups(P<0.05).The rESWT proved significantly superior to the TCM groups in VAS and Lysholm groups at 3 weeks after treatment(P<0.05),although the difference became statistically insignificant at 3 months after treatment between the two groups(P>0.05).During the follow up period,4 patients in the rESWT group had local erythema,while 28 patients in the TCM group got skin rashes,and the complication rate of the rESWT group was significantly lower than the TCM group(P<0.05).At 3 weeks after treatment,the overall efficiency of treatment was 97.44%in the rESWT group,while 57.29%in the TCM group,which proved statistically significant(P<0.05).[Conclusion]Compared with external administration of traditional Chinese medicine,the rESWT dose achieve earlier pain relief and functional improvement,associated with lower incidence of adverse reactions for pes anserine tendinitis.