腓肠肌腱膜松解治疗慢性足底筋膜炎

Gastrocnemius aponeurosis release for treatment of chronic plantar fasciitis

[目的]评价腓肠肌腱膜松解治疗慢性足底筋膜炎的临床疗效。[方法]回顾性分析2018年4月-2019年3月在本科治疗的40例慢性足底筋膜炎患者的临床资料,依据治疗前医患沟通结果将患者分为两组,20例行腓肠肌腱膜松解术治疗(手术组),20例行体外冲击波联合非留体抗炎药物治疗(保守组)。比较两组“第1步”VAS、A0FAS评分和踝背伸活动度(ROM)。[结果]40例患者均顺利完成各组相应的治疗,无严重不良反应或并发症。与治疗前相比,手术组治疗后行走第1步的VAS、A0FAS评分和踝背伸ROM持续改善(P<0.05)。与治疗前相比,保守组治疗后1个月时行走第1步VAS评分显著减少(P<0.05),A0FAS评分和踝背伸ROM显著增加(P<0.05);与治疗后1个月相比,末次随访时保守组行走第1步VAS评分再次显著增加(P<0.05),A0FAS评分显著下降(P<0.05),踝关节背伸ROM无显著变化(P>0.05)。治疗前两组间行走第1步VAS、A0FAS评分和踝背伸ROM的差异无统计学意义(P>0.05)。末次随访时,手术组行走第1步VAS、A0FAS评分和踝背伸ROM均显著优于保守组(P<0.05)。手术组无神经损伤、复杂性局部疼痛等手术并发症发生,末次随访时无足弓塌陷、提踵力量下降等并发症发生。[结论]采用腓肠肌腱膜松解治疗慢性足底筋膜炎的临床效果显著优于体外冲击波联合非留体抗炎药物治疗。

[Objective]To evaluate the clinical outcomes of gastrocnemius aponeurosis release for treatment of chronic plantar fasciitis.[Methods]A retrospective study was conducted on 40 patients who received therapy for chronic plantar fasciitis in our department from April 2018 to March 2019.Based on the results of doctor-patient communication before treatment,the patients were divided into two groups.Of them,20 patients underwent gastrocnemius aponeurosis release(the surgical group),20 patients were treated with extracorporeal shock wave combined with non-steroidal anti-inflammatory drugs(the conservative group).The VAS score for pain at the first step of walking,AOFAS score and ankle dorsiflexion range on motion(ROM)were compared between the two groups.[Results]All the 40 patients had corresponding treatments completed successfully in each group without serious adverse reactions or complications.Compared with those before treatment,the VAS score at the first step of walking,AOFAS score and ankle dorsiflexion ROM continued to improve in the surgical group after treatment(P<0.05).The VAS score at the first step of walking significantly reduced(P<0.05),while the AOFAS score and ankle dorsiflexion ROM at 1 month after treatment significantly increased in the conservative group compared with those before treatment(P<0.05).However,at the latest follow-up the VAS score at the first step of walking increased significantly again(P<0.05),the AOFAS score decreased significantly(P<0.05),and the ankle dorsiflexion ROM remained unchanged significantly in the conservative group compared with those at 1 month after treatment(P>0.05).There was no significant difference in the VAS score at the first step of walking,AOFAS score,and ankle dorsiflexion ROM between the two groups before treatment(P>0.05).At the latest follow-up,the surgical group proved significantly superior to the conservative group in terms of VAS score at the first step of walking,AOFAS score and ankle dorsiflexion ROM(P<0.05).There were no complications in the surgical group,such as nerve injury,complicated local pain,collapse of the foot arch and decrease of heel lifting force at the latest follow-up.[Conclusion]The gastrocnemius aponeurosis release is considerably superior to extracorporeal shock wave combined with non-steroidal anti-inflammatory drugs in term of clinical outcomes for chronic plantar fasciitis.