体外冲击波联合李氏正骨理筋手法治疗足底筋膜炎的临床观察

Clinical observation of extracorporeal shock wave combined with Li's bone-setting and tendonregulating manipulation in the treatment of plantar fasciitis

目的观察体外冲击波联合李氏正骨理筋手法治疗足底筋膜炎的临床疗效。方法将90例足底筋膜炎患者随机分成冲击波组、手法组和联合组,每组30例。冲击波组采用体外冲击波治疗,手法组采用李氏正骨理筋手法治疗,联合组采用体外冲击波联合李氏正骨理筋手法治疗。各组疗程均为2周,观察比较疼痛视觉模拟评分(VAS)、最长可持续行走时间及足底筋膜厚度的变化情况。结果(1)试验期间,各组均未出现脱落病例,90例患者全部完成试验。(2)治疗后、第12周随访时与治疗前比较,各组疼痛VAS及最长可持续行走时间差异均有统计学意义(P<0.05)。组间治疗后比较以及组间第12周随访时比较,手法组疼痛VAS高于冲击波组,而最长可持续行走时间长于冲击波组(P<0.05),联合组疼痛VAS低于冲击波组及手法组,而最长可持续行走时间长于冲击波组及手法组(P<0.05)。(3)第12周随访时与治疗前比较,各组足底筋膜厚度差异有统计学意义,均明显降低(P<0.05)。组间第12周随访时比较,足底筋膜厚度差异无统计学意义(P>0.05)。结论体外冲击波联合李氏正骨理筋手法治疗足底筋膜炎的疗效较佳,优于单纯应用体外冲击波或李氏正骨理筋手法。

Objective To observe the clinical effect of extracorporeal shock wave combined with bone-setting and tendon-regulating manipulation on plantar fasciitis. Methods Ninety patients with plantar fasciitis were randomly divided into an extracorporeal shock wave therapy group(n=30), a manipulation treatment group(n=30) and a combined treatment group(n=30). The extracorporeal shock wave therapy group was administered with the extracorporeal shock wave, the manipulation treatment group was administered with bone-setting and tendon-regulating manipulation, and the combined treatment group was administered with extracorporeal shock wave therapy combined with bone-setting and tendon-regulating manipulation. All groups were treated for 2 weeks, and the changes in the visual analogue scale(VAS) score of pain, maximum sustainable walking time and plantar fascia thickness were observed and compared. Results(1) During the trial,there were no drop-out cases in any group, and all 90 patients completed the trial.(2)The differences in pain VAS score and maximum sustainable walking time were statistically significant( P<0.05) in each group before and after treatment and at the week 12 follow-up visit. After treatment and at the week 12 followup visit,the pain VAS score in the manipulation treatment group was higher than that in the extracorporeal shock wave therapy group( P<0.05),while the pain VAS score in the combined treatment group was lower than that in the extracorporeal shock wave therapy group and that in the manipulation treatment group,and the maximum sustainable walking time was longer than that in the extracorporeal shock wave therapy group and that in the manipulation treatment group( P<0.05).(3)According to the intra-group comparison before treatment and at the week 12 follow-up visit,the plantar fascia thickness was significantly lowered in all groups,and the difference in plantar fascia thickness was statistically significant( P<0.05). The difference in plantar fascia thickness was not statistically significant when compared among groups at the week 12 follow-up visit( P>0.05). Conclusion The extracorporeal shock wave therapy combined with Li’s bonesetting and tendon-regulating manipulation in the treatment of plantar fasciitis has achieved good clinical effects,which is better than the single use of extracorporeal shock wave therapy or Li’s bone-setting and tendon-regulating manipulation.