冲击波与皮质类固醇治疗慢性跖筋膜炎的疗效比较

Shock-wave therapy versus corticosteroids in the treatment of chronic plantar fasciitis

目的比较体外发散式冲击波与局部皮质类固醇(CS)药物注射治疗慢性跖筋膜炎的临床疗效。方法选取2018年3月至2020年5月西安红会医院足踝外科门诊治疗的80例慢性跖筋膜炎患者,进行回顾性研究,以在足底区进行CS局部封闭注射治疗的40例为封闭组,以在足底区和同侧小腿三头肌进行冲击波治疗的40例为冲击波组,比较两组满意度、VAS及Maryland评分等指标。结果两组治疗1、3、6个月时VAS及Maryland评分均较治疗前改善(P<0.05);治疗1个月时封闭组VAS及Maryland评分优于冲击波组,但治疗6个月时冲击波组VAS及Maryland评分优于封闭组(P<0.05)。冲击波组治疗后各时间点的VAS及Maryland评分均较治疗前逐渐改善,除治疗后6个月与3个月比较外,其他时点间两两比较差异均有统计学意义(P<0.05);相反封闭组从治疗1个月后逐渐出现恶化趋势,且治疗6个月时VAS及Maryland评分均较1个月时出现反弹,差异有统计学意义(P<0.05)。治疗6个月时,冲击波组满意度调查优于封闭组(P<0.05)。结论两种治疗方法对于慢性跖筋膜炎均有效,局部CS注射短期内缓解疼痛、改善功能,但体外发散式冲击波的长期临床效果显著,患者满意度高。

Objective To compare the clinical efficacy of divergent type extracorporeal shock wave and local corticosteroid(CS)injection in the treatment of chronic plantar fasciitis.Methods Eighty patients with RPF treated in Xi an Red Cross Hospital from March 2018 to May 2020 were were selected for retrospective study.Forty patients treated with CS local injection in the plantar area were selected as the blocking group,and 40 patients treated with shock wave in the plantar area and ipsilateral triceps were selected as the shock wave group.The patient satisfaction,visual analogue scale(VAS),Maryland foot function scores and other indicators were compared between two groups.Results Compared with those before treatment,VAS and Maryland scores were significantly improved at 1,3 and 6 months of treatment in two groups(P<0.05).VAS and Maryland scores in blocking group were better than those in shock wave group at 1 month of treatment,but they in shock wave group were statistically superior to those in blocking group at 6 months of treatment(P<0.05).The VAS and Maryland scores of shock wave group at each time point after treatment were gradually improved compared with those before treatment.Except for the comparison between June and March after treatment,there were significant differences in other time points(P<0.05).In blocking group,VAS and Maryland scores were worse at 6 months of treatment than those at 1 month of treatment(P<0.05).The patients satisfaction in shock wave group was significantly better than that in blocking group at 6 months of treatment(P<0.05).Conclusion Two therapy methods are effective for chronic plantar fasciitis.Local CS injection can relieve pain and improves function in a short term,but the long-term clinical effect of extracorporeal divergent shock wave is significant,and the patient satisfaction is high.