超声药物导入联合体外冲击波治疗足跟痛的疗效观察

Clinical outcomes of shockwave combined ultrasound drug introduction in patients with heel pain

背景足跟痛可导致足踝功能障碍。体外冲击波治疗可在1~2 d内恢复日常生活,但冲击波疗法也存在疗效持续时间短的局限。超声药物导入是近年来一种较为新颖的给药方法,但目前尚未见将这种方法应用于足跟痛的治疗。目的 探究超声药物导入联合体外冲击波对于治疗足跟痛的疗效。方法 选取于2019年9月-2021年9月就诊解放军总医院第一医学中心康复医学科的足跟痛患者60例,随机分为治疗组和对照组,每组30例,两组均先进行体外冲击波治疗,1次/周。治疗组在冲击波治疗后加用超声药物(双氯芬酸二乙胺乳胶剂)导入法治疗,时间为15 min,5次/周,共2周。对照组在体外冲击波后加用伪刺激超声,方法与治疗组相同。于治疗前、治疗1周和治疗2周后采用视觉模拟量表(visual analogue scale,VAS)和美国足踝外科协会后足评分量表(American Orthopaedic Foot&Ankle Society,AOFAS)评估患者疼痛程度和足踝功能。结果 两组基线资料比较,差异无统计学意义(P>0.05)。治疗后,两组VAS评分较治疗前均显著降低,AOFAS评分均显著提高(P均<0.05);治疗组间相比,治疗1周后两组VAS和AOFAS评分差异无统计学意义,治疗2周后治疗组VAS分数显著低于对照组(3.36±1.00 vs 4.29±1.06),AOFAS分数显著高于对照组(80.22±8.73 vs 71.44±7.58)(P均<0.05)。结论 超声药物导入联合体外冲击波治疗及单纯冲击波治疗均能有效降低足跟痛患者疼痛并改善足踝功能,但联合治疗疗效更佳,推荐治疗周期至少2周。

Background Talalgia can lead to ankle dysfunction. Extracorporeal shock wave therapy can help patients recover to daily life within 1 to 2 days, but shockwave therapy also has the limitation of the short curative effect duration. Ultrasound drug delivery is an innovative drug delivery method in recent years, but it has not been applied to the treatment of talalgia. Objective To observe the changes in pain intensity and ankle function before and after treatment in talalgia patients, and test whether ultrasound drug introduction combined with shockwave is a more effective therapy than shockwave alone. Methods From September 2019 to September 2021, 60 patients with talalgia in the First Medical Center of Chinese PLA General Hospital were randomly divided into treatment group and control group. Patients in the two groups were both treated by shock wave treatment, with the duration of 15 min,1 time per week. After shockwave treatment, the treatment group was given ultrasound drug introduction treatment(diclofenac diethylamine emulgel) for 15 min, 5 times per week for 2 weeks, while the control group had sham stimulation ultrasound drug introduction with the same method as the treatment group. Visual Analog Scale Score(VAS) and American Orthopaedic Foot &Ankle Society(AOFAS) were applied to evaluate the pain degree and ankle function before, at 1-and 2 weeks after treatment.Results There was no significant difference in baseline data between the two groups. After treatment, the VAS score of the two groups decreased significantly over time, while the AOFAS score increased significantly. There was no significant difference in VAS and AOFAS scores between the two groups at 1 week after treatment, however, the differences were significant at 2 weeks after treatment(VAS: 3.36±1.00 vs 4.29±1.06;AOFAS: 80.22±8.73 vs 71.44±7.58;P<0.05, respectively). Conclusion Ultrasound drug delivery combined with shockwave can relieve the pain and improve the ankle function in patients with heel pain, which may be used as a comprehensive clinical treatment for talalgia patients, and the treatment cycle is suggested to be two weeks at least.