体外冲击波治疗足踝部骨髓水肿综合征的临床研究

Clinical study of extracorporeal shock wave in treating bone marrow edema syndrome of foot and ankle

目的探索冲击波治疗足踝部骨髓水肿综合征的有效性和安全性。方法对2014年2月1日至2019年6月30日在陆军军医大学第一附属医院关节外科门诊诊断为足踝部骨髓水肿综合征并采用体外发散式冲击波治疗的21例患者进行随访研究。治疗靶点在局部压痛最明显处或磁共振检查显示骨水肿最明显部位,每周1次,治疗5次为1个疗程。冲击波能流密度为0.18 mJ/mm^(2)。在冲击波治疗后3个月和末次随访时统计分析足部视觉模拟疼痛量表(VAS)、美国足踝外科协会(AOFAS)评分变化,记录治疗期间并发症发生情况。结果21例患者中男6例,女15例;年龄23~73岁,平均(46.5±15.5)岁。与治疗前比较,21例患者治疗后3个月VAS评分明显降低[从(7.71±0.72)分降至(2.38±0.74)分],AOFAS评分明显增加[从(62.33±7.14)分增至(82.86±3.61)分],差异均有统计学意义(P<0.05);其中2例患者治疗后皮肤出现短暂红斑,休息2 d后缓解。21例患者治疗期间未出现感染、血管神经损伤、皮肤坏死等严重并发症;部分患者实施了2个疗程。结论采用体外发散式冲击波治疗足踝部骨髓水肿综合征可有效缓解患者局部疼痛,从而改善运动功能。安全性较高,不良反应轻微,值得进一步深入研究和推广应用。

Objective To explored the effectiveness and safety of extracorporeal shock wave therapy(ESWT)in treating bone marrow edema syndrome(BMES)of the foot and ankle.Methods Twenty-one patients diagnosed as BMES in the foot and ankle and treated by ESWT in the joint surgery department of First Affiliated Hospital of Army Military Medical University from February 1,2014 to June 30,2019 conducted the follow up study.The treatment target spot was at the most obvious local tenderness or the most obvious part of bone edema shown by MRI.The patients were treated once a week,5 times as 1 course of treatment,and the shock wave energy flux density was 0.18 mJ/mm^(2).At 3 months after ESWT and at the last follow-up,the changes in visual analogue scale(VAS)and the American Orthopaedic Foot&Ankle Society(AOFAS)ankle-hindfoot score were statistically analyzed.The complications occurrence during treatment was recorded.Results Among 21 cases,including 6 males and 15 females,aged 23-73(46.5±15.5)years old.Compared with before treatment,the VAS score after 3-month treatment was significantly decreased from(7.71±0.72)points to(2.38±0.74)points(P<0.01),the AOFAS score was significantly increased from(62.33±7.14)points to(82.86±3.61)points,and the differences were statistically significant(P<0.01);among them,2 cases appeared transient erythema on the skin after treatment,which was relieved after 2 d rest.No serious complications such as infection,vascular and nerve injury,and skin necrosis were found in all cases during treatment;some cases implemented the two courses of treatment.Conclusion Adopting ESWT for treating BMES of the foot and ankle could effectively relieve the local pain,thereby improve the motor function,which has high safety and mild adverse reactions,and is worthy of further in depth research,promotion and application.