体外冲击波疗法治疗早中期距骨骨软骨损伤的临床研究

Clinical efficacy of extracorporeal shock wave therapy on early to mid-stage osteochondral lesions of the talus

目的:评价体外冲击波疗法(extracorporeal shock wave therapy,ESWT)治疗早中期距骨骨软骨损伤(osteochondral lesion of the talus,OLT)的临床疗效。方法:将60例符合要求的HeppleⅠ期至Ⅲ期OLT患者随机分为常规组和冲击波组,每组30例。入组后2组患者均采用针刺、超声波治疗、踝周肌力训练、口服双氯芬酸钠肠溶片及限制患肢负重等常规疗法治疗,冲击波组在此基础上辅以ESWT治疗,2组均治疗5周。比较2组患者治疗前及治疗结束后2个月的踝关节疼痛视觉模拟量表(visual analogue scale,VAS)评分、美国足与踝关节协会(American Orthopedic Foot and Ankle Society,AOFAS)踝与后足评分及病灶体积。结果:治疗前2组患者的踝关节疼痛VAS评分、AOFAS踝与后足评分及病灶体积比较,组间差异均无统计学意义(Z=0.139,P=0.709;Z=0.351,P=0.554;Z=0.184,P=0.668)。治疗结束后2个月,2组患者的踝关节疼痛VAS评分均较治疗前降低[(5,2)分,(5,2)分,Z=-2.828,P=0.005;(5,2)分,(3,1)分,Z=-4.902,P=0.000],AOFAS踝与后足评分均较治疗前提高[(69.50,11.75)分,(72.00,11.25)分,Z=-4.450,P=0.000;(68.50,11.50)分,(78.50,13.75)分,Z=-4.793,P=0.000];冲击波组治疗结束后2个月的病灶体积较治疗前减小[(1.77,0.76)cm^(3),(1.27,0.71)cm^(3),Z=-4.783,P=0.000],常规组治疗前后病灶体积的差异无统计学意义[(1.74,0.77)cm^(3),(1.79,0.54)cm^(3),Z=-0.160,P=0.873]。冲击波组治疗结束后2个月的踝关节疼痛VAS评分低于常规组(Z=37.890,P=0.000),AOFAS踝与后足评分高于常规组(Z=3.944,P=0.047),病灶体积小于常规组(Z=15.134,P=0.000)。结论:采用ESWT治疗早中期OLT,有助于缓解踝关节疼痛、改善踝关节功能、控制病灶进展。

Objective:To evaluate the clinical efficacy of extracorporeal shock wave therapy(ESWT)in the treatment of early to mid-stage osteochondral lesions of the talus(OLT).Methods:Sixty eligible patients with Hepple I-ⅢOLT were enrolled and randomly divided into a control group(n=30)and an ESWT group(n=30).All patients were treated with conventional intervention therapies,such as acupuncture,ultrasound therapy,periankle strength training,oral administration of Diclofenac Sodium Enteric-coated Tablets,and protection from weight bearing of the affected limb.The patients in the ESWT group received additional ESWT.The treatment lasted five weeks for all patients.The ankle pain visual analogue scale scores,American Orthopaedic Foot and Ankle Society(AOFAS)Ankle-Hindfoot Scale scores,and the volume of lesions of the two groups were compared before treatment and two months after treatment.Results:There was no significant difference in ankle pain VAS score,AOFAS Ankle-Hindfoot Scale score,and lesion volume between the two group before treatment(Z=0.139,P=0.709;Z=0.351,P=0.554;Z=0.184,P=0.668).Two months after treatment,ankle pain VAS scores of the two groups were lower((5,2)vs(5,2)points,Z=-2.828,P=0.005;(5,2)vs(3,1)points,Z=-4.902,P=0.000)and AOFAS Ankle-Hindfoot Scale scores were higher than those before treatment((69.50,11.75)vs(72.00,11.25)points,Z=-4.450,P=0.000;(68.50,11.50)vs(78.50,13.75)points,Z=-4.793,P=0.000).In the ESWT group,the lesion volume was reduced two months after treatment((1.77,0.76)vs(1.27,0.71)cm(3),Z=-4.783,P=0.000),and there was no significant difference in lesion volume of the control group before and after treatment((1.74,0.77)vs(1.79,0.54)cm(3),Z=-0.160,P=0.873).Compared with the control group two months after treatment,the ESWT group showed reduced ankle pain VAS score(Z=37.890,P=0.000),higher AOFAS Ankle-Hindfoot Scale score(Z=3.944,P=0.047),and smaller lesion volume(Z=15.134,P=0.000).Conclusion:In the treatment of early to mid-stage OLT,ESWT can relieve ankle pain,improve ankle function,and control lesion progression.