超声引导下小针刀精准治疗Ⅱ型痛性副舟骨的近期效果

The mechanism and clinical efficacy of ultrasound-guided small needle scalpel for the treatment of Type Ⅱ painful accessory navicular bone

目的探讨超声引导下小针刀精准治疗Ⅱ型痛性副舟骨的临床疗效。方法回顾性分析门诊收治的36例(36足)Ⅱ型痛性副舟骨患者资料,按是否使用超声引导下小针刀治疗分为小针刀组(17例)和对照组(19例)。所有患者中男17例,女19例。年龄8~53岁。对照组患者采用功能锻炼及服用非甾体抗炎药物治疗。小针刀组患者在功能锻炼基础上加行每周1次(共3次)的超声引导下小针刀治疗。比较两组治疗的有效性,比较两组患者治疗前及治疗后视觉疼痛模拟评分(VAS)、美国矫形足踝协会(AOFAS)中足评分,以此评估临床疗效。结果治疗后,小针刀组有效性为82.2%,对照组有效性为57.8%,小针刀组治疗有效性高于对照组,但差异无统计学意义(χ^(2)=2.598,P=0.273)。两组治疗前的VAS评分相比[(4.70±1.15)分vs(5.47±1.12)分],差异无统计学意义(Z=-1.904,P=0.057);治疗后,小针刀组VAS评分为(2.41±1.73)分,对照组为(3.73±1.93)分,小针刀组VAS评分显著小于对照组(Z=-2.299,P=0.021)。治疗前,两组AOFAS中足评分相比[(74.17±3.94)分vs(72.68±4.73)分],差异无统计学意义(Z=-0.938,P=0.363);治疗后,小针刀组AOFAS中足评分为(85.29±6.27)分,对照组为(72.21±5.08)分,治疗后小针刀组AOFAS中足评分显著大于对照组(Z=-4.652,P=0.000)。结论超声引导下小针刀治疗Ⅱ型痛性副舟骨,针刀精准直达病灶,能在较短时间内使患者疼痛减轻甚至消失,从而恢复日常生活及运动能力,临床在治疗Ⅱ型痛性副舟骨患者时,对其实施小针刀治疗的临床效果是理想的,此法适合在足踝外科领域推广应用。

Objective To investigate the mechanism and clinical efficacy of ultrasound-guided small needle scalpel for the treatment of Type Ⅱ painful accessory navicular bone.Methods The data of 36 patients(36 feet)with Type Ⅱ painful accessory navicular bone treated in outpatient department were retrospectively analyzed,and they were divided into small needle-knife group(17 cases)and control group(19 cases)according to whether ultrasound guided small needle-knife was used.There were 17 males and 19 females.The age ranged from 8 to 53 years.Patients in the control group were treated with functional training and non-steroidal anti-inflammatory drugs;and patients in the small acupotomy group were treated with ultrasound-guided small acupotomy once a week(3 times in total)in addition to the functional training.The efficacy of treatment was compared between the two groups.Visual analogue scale(VAS)and American Orthopaedic Foot and Ankle Association(AOFAS)middle foot score before and after treatment were compared between the two groups.Results The efficacies of small acupotomy group and control group was 82.2% and 57.8%,respectively.The efficacy of small acupotomy group was significantly higher than that of control group(χ^(2)=2.598,P=0.273).There was no significant difference in VAS score between the two groups before treatment[4.70±1.15 vs.5.47±1.12,Z=-1.904,P=0.057].The VAS score of the small acupotomy group after treatment was significantly lower than that in control group(2.41±1.73 vs.3.73±1.93,Z=-2.299,P=0.021).Before treatment,there was no significant difference in AOFAS score between the two groups(74.17±3.94 vs.72.68±4.73,Z=-0.938,P=0.363).After treatment,The AOFAS score of the acupotomy group was significantly higher than that of the control group(85.29±6.27 vs.72.21±5.08,Z=-4.652,P=0.000).Conclusion Ultrasound guided small needle knife in treatment of Type Ⅱ pain accessory navicular bone can rapidly relieve patients′pain and restore the daily life and athletic ability.