体外冲击波与药物治疗距骨骨髓水肿的疗效比较

Effect of extracorporeal shock wave and drug therapy on talus bone marrow edema

目的比较体外冲击波与药物治疗距骨骨髓水肿的疗效。方法选取河北医科大学第三医院康复科门诊2021年9月至2022年3月收治的距骨骨髓水肿损伤患者40例。采用随机数表法将患者随机分为两组,每组20例。实验组患者给予冲击波治疗,对照组患者给予非甾体抗炎药双氯芬酸钠缓释片与双膦酸盐类药阿仑膦酸钠治疗。在治疗前及治疗结束后3个月,采用美国足踝外科协会(American Orthopaedic of Foot and Ankle Society,AOFAS)踝与后足评分评估踝关节功能、视觉模拟评分法(visual analogue scale,VAS)评估疼痛程度、MRI评价距骨骨髓水肿面积。应用Footscan足底压力系统比较治疗前后患者的足底压力变化及踝关节跖屈、背屈角度。结果治疗3个月后,两组VAS评分与AOFAS评分均较治疗前改善(P<0.05),且实验组评分改善幅度优于对照组(P<0.05);两组MRI显示的距骨骨髓水肿面积均较治疗前减少(P<0.05);两组在足底最大压力与平均压力方面均较治疗前提高(P<0.05),且实验组提高幅度优于对照组(P<0.05);在步态周期中,两组的全足支撑期与实验组的足跟着地期均延长(P<0.05)。结论体外冲击波治疗与药物治疗均可改善距骨骨髓水肿患者的疼痛、踝关节功能,减小骨髓水肿的面积,改善患者足底压力,以及延长患侧足在步行周期中的支撑期占比。

Objective To compare the curative effect of extracorporeal shock wave and medicine on talus bone marrow edema.Methods A total of 40 patients with talus bone marrow edema injury admitted to the Rehabilitation Department of the Third Hospital of Hebei Medical University from September 2021 to March 2022 were collected.They were randomly divided into two groups,20 cases in each group.The experimental group was treated with shockwave therapy,while the control group was treated with non-steroidal anti-inflammatory drug diclofenac sodium sustained-release tablets and bisphosphonate drug alendronate for 6 weeks.The American Orthopaedic of Foot and Ankle Society(AOFAS)ankle and hindfoot score was performed to evaluate ankle function before and 3 months after treatment,visual analogue scale(VAS)was used to evaluate the pain,and MRI was used to evaluate the area of talus bone marrow edema.Footscan plantar pressure system was used to compare the changes of plantar pressure the ankle plantar flexion and dorsiflexion angles were measured before and after treatment.Results After 3 months treatment,the VAS and AOFAS scores in both groups were improved compared with those before treatment(P<0.05),and the improvement in the experimental group were better than those in the control group(P<0.05).The area of talar bone marrow edema on MRI in both groups were decreased compared with those before treatment(P<0.05).The maximal and average plantar pressure in both groups were higher than those before treatment(P<0.05),and the increase in experimental group was better than that in control group(P<0.05).During the foot support period,the whole foot support period of the two groups and the foot following ground period of the experimental group were prolonged(P<0.05).Conclusion Extracorporeal shock wave therapy and drug therapy can improve the pain and ankle joint function of patients with talar bone marrow edema,reduce the area of bone marrow edema,improve plantar pressure and prolonge the proportion of supporting period of affected foot in walking cycle,and the effect of shock wave therapy is better than that of drug therapy.