[1]李伟① 秦建忠** 周聚普 张勇 蒋涛② 张勇②.经皮微创跖筋膜松解联合跟骨减压治疗跖筋膜炎12例[J].中国微创外科杂志,2022,01(5):431-435.
　Li Wei,Qin Jianzhong*,Zhou Jupu*,et al.Percutaneous Minimally Invasive Plantar Fascia Release Combined With Calcaneal Decompression for the Treatment of 12 Cases of Refractory Plantar Fasciitis[J].Chinese Journal of Minimally Invasive Surgery,2022,01(5):431-435.
点击复制

经皮微创跖筋膜松解联合跟骨减压治疗跖筋膜炎12例()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2022年5期
页码:
431-435
栏目:
经验交流
出版日期:
2022-07-21

文章信息/Info

Title:
Percutaneous Minimally Invasive Plantar Fascia Release Combined With Calcaneal Decompression for the Treatment of 12 Cases of Refractory Plantar Fasciitis
作者:
李伟① 秦建忠** 周聚普 张勇 蒋涛② 张勇②
(苏州大学附属第二医院手足外科，苏州215004)
Author(s):
Li Wei;  Qin Jianzhong*;  Zhou Jupu*;  et al.
*Department of Hand and Foot Surgery, Second Affiliated Hospital of Soochow University, Suzhou 215004, China
关键词:
跟痛症; 跖筋膜炎; 减压
Keywords:
Heel pain; Plantar fasciitis; Decompression
文献标志码:
B
摘要:
目的探讨经皮微创跖筋膜松解联合跟骨减压治疗保守治疗无效的跖筋膜炎的临床疗效。方法2018年1月~2019年12月对12例保守治疗无效的跖筋膜炎足跟内侧经皮做一小切口，微创下行跖筋膜松解，切断跖筋膜内侧1/2，同时在足跟压痛点处以2.0 mm克氏针垂直跟骨骨面钻孔，进行局部减压。术前后采用疼痛视觉模拟评分(Visual Analogue Scale，VAS)、美国足踝外科协会踝-后足(American Orthopaedic of Foot and Ankle Surgery AnkleHindfoot，AOFASAH)评分及足与踝预后量表(Foot and Ankle Outcome Scale，FAOS)进行评估。结果术后切口均一期愈合，均未发生血管神经损伤、感染等并发症。12例术后随访6~12个月，（9.2±1.7）月。VAS评分由术前(7.9±0.3)分，改善为末次随访时(1.5±0.2)分(P=0.000)。AOFASAH评分由术前(48.9±12)分，提高到末次随访时(82.5±0.7)分(P=0.000)。FAOS评分由术前(42.2±0.8)分，提高到末次随访(82.6±1.1)分(P=0.000)。结论经皮微创跖筋膜松解联合跟骨减压术可有效缓解保守治疗无效的跖筋膜炎症状，创伤小，恢复快。
Abstract:
ObjectiveTo investigate the clinical effect of percutaneous minimally invasive plantar fascia release combined with calcaneal decompression in the treatment of refractory plantar fasciitis.MethodsTwelve cases of refractory plantar fasciitis admitted to our hospital from January 2018 to December 2019 were reviewed. A small incision was made on the inner side of the heel to release the plantar fascia, and the inner 1/2 of the plantar fascia was cut off. At the same time, a 2.0 mm Kirschner wire was drilled perpendicular to the calcaneal surface at the point of heel tenderness as a local decompression. The pain visual analog uescale (VAS), the American Orthepaedic of Foot and Ankle Surgeon AnkleHindfoot (AOFASAH) Score and the Foot and Ankle Outcome Scale (FAOS) were used for preoperative and postoperative followup assessments.ResultsAll the incisions were healed primarily after operation, and there were no complications such as vascular and nerve injury or infection. Postoperative followups lasted for 6-12 months, with an average of (9.2±17) months. The VAS score was improved from (7.9±0.3) points before operation to (1.5±02) points at last followup (P=0.000). The AOFASAH score was improved from (48.9±1.2) points before operation to (82.5±0.7) points at last followup (P=0.000). The FAOS score was improved from (42.2±2.8) points before operation to (82.6±1.1) points at last followup (P=0.000).ConclusionPercutaneous minimally invasive plantar fascia release combined with calcaneal decompression can effectively relieve the symptoms of refractory plantar fasciitis, with less trauma and quicker recovery.

参考文献/References:

[1]Bhatty UN, Khan SH, Zubairy AI. Managing the patient with heel pain. Br J Hosp Med (Lond),2019,80(4):196-200.
[2]郑汉龙,杨渝平.关节镜下治疗跟腱Haglund病的进展.中国微创外科杂志,2014,14(12):1147-1150.
[3]Rasenberg N, Riel H, Rathleff MS, et al. Efficacy of foot orthoses for the treatment of plantar heel pain: a systematic review and metaanalysis. Br J Sports Med,2018,52(16):1040-1046.
[4]陈聚伍,鲍恒,孙保国.顽固性跟痛症手术方法选择.中国矫形外科杂志,2005,13(13):1032-1033.
[5]金成万,严威,尤涛,等.小切口磨削法去除跟骨刺(附17例报告).中国矫形外科杂志,2008,16(21):1608-1609.
[6]Molund M, Husebye EE, Hellesnes J, et al. Proximal medial gastrocnemius recession and stretching versus stretching as treatment of chronic plantar heel pain. Foot Ankle Int,2018,39(12):1423-1431.
[7]Seligman DAR, Dawson D, Streiner DL, et al. Treating heel pain in adults: A randomized controlled trial of hard vs modified soft custom orthotics and heel pads. Arch Phys Med Rehabil,2021,102(3):363-370.
[8]Atkinson B, Holland Walker K, Stigleman S, et al. Plateletrich plasma vs. corticosteroids for refractory plantar fasciitis. Am Fam Physician,2021,103(5):307-308.
[9]Patel MM.A novel treatment for refractory plantar fasciitis. Am J Orthop (Belle Mead NJ),2015,44(3):107-110.
[10]Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the anklehindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int,1994,15(7):349-353.
[11]Carcia CR, Martin RL, Drouin JM. Validity of the foot and ankle ability measure in athletes with chronic ankle instability. J Athl Train,2008,43(2):179-183.
[12]Thomas JL, Christensen JC, Kravitz SR, et al. The diagnosis and treatment of heel pain: a clinical practice guideline-revision 2010. J Foot Ankle Surg,2010,49(3 Suppl):S1-S19.
[13]宁志刚,常非. 成人获得性足跟内侧疼痛(跖筋膜炎)的诊断及治疗——美国足踝外科医师协会2017年共识解读. 足踝外科电子杂志,2020, 7(3):6-9.
[14]Gulle H, Prior T, Miller S, et al. Online questionnaire, clinical and biomechanical measurements for outcome prediction of plantar heel pain: feasibility for a cohort study.J Foot Ankle Res,2021,14(1):34.
[15]Hogan KK, Prince JA, Hoch MC. The evalaution of the foot core system in individuals with plantar heel pain. Phys Ther Sport，2020,42:75-81.
[16]FernandezRodriguez T, FernandezRolle A, TruyolsDominguez S, et al. Prospective randomized trial of electrolysis for chronic plantar heel pain. Foot Ankle Int,2018, 39(9):1039-1046.
[17]AlAshhab ME, Elbegawy HEA, Hasan HAA. Endoscopic plantar fasciotomy through two medial portals for the treatment of recalcitrant plantar fasciopathy. J Foot Ankle Surg,2018,57(2):264-268.
[18]Tweed JL, Barnes MR, Allen MJ, et al. Biomechanical consequences of total plantar fasciotomy: a review of the literature. J Am Podiatr Med Assoc,2009,99(5):422-430.
[19]Whittaker GA, Landorf KB, Munteanu SE, et al. Predictors of response to foot orthoses and corticosteroid injection for plantar heel pain. J Foot Ankle Res,2020,13(1):60.
[20]Cheung JT, An KN, Zhang M. Consequences of partial and total plantar fascia release: a finite element study. Foot Ankle Int,2006,27(2):125-132.
[21]Yildiz KI, Misir A, Kizkapan TB, et al. Changes in rearfoot alignment in chronic plantar heel pain. J Foot Ankle Surg,2018,57(3):518-520.
[22]Nery C, Raduan F, Mansur N, et al. Endoscopic approach for plantar fasciopathy: a longterm retrospective study. Int Orthop,2013,37(6):1151-1156.
[23]Sahu RL. Percutaneous planter fasciitis release under local anesthesia: A prospective study. Chin J Traumatol,2017,20(2):87-89.

备注/Memo

备注/Memo:
基金项目：苏州大学2021年“大学生创新创业训练计划项目”（2021SUDA045）；苏州大学放射医学与辐射防护国家重点实验室开放课题（GZK1202113）；苏州大学附属第二医院核技术医学应用重点人才项目（XKTJ-HRC2021005）；四川大学生物治疗国家重点实验室开放研究课题项目（SKLB202012）**通讯作者，Email：qinjianzhong1978@163.com ①（苏州大学2018级临床医学（5+3）专业，苏州215004）②（苏州大学附属第二医院手足外科硕士研究生， 苏州21
更新日期/Last Update: 2022-07-21