摘要
目的比较放散式体外冲击波和超声引导下局部阻滞治疗慢性足底筋膜炎的临床疗效。方法收集2017年8月至2019年7月就诊于福建中医药大学附属三明市中西医结合医院疼痛科的足底筋膜炎患者100例,按照随机数字表法随机分为冲击波组(n=50)和阻滞组(n=50)。冲击波组使用放散式体外冲击波治疗,高能量手柄,探头15 mm,频率10~15 Hz,治疗压力1.0~2.0 bar,冲击次数2000次,每5日1次,3次为1个疗程,治疗1个疗程。阻滞组在彩色多普勒超声引导下局部穿刺注射治疗,注射镇痛液3~5 ml(复方倍他米松1 ml+2%盐酸利多卡因3 ml+0.9%氯化钠2 ml),1次/周,2次为1个疗程,治疗1个疗程。比较治疗前和首次治疗后1周,末次治疗后1、3个月时早晨起步状态下的疼痛视觉模拟评分(VAS),末次治疗后3个月随访时记录两组治疗疗效、不良反应和患者满意度。结果冲击波组和阻滞组完成试验者各45、41例。两组患者一般资料比较差异均无统计学意义(P均>0.05)。治疗前两组VAS评分相近(P>0.05),治疗后各时点两组VAS评分均较治疗前明显降低(P均<0.05)。首次治疗后1周和末次治疗后1个月时,阻滞组VAS评分均低于冲击波组(P均<0.05),但末次治疗后3个月时冲击波组VAS评分低于阻滞组(P=0.040)。冲击波组首次治疗后1周、末次治疗后1个月时VAS 0~3分患者例数少于阻滞组(P均<0.05);末次治疗后3个月时,两组例数比较差异无统计学意义(P>0.05)。末次治疗后3个月随访时,冲击波组和阻滞组优良率分别为88.9%、75.6%(P>0.05),均未发现严重的不良反应,但两组满意度评分分别为(7.8±3.3)分、(6.3±2.9)分,两组间差异有统计学意义(P=0.025)。结论放散式体外冲击波和超声引导下局部阻滞治疗慢性足底筋膜炎均取得较好的临床疗效,但前者操作简单,无创伤性,患者满意度更高。
Objective To compare the clinical efficacy of radiative extracorporeal shockwave therapy(ESWT)with ultrasonic-guided analgesic solution local injection in the treatment of chronic plantar fasciitis.Methods From August 2017 to July 2019,100 patients with plantar fasciitis treated in the Department of Pain Medicine,Sanming Integrated Medicine Hospital affiliated to Fujian University of Traditional Chinese Medicine,were randomly divided into ESWT group(n=50)and block group(n=50).Patients were treated by extracorporeal shock wave therapy with a high-energy handle in the ESWT group,15 mm probe,10-15 Hz frequency,1.0-2.0 bar treatment pressure,2000 times of impact,once every 5 days,three times as a course.Patients were treated by local injection of analgesic solution 3-5 ml(compound betamethasone injection 1 ml+2%lidocaine hydrochloride injection 3 ml+0.9%sodium chloride 2 ml)in the block group under the guidance of color Doppler ultrasound,once a week,twice as a course.Visual analogue scale(VAS)at walking in the morning was compared before and at 1 week after the first treatment,1 month and 3 months after the last treatment respectively.The treatment efficacy,adverse reactions and patients'satisfaction were recorded in the two groups at 3 months after the last treatment.Results There were 45 and 41 cases finished the follow respectively in ESWT group and block group.There was no significant difference in general condition between the two groups(all P>0.05).Before treatment,VAS was similar in the two groups(P>0.05).At each time point after the treatment,VAS was lower in the two groups than that before treatment(all P<0.05).At 1 week after the first treatment and 1 month after the last treatment,VAS was lower in the block group than that in the ESWT group(all P<0.05),but at 3 months after the last treatment,it was lower than that in the ESWT group(P=0.040).The number of patients with VAS 0-3 was less in the ESWT group than that in the block group at 1 week after the first treatment and 1 month after the last treatment(all P<0.05),but had no statistical difference between the two groups at 3 months after the last treatment(P>0.05).At the follow-up of 3 months after the last treatment,the excellent and good rate was 88.9%and 75.6%in ESWT group and block group respectively(P>0.05),but the satisfaction score was(7.8±3.3)and(6.3±2.9),respectively(P=0.025).No serious adverse reactions were found in both groups.Conclusion Both of ESWT and ultrasonic-guided analgesic solution local injection are of good clinical efficacy in the treatment of chronic plantar fasciitis,but radiative ESWT is more effective,simpler,noninvasive and more satisfactory.
作者
邱小凤
张文强
Qiu Xiaofeng;Zhang Wenqiang(Department of Pain Medicine,Sanming Integrated Medicine Hospital affiliated to Fujian University of Traditional Chinese Medicine,Sanming City,Fujian Province 365001,China)
出处
《中华疼痛学杂志》
2021年第3期271-276,共6页
Chinese Journal Of Painology
关键词
体外冲击波治疗
足底筋膜炎
注射
治疗
Extracorporeal shockwave therapy
Fasciitis,plantar
Injection
Therapy
