牵伸训练治疗跖筋膜炎的病例对照研究

目的:评价牵伸训练联合双氯芬酸二乙胺超声透入以及牵伸训练联合脉冲超声波对跖筋膜炎的治疗效果,并比较其疗效。方法:自2009年6月至2012年3月治疗跖筋膜炎30例,分为3组:超声透入加牵伸组,脉冲超声波加牵伸组,单纯牵伸组,各10例。牵伸组男2例,女8例,平均年龄(46.7±6.5)岁,体质指数(26.7±2.8)kg/m2;脉冲超声波加牵伸组男4例,女6例,平均年龄(45.8±6.1)岁,体质指数(26.4±3.4)kg/m2;超声透入加牵伸组男3例,女7例,平均年龄(48.4±8.0)岁,体质指数(25.4±3.0)kg/m2。超声透入加牵伸和脉冲超声波加牵伸组的超声治疗每日10min,每周治疗5次,共4周,其中超声透入加牵伸组耦合剂使用双氯芬酸二乙胺(扶他林)。另外,所有患者进行小腿后群肌、跟腱及跖筋膜的牵伸训练。在治疗前、治疗后即刻及治疗3个月后,以视觉类比标度(visual analog scale,VAS)评价晨起足跟痛,并抽取足部功能指数量表(foot function index,FFI)中的行动障碍子量表评价患足功能状态。结果:治疗前3组患者资料和足跟痛起始状态组间无明显差异。晨痛及行动障碍的改善:治疗1个月时超声透入加牵伸组改善较单纯牵伸组明显(P<0.05),3个月时3组差异无统计学意义(P>0.05)。而组内比较显示3组晨痛及行动障碍在治疗前后的3个时间点均得到有效改善(P<0.05)。结论:单纯牵伸训练以及联合超声透入或脉冲超声波对治疗跖筋膜炎的晨痛和功能障碍均有效,而联合超声透入治疗效果最佳。

Case-control study of stretching exercise on treatment of plantar fasciitis

Objective: To evaluate the effect of different methods of physical therapy on plantar fasciitis. Methods: From June 2009 to March 2012,30 patients with plantar fasciitis were randomly divided into 3 groups including phonophoresis (PH)combined with stretching exercise,ultrasound (US) combined with stretching exercise,stretching exercise,10 patiens in each group. In stretching exercise group,there were 2 males and 8 females with an average age of (46.7±6.5) years old,the mean constitutional index duration was (26.7±2.8) kg/m². In US combined with stretching exercise group,there were 4 males and 6 females with an average age of (45.8±6.1) years old,the mean constitutional index duration was (26.4±3.4) kg/m². In PH combined with stretching exercise group,there were 3 males and 7 females with an average age of (48.4±8.0) years old,the mean constitutional index duration was (25.4±3.0) kg/m². Patients in PH and US were treated for 10 min everyday by ultrasound,5 times per week,lasted for 4 weeks; and patients by ultrasound therapy in PH were treated with diclofenac diethylamine at the same time. All the 30 patients received instruction for stretching exercises at home. Pain and ability to function were evaluated before treatment,immediately afterwards,and three months later. Morning pain was evaluated by VAS,and the sub-scale of FFI evaluated the affected foot function. Results: Patients's general status and original pain state of plantar fasciitis before treatment had no significant difference among three groups. There were statistical differences of morning pain and FFI-disability score between PH group and stretching exercise group at 1 month (P<0.05),and no statistical differences among three groups at 3 months (P>0.05). Compared with before therapy,the pain and disability score of three groups significantly improved in the three points of time (P<0.05). Conclusion: Stretching exercises and combining with PH or US are effective for pain and disability in patients with plantar fasciitis and that addition of PH to exercise therapy betters the effectiveness.