超声引导下富血小板血浆注射治疗足底筋膜炎的疗效观察

目的观察超声引导下局部注射富血小板血浆(PRP)与类固醇激素治疗足底筋膜炎的临床疗效。方法选择2016年6月至2017年3月就诊于本院疼痛科的足底筋膜炎患者32例,男9例,女23例,年龄36～73岁,BMI 18～35kg/m2。随机分为超声引导下富血小板血浆注射治疗组(PRP组)和超声引导下类固醇激素注射治疗组(S组),每组16例。在超声引导下PRP组将制备出的4ml PRP注入跖筋膜表面。S组将复方倍他米松1ml+2%盐酸利多卡因注射液2ml的混合液注入跖筋膜表面。评估患者注射治疗前(T0)和治疗后1个月(T1)、3个月(T2)、6个月(T3)时晨起后起步状态、步行10步后状态和当天总体平均状态的VAS评分。采用超声测量T0和T2时患者俯卧位时跟骨-筋膜结合处足底筋膜厚度。观察注射部位有无出血、血肿、感染以及足底筋膜有无撕裂等并发症。结果与T0时比较,T1、T2和T3时两组患者晨起后起步状态、步行10步后状态和当天总体平均状态VAS评分均明显降低(P0.05)。与S组比较,T1和T2时PRP组晨起后起步状态、步行10步后状态和当天总体平均状态VAS评分明显升高(P0.05),T3时PRP组晨起后起步状态、步行10步后状态和当天总体平均状态VAS评分明显降低(P0.05)。与T0时比较,T2时两组足底筋膜厚度明显变薄(P0.05),T0和T2时两组足底筋膜厚度差异无统计学意义。两组患者治疗后均未发现出血、血肿、感染以及足底筋膜撕裂等并发症。结论超声引导下局部注射富血小板血浆与类固醇激素均能有效治疗足底筋膜炎,激素局部注射显效快,但富血小板血浆疗效相对更稳定持久。     

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。     

两种冲击波方法治疗慢性跖筋膜炎疗效的比较

[目的]比较两种冲击波方法治疗慢性跖筋膜炎的不同疗效。[方法]选取112例慢性跖筋膜炎患者为研究对象,随机分为足底组和复合组,足底组对足底区进行冲击波治疗,复合组在足底区治疗的基础上对同侧小腿三头肌进行冲击波治疗。分别于治疗前,治疗终结时,治疗后1、4、12周对两组进行视觉模拟评分(VAS)及足底部压痛阈值(PPT)比较分析。[结果]两组在治疗终结时,治疗后1、4、12周VAS评分较治疗前明显降低,差异有统计学意义,尤以复合组显著(P0.05)。复合组在治疗后各时间点VAS评分与足底组比较更低,两组间差异有统计学意义(P0.05)。两组在治疗终结时、治疗后1周PPT与治疗前无明显变化(P0.05),在治疗后4、12周PPT明显改善,与治疗前差异有统计学意义,尤以复合组显著(P0.05)。复合组在治疗后4、12周与足底组比较改善更为明显,两组间差异有统计学意义(P0.05)。[结论]足底筋膜与小腿三头肌同时冲击波治疗效果优于单纯足底筋膜治疗。     

关节镜筋膜深层入路治疗跖筋膜炎

目的观察关节镜筋膜深层入路治疗跖筋膜炎的临床疗效。方法对17例经至少1个月正规非手术治疗效果不理想的单足跖筋膜炎患者在关节镜下筋膜深层入路行清理跟骨骨赘、切断跖筋膜内侧1/3~1/2术。术后1年采用AOFAS踝-后足评分标准评估足踝功能。结果17例患者均获得随访,时间12~19个月。术后患足完全负重时间7~14 d。AOFAS踝-后足评分术前57.0分±7.4分,术后1年91.7分±5.2分,差异有统计学意义(P<0.001)。1例术后残留足跟部疼痛,经非手术治疗疼痛缓解。结论关节镜筋膜深层入路治疗跖筋膜炎创伤小、视野清楚、术后恢复快、效果确切。     

铍针治疗腰背肌筋膜炎疗效观察

腰背肌筋膜炎,是指腰背部肌肉纤维筋膜的一种慢性损伤引起的非细菌性炎症,亦称为＂腰背肌纤维炎＂[1]。是临床常见病症,易被忽略而误诊。我们应用铍针疗法治疗本病20例,并与传统针灸治疗的20例进行对照,疗效满意。现报道如下。     

综合治疗急性坏死性筋膜炎25例

2013年5月—2020年3月,北京朝阳急诊抢救中心收治25例急性坏死性筋膜炎患者,其中男18例、女7例,年龄7~78岁,病变部位主要位于下肢,原始病变范围20 cm×15 cm~83 cm×42 cm。入院后行全身综合治疗,尽早将病灶区域切开引流,去除坏死组织。待创面坏死组织有所减少时开始行负压封闭引流,创面好转后予...     

探讨超声在足底跖筋膜炎诊断中的应用价值

目的 探讨超声在跖筋膜炎诊断及鉴别中的应用价值。方法 回顾性分析2019年1月至2020年7月间,我院203例临床诊断跟痛症患者的临床及超声影像学资料,并总结病因。后对比分析跖筋膜炎患者的双侧跖筋膜及足底脂肪垫的超声参数; 按照BMI是否大于24 kg/m2分组,对比上述参数,探讨超声诊断跖筋膜炎的价值。结果 跖筋膜炎是上述患者足跟痛的首要病因,占82.8%。其中跖筋膜炎患者跖筋膜跟骨止点处的超声测量厚度大于健侧 （0.50 cm vs 0.37 cm）,而脂肪垫厚度小于健侧（0.55 cm vs 0.60 cm）（P<0.05）,中段跖筋膜厚度无差异（P>0.05）。在跟骨止点处,BMI > 24 kg/m2组与BMI < 24 kg/m2组患者右侧跖筋膜无差异（P>0.05）,而BMI > 24 kg/m2组左侧跖筋膜厚于BMI < 24 kg/m2组 （0.46 cm vs 0.40 cm） （P<0.05）。同时,BMI > 24 kg/m2组右侧足底脂肪垫厚度较BMI < 24 kg/m2组增厚 （0.59 cm vs 0.50 cm）（P<0.05）。结论 足底跖筋膜炎超声可直接显示的跖筋膜跟骨止点处增厚,其可为临床提供定量的参数指标,对于足跟痛的软组织因素分析和鉴别有重要临床价值。     

背肌筋膜炎综合治疗效果观察

1998年 8月至 2 0 0 0年 10月 ,笔者应用中频电疗、按摩疗法及 TDP(电磁波 )局部照射综合治疗背肌筋膜炎 46例 ,并与同期 32例常规口服消炎痛及外贴伤湿止痛膏进行对比观察 ,效果满意。1　临床资料1.1　一般情况　本组 78例均符合背肌筋膜炎的诊断标准 [1 ] 。随机分为两组 :(1)观察组 46例 ,男 35例 ,女 11例 ;年龄 2 9～ 5 6岁 ,平均 40± 5 .8岁 :病程 15 d～ 1年 ;因感受风寒湿侵发病 6例 ,劳累损伤致病 38例 ,由感冒诱发 2例 ;单侧致病 43例 ,双侧 3例 ;肩胛内侧嵴缘可触及局限性硬结 35例 ,背阔肌及棱形肌可触及局限性硬结 11例。 (…     

肌骨超声引导下针刀治疗退行性半月板病变的疗效观察

目的 :观察应用肌骨超声引导针刀治疗退行性半月板病变的疗效,为本病的治疗提供一种新方法。方法 :回顾2015年1月至2015年9月北京中医药大学第三附属医院门诊患者,采用肌骨超声引导下针刀治疗退行性半月板病变77例,其中男30例,女47例;年龄44~66岁,平均57.5岁。治疗后2周和1个月门诊随访,对患者治疗前后膝关节Lysholm、VAS评分及半月板膨出距离进行分析比较,总结疗效。结果:治疗前、术后2周及1个月的Lysholm评分分别为51.63±15.26,77.13±11.82,87.56±8.65;治疗前、术后2周和1个月的VAS评分分别为7.080±1.574,2.630±0.310,0.850±0.177,均较术前改善(P=0.00)。治疗前、术后2周和1个月半月板膨出距离分别为(0.400±0.156)mm,(0.298±0.140)mm,(0.240±0.110)mm,治疗后较治疗前明显好转(P=0.00)。结论 :肌骨超声引导下针刀治疗定位准确,对退行性半月板病变疗效显著。肌骨超声引导下针刀治疗操作安全,无并发症,可明显改善患者生活质量。     

中西医结合治疗急性坏死性筋膜炎

目的:观察中西医结合治疗急性坏死性筋膜炎的疗效。方法:16例患者采用手术切开引流,全身应用抗生素,中医辨证治疗。结果:16例患者全部治愈。结论:中西医结合治疗急性坏死性筋膜炎疗效确切可靠。     

Dextrose prolotherapy versus radial extracorporeal shock wave therapy in the treatment of chronic plantar fasciitis: A randomized,controlled clinical trial

In the recent years, prolotherapy is increasingly being used in the field of musculoskeletal medicine. However, few studies have investigated its effectiveness in plantar fasciitis (PF). The purpose of this study was to compare the effectiveness of ultrasound-guided dextrose prolotherapy with radial extracorporeal shock wave therapy (ESWT) in the treatment of chronic PF. This randomized controlled trial was conducted on 59 patients with chronic PF. Patients were randomly assigned into two groups receiving three sessions of radial ESWT (29 patients) vs. two sessions of ultrasound-guided intrafascial 2 cc dextrose 20% injection (30 patients). The following outcome measures were assessed before and then six weeks and 12 weeks after the treatments: pain intensity by visual analog scale (VAS), daily life and exercise activities by Foot and Ankle Ability Measure (FAAM), and the plantar fascia thickness by ultrasonographic imaging. The VAS and FAAM scales showed significant improvements of pain and function in both study groups 6 weeks and 12 weeks after the treatments. A significant reduction was noted for plantar fascia thickness at these intervals (all p < .05). The inter-group comparison revealed that except for the FAAM-sport subscale which favored ESWT, the interaction effects of group and time were not significant for other outcome measures. Dextrose prolotherapy has comparable efficacy to radial ESWT in reducing pain, daily-life functional limitation, and plantar fascia thickness in patients with PF. No serious adverse effects were observed in either group.Level of evidenceLevel I, randomized controlled trial.     

Investigation of the relationship between the thickness of the plantar calcaneonavicular ligament and plantar fascia in patients with plantar fasciitis

BackgroundAlthough patients with plantar fasciitis show spring ligament laxity, the thickness of the spring ligament in patients with plantar fasciitis remains unclear. This study aimed to elucidate the morphological characteristics of the spring ligament in patients with plantar fasciitis based on an ultrasound imaging system (US).MethodsThirty feet of 30 patients (painful group) diagnosed with plantar fasciitis at our hospital and thirty feet of 30 healthy volunteers (healthy group) without plantar pain were investigated. The thicknesses of both the spring ligament and plantar fascia were assessed via a US statistical comparison of the spring ligament and plantar fascia thickness between the painful and healthy groups. This was performed using Welch’s t-test, and the significance level was set at p < 0.01. In addition, Pearson’s correlation coefficient was calculated to assess the correlation between the spring ligament and plantar fascia thickness in the two groups, and the significance level was set at p < 0.01.ResultsThe spring ligament thickness in the painful group was significantly lower than that in the healthy group (p < 0.001). The thickness of the plantar fascia in the painful group was significantly greater than that in the healthy group (p = 0.03). In addition, the correlation between the spring ligament and plantar fascia thickness was moderately negative (r = −0.42, p = 0.001). The thicker the plantar fascia in the subjects, the thinner was the spring ligament.ConclusionsThe thickness of the spring ligament in patients with plantar fasciitis decreased. The thinning of the spring ligament was negatively correlated with the thickening of the plantar fascia as per the US evaluation. Based on the spring ligament thinning determined via US evaluation, interventions such as insoles from an early stage could prevent the onset of plantar fasciitis.     

改良手法牵伸配合针刀松解为主治疗跟骨骨刺综合征的病例对照研究

目的:观察改良跖筋膜牵伸手法配合针刀松解为主治疗跟骨骨刺综合征的临床疗效,并探讨此方法的优点。方法:将115例2010年9月至2015年9月诊断为跟骨骨刺综合征患者分为2组,治疗组58例,男21例,女37例;年龄26~73岁,病程6~51个月;采用改良手法牵伸配合针刀松解治疗。对照组57例,男22例,女35例;年龄31~75,病程7~58个月;采用常规牵伸手法配合针刀松解。分别于治疗后1周、1个月和3个月进行足跟痛NRS评分,采用"Foot and Ankle Ability Measure(FAAM)"量表对两组患者进行疗效评价。结果:治疗组治疗后1、3个月,疼痛NRS评分3.89±0.96,2.46±0.95,均优于对照组的4.52±1.21,4.73±1.11;治疗组FAAM得分率(3.89±0.96)%,(2.46±0.95)%,均优于对照组的(4.52±1.21)%,(4.73±1.11)%;总体疗效治疗组优于对照组。结论:改良跖筋膜牵伸手法配合针刀松解能定位牵伸力点,对跟骨骨刺综合征患者疗效显著,相比传统牵伸手法配合针刀松解有较高的中远期疗效。     

Gastrocnemius recession for recalcitrant plantar fasciitis in overweight and obese patients

Background

Plantar fasciitis is a common foot pathology that is typically treated non-operatively. However, a minority of patients fail non-operative management, develop chronic symptoms, and request a surgical option. Gastrocnemius recession has recently been shown to be effective for the treatment of chronic plantar fasciitis. The purpose of this paper is to present evidence that gastrocnemius recession is safe and effective in the subset of chronic plantar fasciitis patients who are overweight and obese.

急性坏死性筋膜炎诊治体会

目的 总结坏死性筋膜炎(necrotizing fasciitis,NF)的临床诊断和治疗经验. 方法 回顾性分析中国医科大学附属第一医院2006-2012年24例坏死性筋膜炎的临床资料,并总结诊治体会.结果 本组24例坏死性筋膜炎患者,其中男19例,女5例;年龄25 ～ 72岁,平均年龄(54±12)岁.发病部位:会阴部、臀部16例,左下肢3例,背部2例,右下肢2例,右下肢及左背部l例.治疗方法:24例均采取广泛切开引流、彻底清创及有效的抗生素治疗,其中输白蛋白13例,输血9例,应用肠外营养19例,接受高压氧治疗15例.24例中一期治愈17例(70.83％),二期植皮4例(16.67％),复发2例(8.33％),死亡1例(4.17％).结论 坏死性筋膜炎起病较急,进展迅速,必须尽早确诊,给予有效抗生素治疗的同时强调早期切开引流、彻底清创,并要加强临床护理及相关营养等支持疗法.     

两种不同手法强度对慢性跖筋膜炎治疗效果的研究

目的观察两种不同手法强度对慢性跖筋膜炎治疗效果的影响。方法应用强度200N/cm~2康复治疗跖筋膜炎,与强度100 N/cm~2康复治疗的跖筋膜炎作对照,以疼痛日记为疗效指标,晨起第一步时及每天最痛时的VAS评分与对照组相比较。结果经8周治疗且随访3个月,强度200 N/cm~2的手法治疗慢性跖筋膜炎优于强度100 N/cm~2,组间比较,差异有统计学意义(P0.01)。结论在治疗慢性跖筋膜炎方面,手法强度与疗效有着明显关系,大强度手法的效果较好。     

The thickness of heel fat-pad in patients with plantar fasciitis

ObjectiveThe aim of this study was to investigate the thickness of heel fat pad (THP) and to detect the relationship between the plantar fasciitis (PF) and age, occupation, BMI, longitudinal arch, the thickness of heel fat-pad in the patients with PF.MethodsA total of 50 patients (29 women and 21 men; mean age: 46.5 years (range: 22–70)) that were diagnosed with PF were included to this study. Patients' affected side were compared with the healthy opposite side with the angle of medial arch (AMA) and first metatarsophalangeal angle (FMTPA) on the foot radiograms, and THP and thickness of first metatarsal fat pad (TFMFP) using ultrasonography (USG) of both feet.ResultsThe mean AMAs of feet with pain and without pain were 122.56° and 120.60°, respectively. The mean FMTPAs of feet with pain and without pain were 14.72° and 14.40°, respectively. The mean THPs of feet with pain at the point of the medial calcaneal tubercle and the mean TFMFPs of the feet with pain at the point of the first metatarsal head were 19.45 mm and 6.75 mm, respectively. The mean THPs of feet without pain at the point of the medial calcaneal tubercle and the mean TFMFPs of the feet without pain at the point of the first metatarsal head were 19.94 mm and 6.75 mm, respectively. It was observed that the mean AMA in the heels with pain was significantly higher than that of the heel without pain (p < 0.05) and the mean THP in the heels with pain was significantly thinner than that of the heel without pain (p < 0.05).ConclusionThe results indicate that USG is an accurate and reliable imaging technique for the measurement of THP in the diagnosis of plantar fasciitis and the heel pad was thinner in the painful heels of patients with plantar fasciitis.Level of evidenceLevel III, Diagnostic Study.