冲击波联合富血小板血浆治疗跖筋膜炎的临床研究

目的探讨发散式体外冲击波疗法(extracorporeal shock wave therapy,ESWT)与富血小板血浆(platelet rich plasma,PRP)联合治疗慢性跖筋膜炎的临床疗效。方法前瞻性单中心随机对照研究,选取2017年1月至2018年12月因足跟痛于重庆大学附属三峡医院就诊并诊断为慢性跖筋膜炎的患者60例,其中男性19例,女性41例;年龄20~68岁,平均(44.56±10.68)岁。依照随机数字表法分为ESWT治疗组(E组)、PRP治疗组(P组)和ESWT-PRP联合治疗组(联合组),每组20例。比较三组患者治疗前及治疗结束后4、12、24周视觉模拟评分(visual analogue scale,VAS)、改良足功能指数(revised footfunction index,FFI-R)。分别于治疗前及治疗结束后24周采用超声测量跖筋膜厚度。结果三组患者一般资料及治疗前VAS评分、FFI-R评分比较差异无统计学意义(P>0.05),治疗结束后VAS评分、FFI-R评分均较治疗前明显改善(P<0.05)。4周时联合组及E组优于P组(P<0.05),24周时联合组及P组优于E组(P<0.05)。治疗结束24周后三组患者跖筋膜厚度较治疗前均有明显改善(P<0.05),相关性分析发现VAS评分与跖筋膜厚度存在正相关性。所有患者均未出现严重不良反应。结论采用发散式ESWT与PRP联合方案治疗慢性跖筋膜炎安全、有效、起效快、并发症少、治疗效果维持时间长,值得临床研究与推广。

Therapeutic Effectiveness of Radial Extracorporeal Shockwave Therapy Combined with Platelet-rich Plasma Injection on Chronic Plantar Fasciitis

Objective To investigate the clinical efficacy of radial extracorporeal shockwave therapy(ESWT)combined with platelet-rich plasma(PRP)injection in the treatment of chronic plantar fasciitis.Methods In this prospective,single-center,randomized control trial,60 patients with chronic plantar fasciitis treated in our hospital from January 2017 to Dec.2018 were randomly divided into ESWT group,PRP group and ESWT-PRP combined group,with 20 cases in each group.The visual analogue scale(VAS)and revised foot function index(FFI-R)was compared before treatment,and 4,12 and 24 weeks after treatment.We calculated the thickness of the plantar fascia under the ultrasound localization before treatment and 24 weeks after treatment.Results There were no significant differences of the characteristics,VAS scores or FFI-R scores between 3 groups.After treatment,the VAS scores and FFI-R scores of 3 groups were significantly improved than before treatment(P<0.05).The improvement of VAS and FFI-R scores in the ESWT group and ESWT-PRP combined group were superior to the PRP group in the 4th week(P<0.05),while the improvement of VAS and FFI-R scores in the PRP group and ESWT-PRP combined group were superior to the ESWT group in the 24th week(P<0.05).There was significant improvement in the thickness of the plantar fascia before treatment and 24 weeks after treatment in all groups(P<0.05).VAS score was positively correlated with the thickness of the plantar fascia.No serious adverse reactions occurred after the treatment.Conclusion Radial extracorporeal shockwave therapy combined with platelet-rich plasma injection is a safe and effective treatment for chronic plantar fasciitis,and it has rapid onset,lasting results and no adverse effect.It’sworthy further clinical research and promotion.