| 关节镜下射频消融技术治疗跟痛症的疗效分析 |
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Received:December 13, 2012
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| 作者 | Author | 单位 | Unit | E-Mail |
| 李淑媛 |
LI Shu-yuan |
中国人民解放军总医院骨科, 北京 100853
山东省立医院手足外科, 山东 济南 250021 |
Department of Orthopaedics, General Hospital of Chinese PLA, Beijing 100853, China |
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| 张鹏 |
ZHANG Peng |
历下区人民医院皮肤科, 山东 济南 250012 |
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| 曲峰 |
QU Feng |
中国人民解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, General Hospital of Chinese PLA, Beijing 100853, China |
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| 王俊良 |
WANG Jun-Liang |
中国人民解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, General Hospital of Chinese PLA, Beijing 100853, China |
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| 刘玉杰 |
LIU Yu-jie |
中国人民解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, General Hospital of Chinese PLA, Beijing 100853, China |
liuyj301yy@yahoo.com.cn |
| 魏民 |
WEI Min |
中国人民解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, General Hospital of Chinese PLA, Beijing 100853, China |
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| 期刊信息：《中国骨伤》2013年26卷，第5期，第391-394页 |
| DOI：10.3969/j.issn.1003-0034.2013.05.009 |
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目的: 探讨通过关节镜下微创射频消融技术治疗慢性跟痛症的疗效。
方法: 选取2006年1月至2011年12月收治的跟痛症患者13例, 男5例, 女8例;年龄35～68岁。于足跟部标记疼痛点, 行局部浸润麻醉。选取跟骨结节前缘跖腱膜两侧分别建立内外侧入路。皮下组织内注射15～20 ml含0.03%肾上腺素的生理盐水, 后以肌腱剥离器钝性分离皮下组织与跖腱膜, 建立人工腔隙。关节镜监视下以射频消融技术清理增生杂乱的跖腱膜, 清除跟周滑囊, 再以TOPAZ刀头行跖腱膜局部网状打孔治疗。患者手术前后均行疼痛视觉模拟评分(VAS)及美国足踝外科协会后足评分(AOFAS-AH),术后随访6～12个月。
结果: 13例术后恢复良好, 疼痛均有显着改善, VAS评分由术前的8.71±1.64,改善为术后1个月的6.27±2.53及术后6个月的2.30±2.69.AOFAS-AH评分由术前的56.43±3.72,改善为术后1个月的68.15±7.38及术后6个月的84.51±2.93.术中、术后均未出现血管神经损伤、感染等并发症。
结论: 跖腱膜长期受牵拉导致的跖腱膜炎及跟周滑囊炎是引起跟痛症的一个重要原因。关节镜监视下射频消融清除增生的组织及跟周滑囊, 并行跖腱膜打孔治疗, 手术操作简单, 术中无须部分及完全切断跖腱膜或切除跟骨骨刺, 创伤小, 对患者足部功能影响小, 有利于术后康复。 |
| [关键词]:足跟痛 跖痛症 滑囊炎 关节镜 |
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| Arthroscopic treatment of painful heel syndrome with radio-frequency |
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Abstract:
Objective: To evaluate therapy effect of radiofrequency in the treatment of painful heel syndrome under arthroscopy.
Methods: From January 2006 to December 2011,13 patients with painful heel syndrome being admitted into our hospital were studied. There were 5 males and 8 femals,ranging in age from 35 to 68 years. All these surgeries were performed under local anesthesia. After constructing a man-made lacouna in the subcutaneous tissue above plantar fascia,a medial and a lateral portal were established on both sides of plantar fascia and at the anterior edge of calcaneal tuberosity. Hyperplasia and torn fiber tissue of plantar fascia,and plantar calcaneal bursa were removed with radiofrequency probe under arthroscopy. Then penetration of the plantar fascia was carried out in a reticulation-shaped pattern with a special radiofrequency probe TOPAZ. Each patient was assessed with VAS pain evaluation criteria and AOFAS ankle-hindfoot score system (AOFAS-AH) before and after operation. All the patients were followed up,and the duration ranged from 6 to 12 months.
Results: All the 13 patients got excellent recovery with their heel pain relieved significantly. VAS score was 8.71±1.64 before operation,6.27±2.53 at the 1st month after operation,and 2.30±2.69 at the 6th month after operation. AOFAS-AH score was 56.43±3.72 preoperation,68.15±7.38 at 1st month post operation,and 84.51±2.93 at 6th month after operation. There were no perioperative and postoperative complications related to the procedure,such as blood vessel and nerve injury,and infection.
Conclusion: Plantar fasciitis and plantar calcaneal bursitis are main factors of painful heel syndrome. Due to advantages of being easy to operate,having definite effect and no use to do spur removal or plantar fasciotomy. Endoscopy assisted plantar calcaneal bursa removal and plantar fascia penetration by radiofrequency technique can be a satisfactory treatment method for painful heel syndrome. |
| KEYWORDS:Heel pain Metatarsalgia Bursitis Arthroscopes |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 李淑媛,张鹏,曲峰,王俊良,刘玉杰,魏民.关节镜下射频消融技术治疗跟痛症的疗效分析[J].中国骨伤,2013,26(5):391~394 |
| 英文格式: | LI Shu-yuan,ZHANG Peng,QU Feng,WANG Jun-Liang,LIU Yu-jie,WEI Min.Arthroscopic treatment of painful heel syndrome with radio-frequency[J].zhongguo gu shang / China J Orthop Trauma ,2013,26(5):391~394 |
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