| 贺磊,黄臻,许岩,等.经关节镜双内侧入路跖筋膜松解联合富血小板血浆治疗顽固性跟痛症的疗效分析.骨科,2025,16(3): 224-229. |
| 经关节镜双内侧入路跖筋膜松解联合富血小板血浆治疗顽固性跟痛症的疗效分析 |
| Therapeutic effectiveness of arthroscopic fasciotomy via bilateral medial portals combined with platelet-rich plasma in the treatment of intractable calcaneodynia |
| 投稿时间：2024-08-27 |
| DOI：10.3969/j.issn.1674-8573.2025.03.006 |
| 中文关键词: 关节镜 富血小板血浆 跖筋膜炎 跟痛症 跟骨骨刺 |
| 英文关键词: Endoscopic Platelet-rich plasma Plantar fasciitis Calcaneodynia Calcaneus spur |
| 基金项目:湖北民族大学附属民大医院开放课题青年项目（OIR202309Q） |
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| 中文摘要: |
| 目的 探讨经关节镜双内侧入路跖筋膜松解术联合富血小板血浆（platelet-rich plasma，PRP）治疗顽固性跟痛症的临床疗效及安全性。方法 回顾性分析2021年4月至2023年11月湖北民族大学附属民大医院骨科收治的58例顽固性跟痛症病人的临床资料，均采用经关节镜双内侧入路跖筋膜松解术+跟骨骨刺切除术，根据注射药物不同分为三组。其中，封闭组19例，予以皮质类固醇封闭治疗（倍他米松+罗哌卡因封闭共2 mL）；PRP组19例，予以PRP注射治疗（共2 mL）；联合组20例，予以皮质类固醇封闭+PRP注射治疗（倍他米松+罗哌卡因+PRP，共4 mL）。记录并比较三组病人的手术时间、术中出血量、住院时间、完全负重活动时间、疼痛视觉模拟量表（visual analogue scale，VAS）评分、美国足踝外科医师协会（American Orthopaedic Foot and Ankle Society，AOFAS）踝与后足功能评分、跟痛症评分（calcaneodynia score，CS）、血清C-反应蛋白（CRP）、白细胞介素-6（IL-6）。结果 三组病人的手术时间、术中出血量、住院时间的差异均无统计学意义（P＞0.05）。所有病人均获得6个月以上随访，三组病人完全负重活动时间差异无统计学意义（P＞0.05）。三组病人术后的VAS评分、AOFAS评分、CS评分、CRP、IL-6水平与术前比较均显著改善（P＜0.05）。随时间推移，三组病人的血清CRP、IL-6水平均显著降低（P＜0.05），术后3个月封闭组、联合组的CRP水平较PRP组低，差异有统计学意义（P＜0.05）。术后6个月，联合组的VAS评分、AOFAS评分、CS评分、CRP、IL-6水平优于封闭组和PRP组（P＜0.05），PRP组VAS评分、CRP、IL-6水平优于封闭组（P＜0.05）。结论 关节镜下跖筋膜松解联合PRP治疗顽固性跟痛症效果满意，值得临床推广应用。 |
| 英文摘要: |
| Objective To investigate the clinical efficacy and safety of arthroscopic fasciotomy via bilateral medial portals combined with platelet-rich plasma (PRP) in the treatment of intractable calcaneodynia. Methods The clinical data of 58 patients with intractable calcaneodynia admitted from April 2021 to November 2023 were retrospectively analyzed. All patients underwent arthroscopic fasciotomy via bilateral medial approach and calcaneal bone spur resection. The patients were divided into three groups according to the different injection drugs. In corticosteroid group, there were 19 patients, including 9 males and 10 females, treated with arthroscopy procedure combined with corticosteroid injection (betamethasone and ropivacaine injection, 2 mL in total). In PRP group, there were 19 patients, including 10 males and 9 females, treated with arthroscopy procedure combined with PRP injection (2 mL in total). In combined group, there were 20 patients, including 9 males and 11 females, treated with arthroscopy combined with corticosteroid injection and PRP injection (betamethasone, ropivacaine and PRP, 4 mL in total). The operation time, intraoperative blood loss, hospitalization time, time to full weight-bearing activity, visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, calcaneodynia score (CS), the value of C-reactive protein (CRP), and the interleukin-6 (IL-6) level were recorded and compared among the three groups. Results There were no statistically significant differences among the three groups in operation time, intraoperative blood loss, and hospitalization time (P＞0.05). All patients were followed up for more than 6 months, and there was no significant difference in the time of full weight-bearing activity among the three groups (P＞0.05). The VAS score, AOFAS score, CS score, CRP and IL-6 of the three groups significantly improved compared with those before the operation (P＜0.05). Over time, the value of CRP and IL-6 in three groups were significantly decreased (P＜0.05), and the value of CRP of the corticosteroid group and the combined group at 3 months after surgery were lower than those of the PRP group, with statistically significant differences (P＜0.05). At 6 months after operation, the VAS score, AOFAS score, CS score, CRP and IL-6 of the combined group were better than those of corticosteroid group and PRP group (P＜0.05), and the VAS score, CRP and IL-6 of PRP group were better than the corticosteroid group (P＜0.05). Conclusion Arthroscopic fasciotomy combined with PRP injection is effective in the treatment of intractable calcaneodynia, and is worthy of clinical promotion and application. |
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