外侧双入路镜下骨剌切除跖腱膜松解治疗跟痛症△（开放获取）

Lateral biportal arthroscopic calcaneal spur removal and plantar fascia release for heel pain（OA）

摘要:

[目的] 探讨外侧双入路镜下跟骨骨刺清理加跖筋膜松解术治疗跟痛症的临床效果。[方法] 回顾性分析 2017 年 1 月—2022 年 10 月于西南医科大学附属中医医院治疗的 58 例跟痛症患者的临床资料，根据医患沟通结果。29 例行经外侧双入路踝关节镜下骨刺清理加跖筋膜松解术 （手术组），29 例行保守治疗 （保守组）。比较两组治疗期、随访和影像结果。[结果] 手术组 29 例患者均顺利手术，无神经血管损伤，无切口处感染等并发症。保守组治疗期间无不良反应。所有患者均获随访 1 年以上，随访过程中，手术组无不良现象，无症状复发；保守组 2 例分别在 6、12 个月足跟痛复发，再次给予保守治疗后症状缓解。 随时间推移，两组 VAS、AOFAS 和 Maryland 评分均显著改善（P＜0.05）。治疗前两组间 VAS、AOFAS 和 Maryland 评分的差异均无统计学意义（P＞0.05）。治疗后 3、6、12 个月手术组在 VAS 评分 [(3.1±1.1) vs (5.2±1.2), P＜0.001; (1.6±0.8) vs (4.6±1.4), P＜0.001; (0.6±0.6) vs (3.9±1.3), P＜0.001]、AOFAS 评分 [(73.9±10.4) vs (52.2±14.1), P＜0.001; (86.1±5.6) vs (59.0±13.3), P＜0.001; (93.5±2.9) vs (62.4±13.0), P＜0.001] 和 Maryland 评分 [(73.9±10.8) vs (53.0±14.0), P＜0.001; (86.1±5.5) vs (59.3±12.5), P＜0.001; (93.3±2.6) vs (63.0± 13.4), P＜0.001] 均显著优于保守组。影像方面，手术组 29 例患者术后 X 线片显示跟骨骨刺消失，至末次随访时均未出现跟骨骨刺复发患者。保守组跟骨剌的影像均无显著变化。[结论] 外侧双入路镜下行跟骨骨刺清理加跖筋膜松解术治疗跟痛症具有疗效好、医源性创伤少等优点。在防止跟痛症的复发方面明显优于保守治疗。

Abstract:

[Objective] To investigate the clinical outcomes of lateral biportal arthroscopic calcaneal spur resection and plantar fascia release for heel pain. [Methods] A retrospective study was conducted on 58 patients who received treatment for heel pain in our hospital from January 2017 to October 2022. Based on the doctor-patient discussion before treatment, 29 patients underwent the arthroscopic surgery (the surgical group), while other 29 patients received conservative treatment (the conservative group). The documents regarding to treatment period, follow-up and images were compared between the two groups. [Results] All the 29 patients in the surgical group were successfully operated on without neurovascular injury, incision infection and other complications. On other hand, those in the conservative group had no adverse reactions during the therapeutic period. During the follow-up period lasted for more than 1 year, no adverse phenomenon or symptom recurrence happened in anyone of the surgery group, whereas heel pain recurred in 2 cases in the conservative group at 6 and 12 months later respectively, who got symptoms were relieved after conservative treatment again. The VAS, AOFAS and Maryland scores in both groups improved significantly over time (P＜0.05). There were no significant differences in VAS, AOFAS and Maryland scores between the two groups before treatment (P＞0.05). However, the surgical group proved significantly superior to the conservative group in terms of VAS score [(3.1± 1.1) vs (5.2±1.2), P＜0.001; (1.6±0.8) vs (4.6±1.4), P＜0.001; (0.6±0.6) vs (3.9±1.3), P＜0.001], AOFAS score [(73.9±10.4) vs (52.2±14.1), P＜ 0.001; (86.1±5.6) vs (59.0±13.3), P＜0.001; (93.5±2.9) vs (62.4±13.0), P＜0.001] and Maryland score [(73.9±10.8) vs (53.0±14.0), P＜0.001; (86.1±5.5) vs (59.3±12.5), P＜0.001; (93.3±2.6) vs (63.0±13.4), P＜0.001] 3, 6 and 12 months after treatment. With regard to imaging, the post-operative X-rays showed that calcaneal spur disappeared, and no recurrence of calcaneal spur occurred until the last follow-up in all the 29 patients in the surgical group, whereas the spurs revealed in images remained unchanged in all patients of the conservative group over time. [Conclusion] The lateral biportal arthroscopic calcaneal spur resection and plantar fascia release for heel pain have the advantage of good curative effect with less iatrogenic trauma. It is superior to conservative treatment in preventing recurrence of heel pain.