摘要
目的比较关节镜下内侧双通道(MDP)与内外侧单通道(MLSP)入路跖筋膜松解术(EPF)治疗顽固性跟痛症的效果。方法回顾性分析2020年7月至2024年8月期间武汉市第四医院足踝外科收治的24例顽固性跟痛症患者资料。根据手术入路不同将所有患者分为两组:MDP组11例,男3例,女8例;年龄(58.9±6.7)岁;病程(29.5±14.8)个月;采用关节镜下MDP入路EPF治疗。MLSP组13例,男5例,女8例;年龄(62.3±7.1)岁;病程为(32.9±18.2)个月;采用关节镜下MLSP入路EPF治疗。比较两组患者的手术时间、住院时间、随访期间并发症发生情况,以及术后1周、1个月、3个月、12个月的疼痛视觉模拟评分(VAS)和美国足踝外科协会(AOFAS)踝-后足评分等。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。MDP组患者术后1周、1个月、3个月疼痛VAS评分[(4.87±0.84)、(3.33±0.58)、(2.12±0.35)分]显著低于MLSP组患者[(6.07±0.74)、(4.15±0.65)、(2.72±0.58)分],术后1、3个月AOFAS踝-后足评分[(67.7±3.7)、(79.6±3.8)分]显著高于MLSP组患者[(62.2±4.1)、(73.8±4.8)分],差异均有统计学意义(P<0.05)。MDP组与MLSP组患者的手术时间[(46.5±2.2)、(50.3±2.8)min]、住院时间[(7.6±2.2)、(6.5±2.3)d]、并发症发生情况(2/11、4/13)、术后12个月疼痛VAS评分[(0.87±0.20)、(1.05±0.32)分]和AOFAS踝-后足评分[(89.2±3.5)、(86.0±4.9)分]比较差异均无统计学意义(P>0.05)。结论MDP与MLSP入路EPF治疗顽固性跟痛症的近期效果相当。前者早期恢复更快、操作更便捷,后者在实现量化松解方面更具精确性。
Objective To compare the medial dual portals(MDP)and the medial-lateral single portal(MLSP)in endoscopic plantar fasciotomy(EPF)for refractory calcaneal heel pain.Methods A retrospective cohort study was conducted to analyze the 24 patients admitted from July 2020 to August 2024 to Department of Foot and Ankle Orthopaedics,Wuhan Fourth Hospital for refractory calcaneal heel pain.According to the different surgical approaches,the patients were divided into an MDP group of 11 cases treated by EPF through MDP and an MLSP group of 13 cases treated by EPF through MLSP.There were 3 males and 8 females,with an age of(58.9±6.7)years and a disease duration of(29.5±14.8)months in the MDP group;there were 5 males and 8 females,with an age of(62.3±7.1)years and a disease duration of(32.9±18.2)months in the MLSP group.The operation time,hospital stay,follow-up complications,and Visual Analog Scale(VAS)pain scores and American Orthopaedic Foot&Ankle Society(AOFAS)ankle-hindfoot scores at postoperative 1 week,1 month,3 months,and 12 months were compared between the 2 groups.ResultsThere were no statistically significant differences in the preoperative general data between the 2 groups,indicating comparability(P>0.05).In the MDP group,the VAS pain scores at postoperative 1 week,1 month,and 3 months[(4.87±0.84)points,(3.33±0.58)points,and(2.12±0.35)points]were significantly lower than those in the MLSP group[(6.07±0.74)points,(4.15±0.65)points,and(2.72±0.58)points],and the AOFAS ankle-hindfoot scores at postoperative 1 month and 3 months[(67.7±3.7)points,and(79.6±3.8)points]were significantly higher than those in the MLSP group[(62.2±4.1)points,and(73.8±4.8)points](P<0.05).No statistically significant differences were observed between the MDP group and the MLSP group in terms of operation time[(46.5±2.2)min versus(50.3±2.8)min],hospital stay[(7.6±2.2)d versus(6.5±2.3)d],incidence of complications(2/11 versus 4/13),VAS pain score at postoperative 12 months[(0.87±0.20)points versus(1.05±0.32)points],or AOFAS ankle-hindfoot score at postoperative 12 months[(89.2±3.5)points versus(86.0±4.9)points](P>0.05).Conclusions In EPF for refractory calcaneal heel pain,both MDP and MLSP surgical approaches can lead to comparable short-term efficacy.MDP is superior in faster early recovery and more convenient operation while MLSP is superior in more accurate quantitative release.
作者
刘丰
潘昊
黄若昆
Liu Feng;Pan Hao;Huang Ruokun(Department of Foot and Ankle Orthopaedics,Wuhan Fourth Hospital,Wuhan 430000,China)
出处
《中华创伤骨科杂志》
北大核心
2025年第12期1041-1047,共7页
Chinese Journal of Orthopaedic Trauma
基金
湖北省科技厅青年项目(2025AFB293)。
关键词
关节镜检查
顽固性跟痛症
跖筋膜松解
内侧双通道
内外侧单通道
Arthroscopy
Recalcitrant heel pain
Plantar fascia release
Medial dual-portal
Medial-lateral single-portal
