实时B超引导下经皮跖腱膜切断术治疗顽固性跖腱膜炎.DOCVIP

临床医学论文-实时B超引导下经皮跖腱膜切断术治疗顽固性跖腱膜炎 ?????????????? 作者：程迅生，章仁品，罗福成，吴端，赵克义?? 【摘要】? [目的]探讨实时B超引导下经皮跖腱膜切断术治疗顽固性跖腱膜炎的临床疗效。[方法]从1997年6月～2007年5月共对472例顽固性跖腱膜炎患者共611足行实时B超引导下经皮跖腱膜切断术。472例患者中男177例，女295例;年龄20～71岁(平均53.4岁);体态肥胖者176例、正常者279例、瘦弱者17例。单足发病者285例、双足发病者187例，病程6个月～20年(中位数12个月)。对病程大于6个月、VAS(Visual Analog Scale)值≥6、B超检查提示有跖腱膜跟骨附着部明显增厚等跖腱膜炎表现的611足行手术治疗。术前VAS值为6～10分(平均8.4分)。术后有376例患者获得长期随防，随防时间为6～36个月(平均18.4个月)。[结果]术后VAS值为0者有349例(占92.8%);VAS值为1～2者有27例(7.2%)。术后达最佳疗效所需要的时间为7 d～6个月，其中术后达最佳疗效所需要的时间为7～14 d者有302例(80.3%)，为2～3个月者有56例(14.9%)，为4～6个月者有18例(4.8%)。所有病人均无足底内、外侧血管、神经损伤;均无切口感染;无明显切口瘢痕形成。[结论]实时B超引导下经皮跖腱膜切断术是治疗顽固性跖腱膜炎较为简便、安全有效的手术方法。 【关键词】? 跖腱膜炎; 经皮跖腱膜切断术; 实时B超引导 　　Abstract: [Objective]To evaluate the effects of percutaneous plantar fasciotomy guided by real-time B-ultrasound in the treatment of recurrent plantar fasciitis. [Method]From June 1997 to May 2007, 611 feet of 472 patients suffering from recurrent plantar fasciitis were treated with percutaneous plantar fasciotomy guided by real-time B-ultrasound. All the patients were aged from 20～71 years (mean 53.4 years) with the duration of disease from 6 months to 20 years (median 12 months). There were 177 males and 295 females. One foot was involved in 285 and two feet in 187 patients.A total of 611 feet, with the illness duration more than 6 months and VAS (Visual Analog Scale) ≥6 and having B-ultrasound manisfestations such as thickening of plantar fascia on calcaneum, were underwent percutaneous plantar fasciotomy guided by real-time B-ultrasound. Before operation VAS was 6 to 10(mean 8.4).Totally 376 patients were followed from 6 to 36 months(mean 18.4 months).[Result]Postoperative VAS was 0 in 349 (92.8%), 1～2 in 27 patients (7.2%).The time needed to achieve best postopetative effect was 7 days to 6 months.Of all the patients,302 (80.3%) achieved the best effect within 7 to 14 days, 56 (14.9%) within 2 to 3 months and 18 (4.8%) within 4～6 months.No patients were found to have complicated incision infection or injuries to