全内侧深入路造腔内镜技术在难治性跖筋膜炎治疗中的应用

doi:10.3760/cma.j.cn101202-20210731-00189

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摘要目的探讨全内侧深入路造腔内镜技术治疗难治性跖筋膜炎的可行性及其临床疗效。方法回顾性研究。纳入徐州市中心医院2018年5月—2020年5月采用全内侧深入路造腔内镜技术治疗的28例30足难治性跖筋膜炎患者的临床资料。其中,男13例13足,女15例17足;年龄22~57（40±11）岁。症状持续时间8~24（17.0±4.6）个月。观察项目：（1）患者术后切口愈合、症状缓解情况等;（2）比较患者术前、术后1个月及末次随访时的疼痛视觉模拟评分法（VAS）评分、跟痛评分（CS）,以及美国足踝外科协会（AOFAS）踝与后足评分,评价手术治疗的功能效果。结果 28例患者术后均获随访12~24（16.9±3.7）个月。所有患者切口一期愈合,未出现伤口及神经损伤并发症。末次随访时,无一例患者存在足跟部内侧疼痛症状,足趾及踝关节运动理想,无挛缩或畸形。术后1个月及末次随访,患侧足跟部的VAS、CS、AOFAS评分均较术前改善明显,差异均有统计学意义（P值均<0.001）。末次随访患侧足跟部的VAS评分为0分,CS评分为（96.2±4.7）分,AOFAS踝与后足评分为（95.1±4.5）分,获得优27足、良3足,优良率100%。结论对于难治性跖筋膜炎患者,全内侧深入路造腔内镜技术是临床治疗中可供选择的一种疗效较为满意的微创技术。

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关键词 ：跖筋膜炎, 关节镜手术, 内侧入路,深层, 造腔内镜技术

Abstract：Objective To investigate the functional outcomes of all-inside endoscopic procedure through deep-fascial medial portals in treating intractable plantar fasciitis. Methods This study was a retrospective study. The data of 28 intractable plantar fasciitis patients (30 feet) in Xuzhou Central Hospital from May 2018 to May 2020, treated with all-inside endoscopic procedure through deep-fascial medial portals, were collected. The study involved 13 male (13 feet) and 15 female (17 feet) cases, aged 22-57 (40±11) years old. The symptom duration ranged from 8-24 (17.0±4.6) months. The following items were observed: (1) the incision healing and symptom relief. (2) The functional outcomes, visual analogue pain scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle hindfoot scale and calcaneodynia scale (CS), were evaluated at 1 month and the last follow-up time point, respectively. And the above indexes were compared to the pre-surgery items. Results All the patients were followed up from 12 to 24 months, with a mean of (16.9±3.7) months. One-stage incision healing was achieved in all patients without postoperative complications of incision and nerve. None of the medial heel pain, contracture or deformity was observed at the last follow-up. The active movements of the foot and ankle joint were normal. The postoperative VAS, CS, and AOFAS improved significantly at 1 month and final follow-up compared to pre-surgery (all P values <0.001). At the final follow-up time point, the mean VAS, AOFAS and CS was 0, 96.2±4.7 and 95.1±4.5, respectively. According to the AOFAS, 27 feet were excellent and 3 feet were good, the excellent and good rate was 100%. Conclusion For intractable plantar fasciitis, all-inside endoscopic procedure through deep-fascial medial portals could provide satisfying functional outcomes and which is an optimal minimally invasive technique.

Key words： Plantar fasciitis Arthroscopy Medial portal,deep fascial approach Endoscopy without natural articular cavity

收稿日期: 2021-07-31

基金资助:江苏省六大人才高峰高层次人才项目（2019-WSW-173）; 江苏省卫生高层次“六个一工程”拔尖人才项目（LGY2020028）; 徐州市卫健委科技重点项目（XWKYHT20200043）; 徐州市重点研发计划项目（KC21239）

通讯作者: 冯仕明,Email：fengshiming_04@163.com

引用本文:

冯仕明, 马超, 陈杰, 史开宇. 全内侧深入路造腔内镜技术在难治性跖筋膜炎治疗中的应用[J]. 中华解剖与临床杂志, 2022, 27(4): 226-231.
Feng Shiming, Ma Chao, Chen Jie, Shi Kaiyu. Clinical application of all-inside endoscopic procedure through deep-fascial medial portals in treating intractable plantar fasciitis. Chinese Journal of Anatomy and Clinics, 2022, 27(4): 226-231.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20210731-00189 或 http://www.cjac.com.cn/CN/Y2022/V27/I4/226

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