小针刀松解术治疗跟痛症的足底应力研究∗

摘要

目的：测量分析跟痛症患者小针刀治疗前后足底应力学变化,评价针刀在治疗跟痛症中的疗效,为针刀的临床应用提供依据。方法105例跟痛症患者随机分为3组,即治疗1组、治疗2组、对照组,每组35例。治疗组70例完成针刀治疗,其中治疗1组35例切割跖腱膜1/2、治疗2组35例切割跖腱膜1/4,运用体外定位技术进行针刀切割跖腱膜松解术治疗；对照组35例进行封闭治疗。在患者治疗前和治疗后2周时,采用Footscan USB2平板式足底压力测试系统测定足前掌内侧缘( MFF)、足前掌外侧缘( LFF)、足弓( MF)、足跟内侧缘( MHEEL)、足跟外侧缘( LHEEL)各区压力峰值的变化。结果2个治疗组MFF治疗前后无统计学差异,LFF、MF、MHEEL、LHEEL压力峰值治疗前后差异均有统计学意义( P<0.05)。对照组MFF、MF、MHEEL足底压力峰值治疗前后无统计学差异,LFF、LHEEL部压力峰值治疗前后差异有统计学意义(P<0.05)。结论小针刀松解术可以有效改善跟痛症患者的足底应力变化,针刀治疗更有助于患者恢复足部正常的力线。%Objective To study the difference of plantar pressure before and after needle-knife surgery on patients with calcaneodynia, so as to evaluate its efficacy and provide evidence to the clinical applica-tion of needle-knife therapy. Methods A total 70 patients with calcaneodynia were divided into two nee-dle-knife therapy groups ( treatment group, each n=35 ) . After local anesthesia, the needle-knife was inserted into quickly guided by the plantar fascia scale, perpendicular to the direction of metatarsal fasci-a, then cut and separated the ligaments and fascia attached to the bone spur three to five times. In treat-ment group 1, the needle-knives were inserted to half of the scale, and in the treatment group 2, the nee-dle-knives were inserted to quarter of the scale. 35 more patients were assigned to the control group who received blocking therapy. Peak pressure values of medial forefoot ( MFF) , lateral forefoot ( LFF) , mid-foot ( MF) , medial heel ( MHEEL) and lateral heel ( LHEEL) were measured before and after treatment using Footscan USB2 System manufactured in RSscan Co. Ltd. Results There was no difference of MFF pressure in the two treatment groups before and after need-knife therapy, but pressures of LFF, MF, MHEEL and LHEEL showed significant differences between after and before treatement ( P<0 . 05 ) . In control group, the pressures of MFF, MF and MHEEL had no significant differences between before and after treatment, while that of LFF and LHEEL showed differences(P <0. 05). Conclusion Needle-knife surgery can effectively attenuate the plantar stress changes of the patients with calcaneodynia, and be benefit for recovery the normal lines of force of patients’ feet.