背景:足底筋膜炎是肌肉骨骼不适的常见原因。保守治疗失败后,首选微创干预作为二线治疗。我们报告了一种新的技术,该技术可通过超声引导经皮释放足底筋膜内侧三分之一,并使用精细切割装置治疗持续性足底筋膜炎。
方法:这是2013年至2015年接受该技术治疗的所有患者的回顾性病例系列。患者保守治疗失败至少6个月。该程序在局部麻醉下在门诊环境中进行。在连续超声引导下,使用眼科V-Lance刀通过内侧刺伤伤口进入点从跟骨释放足底筋膜内侧三分之一。
结果:15名患者(6名男性和9名女性),平均年龄为54.7岁。疼痛的平均(标准差[SD])视觉模拟评分显著改善,从66.0(SD,18.8)术前各连续随访点:29.3(SD,25.2)在2周,30.0(SD,27.8)在4周,和34.0(SD,26.1)在12周(P<.001)。在4周和12周之间,视觉模拟评分的轻度增加具有统计学意义(P=0.018)。所需镇痛的平均持续时间为5.5天,恢复正常活动所需的平均时间为5.7天。2例患者足外侧缘出现难治性神经性疼痛,无明显异常。
结论:超声引导下使用精细切割装置的经皮松解术可能是治疗持续性足底筋膜炎的另一种选择。这项技术并非没有并发症,从早期到短期,疼痛水平有轻微但有统计学意义的下降。因此,在我们提倡常规使用该技术之前,需要对该技术的长期结果进行调查.
BACKGROUND: Plantar fasciitis is a common cause of musculoskeletal discomfort. Minimally invasive interventions are preferred as second-line treatments following failure of conservative management. We report on a novel technique of ultrasound-guided percutaneous release of the medial third of the plantar fascia with the use of a fine cutting device for the treatment of persistent plantar fasciitis.
METHODS: This is a retrospective
case series of all patients treated with the technique between 2013 and 2015. Patients had failed conservative management for a minimum of 6 months. The procedure was performed in an outpatient setting under local anesthesia. Under continuous ultrasound guidance, release of the medial third of the plantar fascia from the calcaneus was performed using an ophthalmic V-Lance knife through a medial stab wound entry point.
RESULTS: Fifteen patients (six men and nine women) with an average age of 54.7 years were included. The mean (standard deviation [SD]) visual analogue scale score for pain improved significantly, from 66.0 (SD, 18.8) preoperatively to each consecutive follow-up point: 29.3 (SD, 25.2) at 2 weeks, 30.0 (SD, 27.8) at 4 weeks, and 34.0 (SD, 26.1) at 12 weeks (P < .001). The mild increase in visual analogue scale score between 4 and 12 weeks was statistically significant (P = .018). Average duration of required analgesia was 5.5 days and average time required to return to usual activities was 5.7 days. Two patients suffered with refractory neuropathic pain over the lateral border of the foot without any obvious abnormality.
CONCLUSIONS: Ultrasound-guided percutaneous release with the use of a fine cutting device could be an alternative option for the treatment of persistent plantar fasciitis. The technique is not without complications, and a mild but statistically significant decline in pain levels from early to short term has been detected. Therefore, the long-term outcomes of this technique need to be investigated before we can advocate its routine use.