背景:为了比较临床,放射学,在一项初步研究中,冲击波和手术治疗足球运动员近端第五跖骨应力性骨折的功能结果。
■在2017年至2019年之间,包括18名在加泰罗尼亚MutualidaddeFutbolistasEspañoles-Delegación参加的第五meta骨应力性骨折的足球运动员。患者被随机分为2组,接受髓内螺钉手术(第1组)或高能聚焦体外冲击波治疗(第2组每周一次,使用2000次脉冲,能量通量密度为0.21mJ/mm2,频率为4Hz)。临床(疼痛),放射学(骨愈合),比较两组接受治疗前后的功能(Tegner活动量表和美国骨科足踝协会[AOFAS]踝足-后足量表)结果。此外,两组之间还比较了恢复比赛的能力和时间。
■没有患者失访。手术和体外冲击波治疗对骨骼愈合的影响在末次随访中没有统计学意义。疼痛缓解,AOFAS脚踝-后足评分,Tegner得分,时间回到游戏。两组均未出现并发症。
■在这项试点研究中,发现体外冲击波治疗和手术治疗在减轻疼痛方面同样有效,实现骨骼愈合,并允许足球运动员在第五跖骨近端应力性骨折后重返赛场。这项研究表明,ESWT可能是管理足球运动员近端第五meta骨应力性骨折的良好选择。如果这种方法在更大的试验中被证明是成功的,冲击波方法可能有助于避免已知的手术治疗并发症,如伤口问题,神经损伤,硬件不容忍。应进行更大样本量的进一步调查,以确认本结论。
■二级,治疗性的,先导随机对照试验。
To compare the clinical, radiologic, and functional outcomes between shockwave and operative treatments for proximal fifth metatarsal stress fractures in soccer players in a pilot
study.
Between 2017 and 2019, 18 soccer players with fifth metatarsal stress fractures attended at Mutualidad de Futbolistas Españoles-Delegación Catalana were included. Patients were randomly assigned into 2 groups receiving either surgery with an intramedullary screw (group 1) or high-energy focused extracorporeal shockwave treatment (group 2 performed once a week for 3 weeks using 2000 impulses at an energy flux density of 0.21 mJ/mm2 and 4 Hz frequency). Clinical (pain), radiologic (bone healing), and functional (Tegner Activity Scale and American Orthopaedic Foot & Ankle Society [AOFAS] ankle-hindfoot scales) outcomes before and after receiving the treatment were compared between both groups. In addition, ability and time to return to play was also compared between groups.
No patients were lost to follow-up. There were no statistically significant differences at last follow-up between surgery and extracorporeal shockwave treatment for bone healing, pain relief, AOFAS ankle-hindfoot score, Tegner score, and time return to play. No complications were reported in either of the 2 groups.
In this pilot
study, extracorporeal shockwave treatment and operative treatment were found to be equally effective at reducing pain, achieving bone healing, and allowing the soccer players to return to play after proximal fifth metatarsal stress fractures. This
study suggests that ESWT may be a good option for the management of proximal fifth metatarsal stress fractures in soccer players. If this approach proves successful in larger trials, the shockwave approach might help avoid known complications of the surgical treatment like wound problems, nerve injury, and hardware intolerance. Further investigations with larger sample size should be conducted in order to confirm the present conclusions.
Level II, therapeutic, pilot randomized controlled
trial.