■本研究旨在评估在体育活动中发展的无创伤内侧芝麻骨痛(MSP)患者中保守治疗的有效性。次要目的是使用磁共振成像(MRI)确定对保守治疗无反应的患者的详细基础病理。
■从2015年3月至2022年8月,我们前瞻性随访了27例患者,这些患者在我们的门诊就诊时患有与非创伤性运动相关的MSP。MSP的保守治疗方案包括使用口服镇痛药,活动限制,鞋垫修改,局部皮质类固醇注射,和引导walker应用程序与拐杖。尽管完成了保守治疗,但仍经历持续性疼痛的所有患者均进行了MRI检查。
■完成保守治疗方案后,48.1%的患者报告疼痛减轻。疼痛发作时年龄较小的患者(p=0.001),较高的体重指数(p=0.001),保守治疗后,两部分的籽骨内侧(p=0.010)更容易出现持续性疼痛。体育活动的类型也是一个因素,因为与跑步和跳舞相关的MSP与源自高尔夫的MSP相比,对保守治疗的反应更好。五人制足球,和蹲下举重。核磁共振成像,42.8%的患者没有出现特定的异常发现,软组织如皮下脂肪和法氏囊的信号变化是最常见的,其次是籽骨内侧的骨内信号变化和籽骨内侧的软骨或软骨下病变(各28.6%)。
■只有不到一半的患者因运动而经历了MSP,保守治疗成功。从业者应该意识到保守治疗失败的众多可能原因,比如滑囊炎,内侧型芝麻突炎,应力断裂,或内侧籽骨和meta骨之间的软骨损伤。MRI评估可能有助于对保守治疗无反应的MSP患者。
UNASSIGNED: This study aimed to evaluate the effectiveness of conservative treatment in selected patients with atraumatic medial sesamoid pain (MSP) that developed during sports activities. The secondary aim was to determine the detailed underlying pathology in patients who did not respond to conservative treatment using magnetic resonance imaging (MRI).
UNASSIGNED: From March 2015 to August 2022, we prospectively followed 27 patients who presented to our outpatient clinic with atraumatic sports-related MSP. The conservative treatment protocol for MSP included the use of oral analgesics, activity restriction, insole modification, local corticosteroid injections, and boot walker application with crutches. MRI was performed for all patients who experienced persistent pain despite the completion of conservative treatment.
UNASSIGNED: After the completion of the conservative treatment protocol, 48.1% of the patients reported a reduction in pain. Patients with younger age at pain onset (p = 0.001), higher body mass index (p = 0.001), and a bipartite medial sesamoid (p = 0.010) were more likely to experience persistent pain after conservative treatment. The type of sports activity was also a factor since running- and dancing-related MSP tended to respond better to conservative treatment compared to MSP originating from golf, futsal, and weightlifting with squatting. On MRI, 42.8% of patients showed no specific abnormal findings, with signal changes in soft tissues such as the subcutaneous fat and bursa being the most common, followed by intraosseous signal changes of the medial sesamoid bone and chondral or subchondral lesions of the medial sesamoid metatarsal joint (28.6% each).
UNASSIGNED: Conservative treatment was successful in less than half of the patients who experienced MSP due to sports activity. Practitioners should be aware of the numerous possible causes of conservative treatment failure, such as bursitis, medial sesamoiditis, stress fracture, or chondral lesions between the medial sesamoid and metatarsal. MRI evaluation may be helpful in MSP patients who do not respond to conservative treatment.