摘要
目的观察和比较超声引导下高容量注射治疗(HVUGI)与冲击波治疗(ESWT)慢性非止点跟腱腱病的临床疗效。方法选择2017年3月至2018年2月慢性非止点跟腱腱病保守治疗无效的患者52例,男21例,女31例,年龄35~70岁,BMI 18~35 kg/m^2。随机分为HVUGI组(H组)和ESWT组(E组),每组26例。H组在超声引导下将1%利多卡因10 ml及生理盐水40 ml注入到跟腱与跟腱前脂肪垫之间。E组采用瑞士STORZ医用放射式冲击波治疗仪MP100治疗跟腱疼痛部位,每周治疗1次,共3次。分别在治疗前、治疗后6周、3个月和6个月采用VAS评估疼痛程度,采用0~10分评估踝关节僵硬程度,采用维多利亚学院足踝运动功能评估评分(VISA-A)综合评估跟腱病变程度。观察注射部位有无出血、血肿、感染以及跟腱断裂等并发症。结果与治疗前比较,治疗后6周至6个月两组患者VAS疼痛评分均明显降低(P<0.05),治疗后6周H组、治疗后6个月两组患者僵硬程度评分均明显降低(P<0.05)。与治疗前比较,治疗后6周至6个月两组患者VISA-A评分均明显升高(P<0.05)。两组VAS疼痛评分、僵硬程度评分和VISA-A评分差异均无统计学意义。两组患者治疗后均无出血、血肿、感染以及跟腱断裂等并发症。结论冲击波及超声引导下高容量注射治疗慢性非止点跟腱腱病具有良好效果,而高容量注射治疗在治疗后6周时僵硬程度的改善优于冲击波治疗。
Objective To investigate the effects of high-volume ultrasound-guided injection(HVUGI) and extracorporeal shock wave therapy(ESWT) in chronic noninsertional Achilles tendinopathy. Methods A total of 52 patients with chronic Achilles tendinopathy were included, 21 males and 31 females, aged 35-70 years, BMI 18-35 kg/m^2, were randomly assigned to group H(received high-volume ultrasound-guided injection, n = 26) and group E(received extracorporeal shock wave therapy, n = 26). In group H, a single dose of 1% lidocaine 10 ml and sterile saline 40 ml were injected. In group E, the patients received 3 sessions of ESWT(1 session per week). The outcomes included average pain, average stiffness and Victorian Institute of Sports Assessment-Achilles(VISA-A). The outcomes were assessed at baseline and at 6, 12, and 24 weeks of follow-up. To observe the complications such as bleeding, hematoma, infection and tearing of tendon at the injection site after treatment. Results Regarding the pain severity, group H and group E had significantly lower mean pain scores at 6-24 weeks than before injection(P < 0.05). The values did improve to a significant extent for both groups at the 6-month point compared with baseline, and also for group H at 6 weeks(P < 0.05). The VISA-A patient-rated outcome measures improved in both groups from baseline and all time points. No complications such as hemorrhage, hematoma, infection or tendon tear were found after treatment in both groups. Conclusion Patients with chronic noninsertional Achilles tendinitis have improved to a statistically significant extent following either a HVUGI or ESWT procedure. HVUGI for 6 weeks improves stiffness better than ESWT does.
作者
程浩
陆伟萍
高献忠
徐晨婕
管华
鲍红光
CHENG Hao;LU Weiping;GAO Xianzhong;XU Chenjie;GUAN Hua;BAO Hongguang(Department of Anesthesiology,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2019年第12期1201-1204,共4页
Journal of Clinical Anesthesiology
关键词
超声引导
高容量注射
冲击波治疗
跟腱腱病
Ultrasound guided
High-volume injection
Extracorporeal shock wave therapy
Achilles tendinitis
