关节镜下跟骨刺切除治疗老年难治性跖筋膜炎

目的 评价关节镜下跟骨刺切除治疗老年难治性跖筋膜炎的疗效。方法 纳入2014年1月到2017年6月于海军军医大学（第二军医大学）长征医院骨科门诊就诊的跖筋膜炎患者22例。纳入患者年龄均≥70岁，病程持续6个月以上并经多种方法治疗后疼痛缓解不明显，接受关节镜下骨刺切除并部分跖筋膜松解术。记录患者术后恢复日常行走的时间。分析患者术后1个月时的视觉模拟量表（VAS）评分和跟痛症评分（CS）以及术后6个月12条简明健康状况调查问卷（SF-12）评分，并与术前数据进行比较以评定手术疗效。结果 22例患者术后恢复日常行走的平均时间为（12.4±5.5）d。术后2例双足跖筋膜炎患者失访，共20例患者（22足）完成随访。与术前相比，术后1个月VAS评分和CS均改善[0.7（0.0～3.2）vs 5.3（3.8～7.0），Z=2.1，P<0.01；87.0±11.3vs 38.9±10.1，t=14.2，P<0.01]。术后6个月SF-12生理和心理评分均较术前升高（50.9±10.7 vs 45.3±9.6、47.2±9.2 vs 34.2±10.6，t=4.3、4.1，P均<0.01）。结论 关节镜下跟骨刺切除并部分松解跖筋膜可有效缓解跖筋膜炎患者症状，且无严重并发症发生。
Objective To evaluate the effcacy of arthroscopic heel spur fasciotomy for the treatment of refractory plantar fasciitis in elderly patients. Methods Twenty-two patients with plantar fasciitis diagnosed from Jan. 2014 to Jun. 2017 in the Department of Orthopedics of Changzheng Hospital of Navy Medical University (Second Military Medical University) were enrolled. All the patients aged ≥ 70 years old, with the course lasting for more than 6 months and incurable pain after a variety of treatment, and received arthroscopic heel spur removal and partial iliac fascia lysis. The time for the recovery of daily walking was recorded. The visual analogue scale (VAS) score and the calcaneodynia score (CS) at 1 month after surgery and the 12-item short-form health survey questionnaire (SF-12) score at 6 months after surgery of the patients were analyzed and compared with the preoperative data to evaluate the curative effect. Results The average time for recovery of daily walking in the 22 patients was (12.4±5.5) d. Two patients with bilateral plantar fasciitis were lost to followup after surgery, and a total of 20 patients (22 feet) were followed up. Compared with pre-operation, the VAS score and CS of patients were signifcantly improved at 1 months after surgery (0.7[0.0-3.2] vs 5.3[3.8-7.0], Z=2.1, P<0.01; 87.0±11.3 vs 38.9±10.1, t=14.2, P<0.01). The physiological and psychological scores of SF-12 of patients were significantly increased at 6 months after operation versus pre-operation (50.9±10.7 vs 45.3±9.6, 47.2±9.2 vs 34.2±10.6; t=4.3 and 4.1, both P<0.01). Conclusion Arthroscopic heel spur removal with partial iliac fascia lysis can effectively relieve the symptoms of patients with plantar fasciitis, without serious complications