改良双入路法内窥镜下跖筋膜松解术的临床应用及效果*

目的探讨应用改良双入路法内窥镜下进行跖筋膜松解术的临床应用及临床效果分析。方法自2015年5月至2017年4月，我院骨科对经过保守治疗9个月以上仍无效的20例（22足）跖筋膜炎患者，在改良双入路内窥镜下进行跖筋膜松解术。在足底内侧建立两个通道，首先在跖筋膜下方进行清理、松解，切开跖筋膜内侧1/3-1/2，进入跖筋膜上方间隙进一步松解。12例存在跟骨骨刺给予切除骨刺，3例存在足底麻木者给予松解足底外侧神经及第一分支。分别对治疗前及治疗后6～9月进行美国足踝外科协会后足评分（AOFAS-AH）及视觉模拟评分（VAS）评分，观察临床效果。结果 20例（22足）切口均甲级愈合，无神经、血管损伤及其他并发症。经改良双入路内窥镜下跖筋膜松解术治疗后，随访6～9个月，20例（22足）患者AOFAS-HA评分明显增高，平均由46.8分升高到89.1分，VAS评分明显下降，平均由8.6分下降到1.2分，优良率达90%。结论改良双入路法内窥镜下进行跖筋膜松解术具有恢复快、安全有效等优势，是治疗顽固性跖筋膜炎的良好方法，值得临床推广应用。

英文摘要:

Objective To investigate the clinical application and effect of a modified 2-incision approach applied in endoscopic plantar fascia release (EPFR). Methods Twenty-two feet of twenty patients from May 2015 to April 2017 underwent EPFR using a modified 2-incision approach for symptomatic plantar fasciopathy unresponsive to nonoperative measures. Setting two portals at the medial heel, debridement and releasing of the plantar fascial, and then cutting the inside of plantar fascia from 1/3 to 1/2 to release the plantar fascia. 12 cases with calcaneal spur were removed, and 3 cases with plantar numbness were released the nerve. The American Orthopaedic Foot & Ankle Society (AOFAS) score and Visual Analogue Score (VAS) was administered to all patients based on their performance pre and post (6 months to 9 months) the surgical protocols. Results All the wounds of twenty-two feet of twenty patients were healed at the first grade, and there were no injuries of nerve and blood vessel. After the EPFR by a modified 2-incision approach for 6-9 months, we visited the patients and found that, the mean preoperative AOFAS score of 46.8 improved to 89.1 and the mean preoperative VAS score of 8.6 improved to 1.2 at the last follow-up. Conclusion The modified 2-incision approach applied in EPFR has advantages of fast recovery, high certainty of clinical effect. This approach could be a viable alternative to more invasive procedures for management of recalcitrant plantar fasciopathy and deserved extensive promotion.

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