Maier M, Steinborn M, Schmitz C, Stäbler A, Köhler S, Pfahler M, Dürr H R, Refior H J
Department of Orthopaedic Surgery, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany.
J Rheumatol. 2000 Oct;27(10):2455-62.
To clarify morphologic features associated with the clinical outcome of extracorporeal shock wave application (ESWA) in chronic plantar fasciitis.
In this prospective study 43 patients (48 heels) with chronic courses of plantar fasciitis were clinically examined before and after repetitive low energy ESWA. Standard radiographs of the affected heels were obtained before ESWA to document the existence of a calcaneal heel spur. Magnetic resonance imaging (MRI) was performed before ESWA to evaluate abnormalities of the plantar fascia, the surrounding soft tissue structures, and bone marrow edema of the calcaneus.
After ESWA (mean followup 19.3 mo), clinical evaluation of all 48 heels revealed a statistically significant decrease in the mean visual analog scale score from 74.5 to 25.4. Using the Roles and Maudsley score (RM), an established scoring system for categorizing results of treatment following ESWA for patients with plantar fasciitis, patients could be divided into 2 groups, i.e., satisfactory clinical outcome of ESWA (grades 1 and 2 by RM scale; n = 36 heels) and unsatisfactory outcome (grades 3 and 4 by RM scale; n = 12 heels). While thickness of plantar aponeurosis, soft tissue signal intensity changes, and soft tissue contrast medium uptake did not correlate with clinical outcome, the presence of a calcaneal bone marrow edema was highly predictive for satisfactory clinical outcome (positive predictive value 0.94, sensitivity 0.89, specificity 0.8).
This study indicates that in patients with chronic plantar fasciitis, the presence of calcaneal bone marrow edema on pretherapeutic MRI is a good predictive variable for a satisfactory clinical outcome of ESWA.
阐明与慢性足底筋膜炎体外冲击波治疗（ESWA）临床疗效相关的形态学特征。
在这项前瞻性研究中，对43例（48足跟）慢性足底筋膜炎患者在重复低能量ESWA治疗前后进行了临床检查。在ESWA治疗前获取患侧足跟的标准X线片，以记录跟骨骨刺的存在情况。在ESWA治疗前进行磁共振成像（MRI），以评估足底筋膜、周围软组织结构及跟骨骨髓水肿的异常情况。
ESWA治疗后（平均随访19.3个月），对所有48足跟的临床评估显示，视觉模拟量表评分均值从74.5显著降至25.4。使用Roles和Maudsley评分（RM），这是一种用于对足底筋膜炎患者ESWA治疗结果进行分类的既定评分系统，患者可分为两组，即ESWA临床疗效满意组（RM量表1级和2级；n = 36足跟）和疗效不满意组（RM量表3级和4级；n = 12足跟）。虽然足底腱膜厚度、软组织信号强度变化及软组织对比剂摄取与临床疗效无关，但跟骨骨髓水肿的存在对满意的临床疗效具有高度预测性（阳性预测值0.94，敏感性0.89，特异性0.8）。
本研究表明，在慢性足底筋膜炎患者中，治疗前MRI显示的跟骨骨髓水肿是ESWA获得满意临床疗效的良好预测变量。
