Deparment of Orthopaedics, Ain Shams University, Cairo, Egypt.
Arthroscopy. 2010 Sep;26(9):1241-5. doi: 10.1016/j.arthro.2010.01.026. Epub 2010 Jul 13.
The purpose of this study was to assess the outcome of endoscopic plantar fascia release (EPFR) after failed extracorporeal shock wave therapy (ESWT).
Eighteen patients (twenty-one feet) had persistent painful heel after treatment by ESWT for at least 6 months. The treatment protocol included 2,000 pulses of 0.12 mJ/mm(2) given in 1 session weekly for 7 sessions. Preoperative and postoperative assessment of pain and functional evaluation were done blindly by the second author using a visual analog scale (VAS) score and the modified American Orthopaedic Foot & Ankle Society (AOFAS) score for the hindfoot. EPFR was done without the use of a tourniquet under local ankle block. A monopolar hooked soft-tissue electrode (ConMed Linvatec, Largo, FL) was used to sever the plantar fascia and to control bleeding. The mean follow-up period was 25.8 months. Only 17 patients (20 feet) completed 2 years' follow-up.
The mean preoperative VAS score was 72.52, and the mean preoperative modified AOFAS score was 24.23. There was a statistically significant improvement in VAS score, modified AOFAS score, and morning pain at 2 years' follow-up (P < .05). Of the patients, 9 (50%) had excellent results, 6 (35%) had good results, 1 (10%) had a fair result, and 1 (5%) had failure of improvement of pain. No major complications were found; 2 patients had hyperkeratosis at the portal site, and 1 patient had paresthesia at the lateral border of the foot.
EPFR yielded good to excellent outcomes in 85% of 17 patients with plantar fasciitis resistant to treatment by ESWT after 2 years' follow-up.
Level IV, therapeutic case series.
本研究旨在评估体外冲击波治疗（ESWT）失败后行内镜足底筋膜松解术（EPFR）的疗效。
18 例（21 足）患者接受 ESWT 治疗至少 6 个月后出现持续性足跟疼痛。治疗方案包括：1 次治疗给予 2000 个 0.12mJ/mm²的脉冲，每周 1 次，共 7 次。由第二位作者采用视觉模拟评分（VAS）和改良美国矫形足踝协会（AOFAS）后足评分进行盲法术前和术后疼痛及功能评估。在局部踝部阻滞下进行 EPFR，不使用止血带。使用单极钩状软组织电极（康美 Linvatec，Largo，FL）切断足底筋膜并控制出血。平均随访时间为 25.8 个月。仅有 17 例（20 足）完成 2 年随访。
术前 VAS 评分为 72.52，改良 AOFAS 评分为 24.23。2 年随访时 VAS 评分、改良 AOFAS 评分和晨痛均有显著改善（P<0.05）。患者中，9 例（50%）疗效优，6 例（35%）良，1 例（10%）可，1 例（5%）疼痛改善无进步。未发现严重并发症；2 例患者在切口部位出现过度角化，1 例患者出现足部外侧边缘感觉异常。
2 年随访时，17 例 ESWT 治疗后足底筋膜炎患者中有 15 例（85%）行 EPFR 后取得了良好至优秀的疗效。
IV 级，治疗性病例系列研究。
