Notarnicola Angela, Maccagnano Giuseppe, Tafuri Silvio, Forcignanò Maria Immacolata, Panella Antonio, Moretti Biagio
Course of Motor and Sports Sciences, Faculty of Medicine and Surgery, University of Study of Bari, Lungomare Starita 1, 70123, Bari, Italy,
Lasers Med Sci. 2014 May;29(3):1217-25. doi: 10.1007/s10103-013-1510-3. Epub 2013 Dec 19.
The application of laser therapy on soft tissue is used for pain relief, anti-inflammation action and biostimulation. The efficiency of High Energy Laser Therapy has not yet been studied on Achilles tendinopathy. The aim of the study is to evaluate the effectiveness of a flow of Cold air and High Energy Laser Therapy (CHELT) versus Extracorporeal Shock Waves Therapy (ESWT) in the treatment of Achilles tendinopathy. In this prospective, clinical trial, 60 subjects affected by insertional Achilles tendinopathy were enrolled and randomized to CHELT (30 subjects) or to ESWT (30 subjects). In CHELT group the patients received ten daily sessions of 1,200 J and 12 W of laser therapy (wavelength of 1,084, 810 and 980 nm) added to a flow of cold air at -30 °C. In the ESWT group, the patients received three sessions at 3- to 4-day intervals of 1,600 impulses with an energy flux density (EFD) of 0.05-0.07 mJ/mm(2). Both groups of participants performed stretching and eccentric exercises over a 2-month period. The visual analogue scale (VAS), the Ankle-Hindfoot Scale, and the Roles and Maudsley Score were measured before treatment (T0), and at end of the treatment session (T1) and 2 (T2) and 6 months (T3) after treatment during the follow-up examinations. In both groups, we found a statistically significant improvement of the VAS at T1, T2 and T3 (p < 0.01). The difference between the two groups was statistically significant in favour of the CHELT group (p < 0.001). At 2 months, the CHELT group was statistically better for Ankle-Hindfoot Scale and the Roles and Maudsley Score (p < 0.05) and at 6 months only for the Roles and Maudsley Score (p < 0.001). High Energy Laser Therapy gave quicker and better pain relief. It also gave the patient a full functional recovery and greater satisfaction.
激光疗法在软组织上的应用用于缓解疼痛、抗炎和生物刺激。高能激光疗法对跟腱病的疗效尚未得到研究。本研究的目的是评估冷空气与高能激光疗法（CHELT）联合治疗与体外冲击波疗法（ESWT）治疗跟腱病的有效性。在这项前瞻性临床试验中，60例患有插入性跟腱病的受试者被纳入并随机分为CHELT组（30例受试者）或ESWT组（30例受试者）。在CHELT组中，患者每天接受10次激光治疗，每次1200焦耳、12瓦（波长为1084、810和980纳米），并附加-30°C的冷空气流。在ESWT组中，患者每隔3至4天接受3次治疗，每次1600次脉冲，能量通量密度（EFD）为0.05-0.07毫焦/平方毫米。两组参与者在2个月内进行伸展和离心运动。在治疗前（T0）、治疗结束时（T1）、治疗后2个月（T2）和治疗后6个月（T3）的随访检查中，测量视觉模拟量表（VAS）、踝后足量表以及罗尔斯和莫兹利评分。在两组中，我们发现T1、T2和T3时VAS有统计学意义的改善（p<0.01）。两组之间的差异有统计学意义，有利于CHELT组（p<0.001）。在2个月时，CHELT组在踝后足量表以及罗尔斯和莫兹利评分方面在统计学上更好（p<0.05），在6个月时仅在罗尔斯和莫兹利评分方面更好（p<0.001）。高能激光疗法能更快、更好地缓解疼痛。它还能使患者实现完全功能恢复并获得更高的满意度。
