Martinelli Nicolò, Bianchi Alberto, Sartorelli Elena, Dondi Alessandra, Bonifacini Carlo, Malerba Francesco
J Am Podiatr Med Assoc. 2015 Jan-Feb;105(1):27-32. doi: 10.7547/8750-7315-105.1.27.
Bone marrow edema (BME) of the talus is a rare, mostly self-limiting cause of foot and ankle pain. We sought to investigate in patients with idiopathic BME of the talus the effectiveness of pulsed electromagnetic fields and to determine the effect of this therapy on magnetic resonance imaging findings.
Six patients with BME of the talus confirmed by magnetic resonance imaging were enrolled. Pain was quantified with a visual analog scale from 0 (no pain) to 10 (the worst pain imaginable). The clinical outcome was assessed using the American Orthopaedic Foot and Ankle Society scoring system. Treatment consisted of pulsed electromagnetic field stimulation 8 h/d for 30 days. The device used generated pulses 1.3 milliseconds in duration, with a frequency of 75 Hz and a mean ± SD induced electric field of 3.5 ± 0.5 mV.
The mean American Orthopaedic Foot and Ankle Society score improved from 59.4 (range, 40-66) before treatment to 94 (range, 80-100) at the last follow-up. The visual analog scale score decreased significantly from 5.6 (range, 4-7) before treatment to 1 (range, 0-2) at the last follow-up. Magnetic resonance imaging showed that BME improved after 1 month of treatment and resolved completely within 3 months in 5 patients, with normal signal intensity and no signs of progression to avascular necrosis.
A significant reduction in BME area was associated with a significant decrease in pain within 3 months of beginning treatment.
距骨骨髓水肿（BME）是足踝疼痛的一种罕见病因，大多可自行缓解。我们旨在研究脉冲电磁场对特发性距骨骨髓水肿患者的疗效，并确定该疗法对磁共振成像结果的影响。
纳入6例经磁共振成像确诊为距骨骨髓水肿的患者。采用视觉模拟评分法对疼痛进行量化，范围为0（无疼痛）至10（难以想象的最严重疼痛）。使用美国矫形足踝协会评分系统评估临床疗效。治疗包括每天8小时的脉冲电磁场刺激，持续30天。所使用的设备产生持续时间为1.3毫秒的脉冲，频率为75赫兹，平均±标准差感应电场为3.5±0.5毫伏。
美国矫形足踝协会平均评分从治疗前的59.4（范围40 - 66）提高到最后一次随访时的94（范围80 - 100）。视觉模拟评分从治疗前的5.6（范围4 - 7）显著降低到最后一次随访时的1（范围0 - 2）。磁共振成像显示，治疗1个月后骨髓水肿有所改善，5例患者在3个月内完全消退，信号强度恢复正常，无进展为缺血性坏死的迹象。
开始治疗后3个月内，骨髓水肿面积显著减少与疼痛显著减轻相关。
