Ulusoy Aslihan, Cerrahoglu Lale, Orguc Sebnem
Physiatrist, Department of Physical Medicine and Rehabilitation, Celal Bayar University Medical School, Manisa, Turkey.
Professor, Department of Physical Medicine and Rehabilitation, Celal Bayar University Medical School, Manisa, Turkey.
J Foot Ankle Surg. 2017 Jul-Aug;56(4):762-767. doi: 10.1053/j.jfas.2017.02.013.
We determined and compared the effectiveness of low-level laser therapy (LLLT), therapeutic ultrasound (US) therapy, and extracorporeal shock wave therapy (ESWT) using magnetic resonance imaging (MRI). We performed a randomized, prospective, comparative clinical study. A total of 60 patients with a diagnosis of chronic plantar fasciitis were divided randomly into 3 treatment groups: group 1 underwent 15 sessions of LLLT (8 J/cm; 830 nm); group 2 underwent 15 sessions of continuous US (1 mHz; 2 W/cm); and group 3 underwent 3 sessions of ESWT (2000 shocks). All patients were assessed using the visual analog scale (VAS), heel tenderness index (HTI), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, Roles-Maudsley score, and MRI before and 1 month after treatment. The primary efficacy success criterion was the percentage of decrease in heel pain of >60% from baseline at 1 month after treatment for ≥2 of the 3 heel pain (VAS) measurements. Significant improvement was measured using the mean VAS, AOFAS scale, and HTI scores for all 3 groups. The thickness of the plantar fascia had decreased significantly on MRI in all 3 groups. The treatment success rate was 70.6% in the LLLT group, 65% in the ESWT group, and 23.5% in the US group. LLLT and ESWT proved significantly superior to US therapy using the primary efficacy criterion (p = .006 and p = .012, respectively), with no significant difference between the LLLT and ESWT groups (p > .05). The treatment of chronic plantar fasciitis with LLLT and ESWT resulted in similar outcomes and both were more successful than US therapy in pain improvement and functional outcomes.
我们使用磁共振成像（MRI）测定并比较了低强度激光疗法（LLLT）、超声（US）疗法和体外冲击波疗法（ESWT）的疗效。我们开展了一项随机、前瞻性、对比性临床研究。总共60例诊断为慢性足底筋膜炎的患者被随机分为3个治疗组：第1组接受15次低强度激光疗法（8 J/cm；830 nm）；第2组接受15次连续超声治疗（1 mHz；2 W/cm）；第3组接受3次体外冲击波疗法（2000次冲击）。所有患者在治疗前和治疗后1个月均使用视觉模拟量表（VAS）、足跟压痛指数（HTI）、美国矫形足踝协会（AOFAS）踝-后足量表、罗尔斯-莫兹利评分以及MRI进行评估。主要疗效成功标准是治疗后1个月时，3次足跟疼痛（VAS）测量中有≥2次足跟疼痛较基线水平降低>60%。使用所有3组的平均VAS、AOFAS量表和HTI评分来衡量显著改善情况。所有3组的足底筋膜厚度在MRI上均显著降低。低强度激光疗法组的治疗成功率为70.6%，体外冲击波疗法组为65%，超声治疗组为23.5%。使用主要疗效标准时，低强度激光疗法和体外冲击波疗法均显著优于超声疗法（分别为p = 0.006和p = 0.012），低强度激光疗法组和体外冲击波疗法组之间无显著差异（p>0.05）。低强度激光疗法和体外冲击波疗法治疗慢性足底筋膜炎的效果相似，且在疼痛改善和功能结局方面均比超声疗法更成功。
