Christel P, Rigal S, Poux D, Roger B, Witvoët J
Service de Chirurgie Orthopédique et Réparatrice, Hôpital Saint-Louis, Paris.
Rev Chir Orthop Reparatrice Appar Mot. 1993;79(3):218-25.
Among the various lesions of the hindfoot in athletes, plantar fascia ruptures are not well documented and their surgical treatment is not often reported in the literature. The purpose of the current work was to more precisely define therapeutic indications and to evaluate the results of the surgical treatment based on the excision-release of the plantar fascia. Between 1986 and 1991, 19 patients (5 females, 14 males, average age 32 years) were operated on by one surgeon. All patients were either recreational or competitive athletes. The plantar fascia rupture occurred 18 times during sports activity. Surgical treatment was indicated when pain persisted despite a well conducted conservative treatment. In 17 cases, MRI allowed to plan the operative strategy by showing the fascia lesion. The patients were operated after an average of 8 months following the initial injury (6-16 months). One patient was lost for follow-up, 2 had a follow-up below 6 months, thus 16 patients were available for analysis. The clinical outcome was evaluated through persistence of pain, return to sports, and functional activity. With a 16-month average follow-up (6-51 months) it was observed that pain constantly disappeared and that 11 patients over 16 returned to the same level of sports activity after 6 months with a time-stable result. After failure of a well conducted conservative treatment, surgical treatment of plantar fascia rupture must be proposed. Surgical technique is based not only on fascia release but also on the excision of the pathological scar tissue in order to avoid the restoration of the continuity of the fascia with the calcaneus.
在运动员后足的各种损伤中，足底筋膜断裂的记录并不完善，其手术治疗在文献中也不常被报道。本研究的目的是更精确地确定治疗指征，并评估基于足底筋膜切除松解术的手术治疗效果。1986年至1991年间，一名外科医生为19例患者（5名女性，14名男性，平均年龄32岁）实施了手术。所有患者均为业余或职业运动员。足底筋膜断裂18次发生在体育活动期间。当经过良好的保守治疗后疼痛仍持续时，即表明需要进行手术治疗。在17例病例中，MRI通过显示筋膜损伤来规划手术策略。患者在初次受伤后平均8个月（6 - 16个月）接受手术。1例患者失访，2例随访时间不足6个月，因此有16例患者可供分析。通过疼痛持续情况、恢复运动情况和功能活动来评估临床结果。平均随访16个月（6 - 51个月）后观察到，疼痛持续消失，16例患者中有11例在6个月后恢复到相同的运动水平，且结果稳定。在经过良好的保守治疗失败后，必须建议对足底筋膜断裂进行手术治疗。手术技术不仅基于筋膜松解，还基于切除病理性瘢痕组织，以避免筋膜与跟骨恢复连续性。
