体外冲击波与局部封闭疗法治疗跟腱炎的临床疗效对比研究

发布时间：2018-01-21 14:15

本文关键词： 跟腱炎体外冲击波局部封闭疗法　出处：《福建中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的本研究通过分析跟腱炎患者治疗前后的评分数据,观察比较体外冲击波疗法与局部封闭疗法治疗跟腱炎之间的临床疗效,旨在为体外冲击波治疗跟腱炎研究提供客观依据,从而为跟腱炎患者提供新型显效快、疗效好、痛苦少的代替方法。方法选择就诊于福建省南平市第一医院符合纳入与排除标准的38例跟腱炎患者作为受试者,随机分为体外冲击波治疗组(试验组)、局部封闭疗法治疗组(对照组)。试验组接受瑞士 Dolor Clast EMS体外冲击波治疗,能流密度0.16mJ/mm2,治疗压力2-3bar,冲击波次数2000次,手持压力低-中,冲击频率5-10hz,治疗时间10min;每周治疗1次,共3次。对照组接受醋酸曲安奈德联合2%盐酸利多卡因注射液的痛点局部封闭注射疗法,每周治疗1次,共2次。体外冲击波组患者在第1次治疗(首次治疗)、第2次治疗、第3次治疗(疗程结束时)、疗程结束后6周均进行评估。局部封闭疗法组患者分别在首次治疗、疗程结束时、疗程结束后6周进行评估。评估方法主要采用视觉模拟评分(Visual Analogue Scale,VAS)、维多利亚学院足踝运动功能评估评分(Victorian Institute of Sport Assessment Score-Achillea,VISA-A)。结果本研究38例患者中,因部分患者未完成随访以及中断治疗予以剔除,最终纳入患者31例。(1)两组患者在接受治疗前,一般资料(年龄、性别)和临床资料(病程、VAS评分、VISA-A评分)比较分析,两组之间差异无统计学意义(P0.05)。(2)两组患者在治疗前VAS评分、VISA-A评分相近,在首次治疗、疗程结束时及疗程结束后6周不同时期的VAS评分较治疗前明显降低,VISA-A评分较治疗前明显增高,其前后差异有统计学意义(P0.05)。(3)在首次治疗结束时,局部封闭疗法组VAS评分、VISA-A评分均优于体外冲击波治疗组,两组之间有统计学意义(P0.05)。疗程结束时、疗程结束后6周,两组患者之间的VAS评分、VISA-A评分基本相近,两组之间差异无统计学意义(P0.05)。(4)在第1次治疗、第2次治疗、第3次治疗,体外冲击波治疗组患者的VAS评分、VISA评分随着治疗时间变化而变化,后期治疗效果均优越于前期治疗效果,不同时间点之间差异有统计学意义(P0.05)。结论体外冲击波疗法与局部封闭疗法两组治疗方案治疗跟腱炎的临床疗效具有等效性,局部封闭疗法在短期内治疗跟腱炎显效速度较体外冲击波疗法快,但是体外冲击波疗法在远期疗效上具有累积效应,鉴于体外冲击波的安全性,体外冲击波疗法更值得临床推荐。
[Abstract]:Objective to observe and compare the clinical efficacy of extracorporeal shock wave therapy (ESWT) and local blocking therapy (LCT) in the treatment of Achilles tendon by analyzing the scoring data before and after treatment of Achilles tendinitis. The aim is to provide objective basis for the study of extracorporeal shock wave in the treatment of Achilles tendinitis, thus providing a new type of remarkable effect and good curative effect for the patients with Achilles tendinitis. Methods 38 patients with Achilles tendinitis who met the criteria of inclusion and exclusion were randomly divided into extracorporeal shock wave treatment group (experimental group). The experimental group was treated with Dolor Clast EMS extracorporeal shock wave (ESWL), and the energy flow density was 0.16mJ / mm2. The treatment pressure was 2 ~ 3 bar. the shock wave was 2 000 times, the handheld pressure was low-medium, the shock frequency was 5-10 h / z, the treatment time was 10 min; The control group was treated with triamcinolone acetonide acetate combined with 2% lidocaine hydrochloride injection once a week. Two times. The patients in the extracorporeal shock wave group were treated at the first time (the first treatment, the second treatment, and the third treatment) (at the end of the course of treatment). The patients in the local block therapy group were treated for the first time and at the end of the course of treatment. Six weeks after the end of the course of treatment, the main evaluation methods were visual Analogue scale scale (VAS). Victoria College foot and ankle motor function assessment scale (. Victorian Institute of Sport Assessment Score-Achillea. Results among 38 patients in this study, 31 patients were included in the study before treatment because some patients were not followed up and interrupted treatment was eliminated. General data (age, sex) and clinical data (course of disease / VAS score / VISA-A score) were compared and analyzed. There was no significant difference between the two groups (P0.05. 2) the VAS score and VISA-A score of the two groups were similar before treatment, and they were treated for the first time. The VAS scores at the end of the course and 6 weeks after the treatment were significantly lower than those before treatment, and the scores of VISA-A were significantly higher than those before treatment. At the end of the first treatment, the VAS score and VISA-A score of the local block therapy group were better than that of the extracorporeal shock wave group. At the end of the course of treatment, 6 weeks after the end of the course of treatment, the VAS score and VISA-A score were similar between the two groups. There was no significant difference between the two groups in the VAS score of the patients in the first, second and third treatment groups. The VISA score changed with the change of treatment time, and the effect of later treatment was superior to that of early treatment. Conclusion the two groups of extracorporeal shock wave therapy and local blocking therapy are effective in the treatment of Achilles tendinitis. Local blocking therapy is more effective than extracorporeal shock wave therapy in the short term, but ESWT has cumulative effect in the long term, in view of the safety of extracorporeal shock wave. Extracorporeal shock wave therapy is more worthy of clinical recommendation.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R686.1

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