[1]武艺龙,王孝辉,李云朋,等.肌筋膜链理论指导下的针刀疗法治疗跖筋膜炎的临床研究[J].中医正骨,2025,37(11):25-31.
　WU Yilong,WANG Xiaohui,LI Yunpeng,et al.Acupotomy therapy for treatment of plantar fasciitis guided by myofascial chain theory:a clinical study[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2025,37(11):25-31.
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肌筋膜链理论指导下的针刀疗法治疗跖筋膜炎的临床研究()

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第37卷
期数:
2025年11期
页码:
25-31
栏目:
临床研究
出版日期:
2025-11-20

文章信息/Info

Title:
Acupotomy therapy for treatment of plantar fasciitis guided by myofascial chain theory:a clinical study
作者:
武艺龙1; 王孝辉2; 李云朋3; 田勇1; 董家赫1; 徐向阳1
1.河南中医药大学骨伤学院,河南 郑州 450002; 2.河南省洛阳正骨医院/河南省骨科医院,河南 洛阳 471002; 3.河南省中医院,河南 郑州 450002
Author(s):
WU Yilong1; WANG Xiaohui2; LI Yunpeng3; TIAN Yong1; DONG Jiahe1; XU Xiangyang1
1.College of Orthopaedics and Traumatology of Henan University of Chinese Medicine,Zhengzhou 450002,Henan,China 2.Luoyang Orthopedic-Traumatological Hospital,Luoyang 471002,Henan,China 3.Henan Province Hospital of TCM,Zhengzhou 450002,Henan,China
关键词:
筋膜炎; 足底;  针刀疗法;  腓肠肌;  腘绳肌;  肌筋膜链;  后表线;  随机对照试验专题
Keywords:
fasciitis; plantar;  acupotomy therapy;  gastrocnemius muscle;  hamstring muscles;  myofascial chain;  superficial back line;  rando-mized controlled trials as topic
摘要:
目的:探讨肌筋膜链理论指导下的针刀疗法治疗跖筋膜炎的临床疗效和安全性。方法:将2023年12月至2024年10月收治的177例跖筋膜炎(plantar fasciitis,PF)患者随机分为3组,每组59例。常规组对跖筋膜痛点进行针刀松解; 腓肠肌组在跖筋膜痛点针刀松解的基础上,根据肌筋膜链理论进行腓肠肌痛点松解; 腘绳肌组根据肌筋膜链理论同时进行跖筋膜、腓肠肌和腘绳肌痛点针刀松解。共治疗4次,2次治疗间隔2 d。分别于治疗前及治疗结束后1周、4周、12周,采用疼痛视觉模拟量表(visual analogue scale,VAS)评分评定足部疼痛程度,采用Maryland足部评分标准和美国足与踝关节协会(American Orthopedic Foot and Ankle Society,AOFAS)踝与后足评分标准评定足部功能,采用超声诊断仪测定跖筋膜厚度。治疗和随访期间,观察并发症发生情况。结果:①足部疼痛VAS评分。3组足部疼痛VAS评分均随时间呈逐渐降低的趋势(F=138.510,P=0.000; F=196.452,P=0.000; F=276.465,P=0.000); 治疗前3组足部疼痛VAS评分的差异无统计学意义; 治疗结束后1周、4周、12周,常规组的足部疼痛VAS评分均高于腓肠肌组和腘绳肌组(P=0.002,P=0.000; P=0.016,P=0.000; P=0.007,P=0.000),腓肠肌组的足部疼痛VAS评分均高于腘绳肌组(P=0.014,P=0.026,P=0.034)。②Maryland足部评分。3组Maryland足部评分均随时间呈逐渐升高的趋势(F=236.203,P=0.000; F=327.969,P=0.000; F=322.888,P=0.000); 治疗前3组Maryland足部评分的差异无统计学意义; 治疗结束后1周、4周、12周,常规组的Maryland足部评分均低于腓肠肌组和腘绳肌组(P=0.033,P=0.000; P=0.000,P=0.000; P=0.000,P=0.000),腓肠肌组的Maryland足部评分均低于腘绳肌组(P=0.000,P=0.047,P=0.016)。③AOFAS踝与后足评分。3组AOFAS踝与后足评分均随时间呈逐渐升高的趋势(F=201.857,P=0.000; F=278.714,P=0.000; F=476.421,P=0.000); 治疗前3组AOFAS踝与后足评分的差异无统计学意义; 治疗结束后1周、4周、12周,常规组的AOFAS踝与后足评分均低于腓肠肌组和腘绳肌组(P=0.018,P=0.000; P=0.000,P=0.000; P=0.001,P=0.000),腓肠肌组的AOFAS踝与后足评分均低于腘绳肌组(P=0.027,P=0.013,P=0.000)。④跖筋膜厚度。3组跖筋膜厚度均随时间呈逐渐减小的趋势(F=69.116,P=0.000; F=89.293,P=0.000; F=160.270,P=0.000); 治疗前3组跖筋膜厚度的差异无统计学意义; 治疗结束后1周、4周、12周,常规组的跖筋膜厚度均大于腓肠肌组和腘绳肌组(P=0.004,P=0.000; P=0.009,P=0.000; P=0.000,P=0.000); 治疗结束后1周,腓肠肌组和腘绳肌组跖筋膜厚度的差异无统计学意义; 治疗结束后4周、12周,腓肠肌组的跖筋膜厚度均大于腘绳肌组(P=0.002,P=0.002)。⑤并发症。治疗和随访期间,3组均未发生神经损伤、局部感染等并发症。结论:在肌筋膜链理论指导下,应用针刀同时对跖筋膜、腓肠肌、腘绳肌痛点进行松解,可有效缓解PF患者的足部疼痛症状、改善足部功能、恢复跖筋膜厚度,作用效果和持续时间均优于单纯跖筋膜松解,而且具有较高的安全性。
Abstract:
Objective:To investigate the clinical efficacy and safety of acupotomy therapy in treatment of plantar fasciitis(PF)guided by myofascial chain theory.Methods:One hundred and seventy-seven patients with PF admitted from December 2023 to October 2024 were randomized into conventional group,gastrocnemius group,and hamstring group,with 59 ones in each group.The patients in conventional group were treated with acupotomy release targeting the trigger point in the plantar fascia,the ones in gastrocnemius group targeting the trigger points in both plantar fascia and gastrocnemius based on myofascial chain theory,while the ones in hamstring group further targeting the trigger point in hamstring,except for the aforementioned 2 trigger points in plantar fascia and gastrocnemius,guided by the same theory.All patients were treated for 4 sessions,with a 2-day interval between sessions.The foot pain was assessed by the visual analogue scale(VAS),the foot function was evaluated using the Maryland foot score and the American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot score,and the thickness of plantar fascia was measured with an ultrasound diagnostic instrument before the treatment,at 1,4,and 12-week post-treatment,respectively.Additionally,the complications were monitored in the 3 groups throughout the treatment and follow-up periods.Results:①The foot pain VAS score.The foot pain VAS score presented a gradual decreasing trajectory over time in the 3 groups(F=138.510,P=0.000; F=196.452,P=0.000; F=276.465,P=0.000).In addition,the foot pain VAS score was not significantly different among the 3 groups before the treatment,while,at 1,4,and 12-week post-treatment,it was higher in conventional group compared to gastrocnemius group and hamstring group(P=0.002,P=0.000; P=0.016,P=0.000; P=0.007,P=0.000),with the hamstring group showing a superior effect over gastrocnemius group(P=0.014,P=0.026,P=0.034).②The Maryland foot score.The Maryland foot score presented a gradual increasing trajectory over time in the 3 groups(F=236.203,P=0.000; F=327.969,P=0.000; F=322.888,P=0.000).In addition,the Maryland foot score was not significantly different among the 3 groups before the treatment,while,at 1,4,and 12-week post-treatment,it was lower in conventional group compared to gastrocnemius group and hamstring group(P=0.033,P=0.000; P=0.000,P=0.000; P=0.000,P=0.000),with the hamstring group showing a superior effect over gastrocnemius group(P=0.000,P=0.047,P=0.016).③The AOFAS ankle-hindfoot score.The AOFAS ankle-hindfoot score presented a gradual increasing trajectory over time in the 3 groups(F=201.857,P=0.000; F=278.714,P=0.000; F=476.421,P=0.000).In addition,the AOFAS ankle-hindfoot score was not significantly different among the 3 groups before the treatment,while,at 1,4,and 12-week post-treatment,it was lower in conventional group compared to gastrocnemius group and hamstring group(P=0.018,P=0.000; P=0.000,P=0.000; P=0.001,P=0.000),with the hamstring group showing a superior effect over gastrocnemius group(P=0.027,P=0.013,P=0.000).④The plantar fascia thickness.The plantar fascia thickness presented a gradual decreasing trajectory over time in the 3 groups(F=69.116,P=0.000; F=89.293,P=0.000; F=160.270,P=0.000).In addition,the plantar fascia thickness was not significantly different among the 3 groups before the treatment,while,at 1,4,and 12-week post-treatment,it was greater in conventional group compared to gastrocnemius group and hamstring group(P=0.004,P=0.000; P=0.009,P=0.000; P=0.000,P=0.000),with no significant difference observed between gastrocnemius group and hamstring group at 1-week post-treatment,and greater plantar fascia thickness observed in gastrocnemius group compared to hamstring group at 4 and 12-week post-treatment(P=0.002,P=0.002).⑤Complications.No complications,such as nerve injury or local infection,occurred in any group throughout the treatment and follow-up periods.Conclusion:Acupotomy release targeting trigger points in the plantar fascia,gastrocnemius,and hamstrings,guided by myofascial chain theory,can effectively alleviate foot pain,improve foot function,and restore plantar fascia thickness in PF patients.This comprehensive approach demonstrates superior efficacy and longer-lasting effects,with a favorable safety profile,compared to isolated plantar fascia release.

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通讯作者:王孝辉 E-mail:963099784@qq.com
更新日期/Last Update: 1900-01-01