[1]黄鲁丰,贺华勇,李杰华,等.跟痛症患者跟骨内侧突骨刺的解剖学研究[J].中医正骨,2021,33(04):51-54.
　HUANG Lufeng,HE Huayong,LI Jiehua,et al.An anatomical study of calcaneal medial process spurs in patients with calcaneodynia[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(04):51-54.
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跟痛症患者跟骨内侧突骨刺的解剖学研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期数:
2021年04期
页码:
51-54
栏目:
基础研究
出版日期:
2021-04-20

文章信息/Info

Title:
An anatomical study of calcaneal medial process spurs in patients with calcaneodynia
作者:
黄鲁丰1; 贺华勇1; 李杰华1; 叶永亮1; 颜仰雪2; 廖立青3
(1.广州市正骨医院,广东 广州 510045; 2.广州市天河区中医医院,广东 广州 510665; 3.南方医科大学中医药学院,广东 广州 510515)
Author(s):
HUANG Lufeng1; HE Huayong1; LI Jiehua1; YE Yongliang1; YAN Yangxue2; LIAO Liqing3
1.Guangzhou Orthopedic Hospital,Guangzhou 510045,Guangdong,China2.Tianhe Hospital of TCM,Guangzhou 510665,Guangdong,China3.School of Chinese Medicine of Southern Medical University,Guangzhou 510515,Guangdong,China
关键词:
跟骨骨刺;  足跟痛;  解剖
Keywords:
heel spur;  heel pain;  dissection
摘要:
目的:探讨跟痛症患者跟骨内侧突骨刺的解剖学特点,分析其形成因素。方法:从跟痛症患者中选取经X线检查确定合并跟骨内侧突骨刺者,拍摄跟骨侧位X线片,测量骨刺的厚度和长度。分析患者的性别和年龄,比较不同性别患者的年龄和不同年龄患者的性别,比较不同侧别、类型跟骨内侧突骨刺的长度及厚度。结果:①不同性别患者的年龄。共纳入113例合并跟骨内侧突骨刺的跟痛症患者,男45例、女68例。男性组年龄(51.80±12.66)岁,女性组年龄(58.03±9.00)岁,男性患者的年龄小于女性(t’=-2.492,P=0.015)。②不同年龄患者的性别。<45岁组男11例(73%)、女4例(27%),45～55岁组男14例(41%)、女20例(59%),>55岁组男20例(31%)、女44例(69%); 3组患者性别分布的差异有统计学意义(χ2=9.018,P=0.011),进一步两两比较发现,<45岁组与45～55岁组性别分布的差异无统计学意义(χ2=4.307,P=0.038),45～55岁组与>55岁组性别分布的差异无统计学意义(χ2=0.966,P=0.326),>55岁组的女性占比高于<45岁组(χ2=9.026,P=0.003)。③不同侧别跟骨内侧突骨刺的长度及厚度。跟骨内侧突骨刺,左侧50例、右侧58例、双侧5例。左侧跟骨内侧突骨刺的长度小于右侧[(4.09±1.80)mm,(5.03±1.96)mm,t=2.600,P=0.011]。左侧与右侧跟骨内侧突骨刺厚度的差异无统计学意义[(3.42±1.14)mm,(3.92±1.73)mm,t=1.754,P=0.084]。④不同类型跟骨内侧突骨刺的长度及厚度。单纯跟骨内侧突骨刺93例,跟骨内侧突和跟腱止点处骨刺20例。不同类型跟骨内侧突骨刺长度的差异无统计学意义[(4.74±1.98)mm,(4.19±1.77)mm,t=-1.148,P=0.253]。不同类型跟骨内侧突骨刺厚度的差异无统计学意义[(3.65±1.14)mm,(4.08±2.68)mm,t’=0.698,P=0.493]。结论:跟痛症患者的跟骨内侧突骨刺,左侧骨刺长度小于右侧,两侧骨刺厚度无明显差别,不同类型骨刺的长度及厚度均无明显差别; 男性患者的年龄小于女性,55岁以上患者中女性患者比例较高; 跟骨内侧突骨刺的形成可能与激素水平变化有关。
Abstract:
To explore the anatomical characteristics of plantar calcaneal spurs(PCS)at medial process in patients with calcaneodynia,and to analyze the factors of its formation.Methods:The patients who were diagnosed with PCS at medial process by X-ray examination were selected from the ones with calcaneodynia.The calcaneal lateral X-ray films were taken,and the thickness and length of PCS were measured on the X-ray films.The gender and age of the patients were analyzed.The age of patients were compared between different genders and the gender of patients were compared between different ages.The length and thickness of PCS were compared between different sides and types.Results:One hundred and thirteen patients were included in the study,and they consisted of 45 males and 68 females and ranged in age of 51.80±12.66 years in males and 58.03±9.00 years in females.The male patients were younger than the female patients(t’=-2.492,P=0.015).The patients include 11 males(73%)and 4 female(27%)in group aged less than 45 years,14 males(41%)and 20 females(59%)in group aged from 45 to 55 years,and 20 males(31%)and 44 females(69%)in group aged over 55 years.There was statistical difference in gender distribution between the 3 groups(χ2=9.018,P=0.011).Further pairwise comparison showed that there was no statistical difference in gender distribution between group aged less than 45 years and group aged from 45 to 55 years(χ2=4.307,P=0.038),as well as between group aged from 45 to 55 years and group aged over 55 years(χ2=0.966,P=0.326).The proportion of females was higher in group aged over 55 years compared to group aged less than 45 years(χ2=9.026,P=0.003).The PCS located in left calcaneus for 50 patients,right for 58 patients and bilateral for 5 patients.The length of PCS was shorter in left calcaneus compared to the right calcaneus(4.09±1.80 vs 5.03±1.96 mm,t=2.600,P=0.011).There was no statistical difference in thickness of PCS between the left calcaneus and the right calcaneus(3.42±1.14 vs 3.92±1.73 mm,t=1.754,P=0.084).The PCS were merely on medial process in 93 patients and on both medial process and the ending point of tendo calcaneus in 20 patients.There was no statistical difference in the length and thickness of PCS between different types(4.74±1.98 vs 4.19±1.77 mm,t=-1.148,P=0.253; 3.65±1.14 vs 4.08±2.68 mm,t’=0.698,P=0.493).Conclusion:In patients with calcaneodynia and PCS,the length of PCS is shorter in left calcaneus compared to the right calcaneus,and the differences in thickness of PCS between bilateral sides and in length and thickness of PCS between different types are not statistically significant.Moreover,the male patients are younger than the female patients.The PCS is more common in females patients aged over 55 years,and its formation may be related to the changes of hormone levels.

参考文献/References:

[1] 李义凯.软组织痛的基础与临床[M].香港:世界医药出版社,2011:567-573.
[2] LAREAU C R,SAWYER G A,WANG J H,et al.Plantar and medial heel pain:diagnosis and management[J].J Am Acad Orthop Surg,2014,22(6):372-380.
[3] ALSHAMI A M,SOUVLIS T,COPPIETERS M W.A review of plantar heel pain of neural origin:differential diagnosis and management[J].Man Ther,2008,13(2):103-111.
[4] 陈辉,王翰,陶然,等.超声引导自体脂肪注射治疗跟痛症[J].中国疼痛医学杂志,2020,26(4):318-320.
[5] 马木提·阿木丁,张旭,陈平波.跟痛症的中西医研究进展[J].新疆中医药,2020,38(2):108-111.
[6] OSBORNE H R,BREIDAHL W H,ALLISON G T.Critical differences in lateral X-rays with and without a diagnosis of plantar fasciitis[J].J Sci Med Sport,2006,9(3):231-237.
[7] RAJKOHILA J,DANIEL P,SUGANTHY J.Study of calcaneal spurs and lateral tubercular bar in Indian population[J].Journal of the Anatomical Society of India,2016,65(1):29-32.
[8] 叶永亮,霍力为,罗曼,等.跟痛症相关的解剖学研究[J].中医正骨,2019,31(2):1-4.
[9] JOHANNSEN F,KONRADSEN L,HERZOG R,et al.Plantar fasciitis treated with endoscopic partial plantar fasciotomy-One-year clinical and ultrasonographic follow-up[J].Foot(Edinb),2019,39:50-54.
[10] CARLI A B,TEKIN L,AKARSU S,et al.Calcaneal spur in an 18-month-old boy[J].Scand J Rheumatol,2013,42(1):83-84.
[11] LOPES A D,HESPANHOL L C Jr,YEUNG S S,et al.What are the main running-related musculoskeletal injuries?A systematic review[J].Sports Med,2012,42(10):891-905.
[12] LI J,MUEHLEMAN C.Anatomic relationship of heel spur to surrounding soft tissues:greater variability than previously reported[J].Clin Anat,2007,20(8):950-955.
[13] ABREU M R,CHUNG C B,MENDES L,et al.Plantar calcaneal enthesophytes:new observations regarding sites of origin based on radiographic,MR imaging,anatomic,and paleopathologic analysis[J].Skeletal Radiol,2003,32(1):13-21.
[14] BEYTEMüR O,?Cü M.The age dependent change in the incidence of calcaneal spur[J].Acta Orthop Traumatol Turc,2018,52(5):367-371.
[15] 武凯,廖立青,李义凯.跟骨骨刺定位与病因学特点的X射线片评价[J].中国组织工程研究,2020,24(18):2906-2910.
[16] MENZ H B,ZAMMIT G V,LANDORF K B,et al.Plantar calcaneal spurs in older people:longitudinal traction or vertical compression?[J].J Foot Ankle Res,2008,1(1):7.
[17] MORETTI B,GAROFALO R,PATELLA V,et al.Extracorporeal shock wave therapy in runners with a symptomatic heel spur[J].Knee Surg Sports Traumatol Arthrosc,2006,14(10):1029-1032.
[18] BRAND P W.Pressure sores-the problem[J].J Tissue Viability,2006,16(2):9-11.
[19] 李忠,姜厚森,刘俊华,等.顽固性跟痛症的手术治疗[J].中国矫形外科杂志,2018,26(10):918-922.
[20] 丛强,夏传龙,杜宏伟,等.足跟痛治疗鞋治疗跟痛症效果分析[J].中国矫形外科杂志,2019,27(13):1242-1243.
[21] KIRKPATRICK J,YASSAIE O,MIRJALILI S A.The plantar calcaneal spur:a review of anatomy,histology,etiology and key associations[J].J Anat,2017,230(6):743-751.
[22] 张宇,庄汝杰.发散式冲击波治疗跖腱膜炎性跟痛症[J].中医正骨,2018,30(8):70-71.
[23] 张琥,张旻,龚幼波,等.太极拳对早期膝骨关节炎患者步态影响的研究[J].中医正骨,2018,30(9):34-38.

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通讯作者:廖立青 E-mail:2270307940@qq.com
更新日期/Last Update: 1900-01-01