[1]丰凡翔,张鑫,刘付龙,等.体外冲击波疗法治疗早中期距骨骨软骨损伤的临床研究[J].中医正骨,2023,35(01):25-29,35.
　FENG Fanxiang,ZHANG Xin,LIU Fulong,et al.Clinical efficacy of extracorporeal shock wave therapy on early to mid-stage osteochondral lesions of the talus[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2023,35(01):25-29,35.
点击复制

体外冲击波疗法治疗早中期距骨骨软骨损伤的临床研究()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第35卷
期数:
2023年01期
页码:
25-29,35
栏目:
临床研究
出版日期:
2023-01-20

文章信息/Info

Title:
Clinical efficacy of extracorporeal shock wave therapy on early to mid-stage osteochondral lesions of the talus
作者:
丰凡翔; 张鑫; 刘付龙; 杨济嵘; 肖依诚; 李军明
(四川省骨科医院,四川 成都 610041)
Author(s):
FENG Fanxiang; ZHANG Xin; LIU Fulong; YANG Jirong; XIAO Yicheng; LI Junming
Sichuan Province Orthopedic Hospital,Chengdu 610041,Sichuan,China
关键词:
冲击波;  距骨骨软骨损伤;  磁共振成像;  成像; 三维;  临床试验
Keywords:
shock wave;  osteochondral lesion of the talus;  magnetic resonance imaging;  imaging; three-dimensional;  clinical trial
摘要:
目的:评价体外冲击波疗法(extracorporeal shock wave therapy,ESWT)治疗早中期距骨骨软骨损伤(osteochondral lesion of the talus,OLT)的临床疗效。方法:将60例符合要求的HeppleⅠ期至Ⅲ期OLT患者随机分为常规组和冲击波组,每组30例。入组后2组患者均采用针刺、超声波治疗、踝周肌力训练、口服双氯芬酸钠肠溶片及限制患肢负重等常规疗法治疗,冲击波组在此基础上辅以ESWT治疗,2组均治疗5周。比较2组患者治疗前及治疗结束后2个月的踝关节疼痛视觉模拟量表(visual analogue scale,VAS)评分、美国足与踝关节协会(American Orthopedic Foot and Ankle Society,AOFAS)踝与后足评分及病灶体积。结果:治疗前2组患者的踝关节疼痛VAS评分、AOFAS踝与后足评分及病灶体积比较,组间差异均无统计学意义(Z=0.139,P=0.709; Z=0.351,P=0.554; Z=0.184,P=0.668)。治疗结束后2个月,2组患者的踝关节疼痛VAS评分均较治疗前降低[(5,2)分,(5,2)分,Z=-2.828,P=0.005;(5,2)分,(3,1)分,Z=-4.902,P=0.000],AOFAS踝与后足评分均较治疗前提高[(69.50,11.75)分,(72.00,11.25)分,Z=-4.450,P=0.000;(68.50,11.50)分,(78.50,13.75)分,Z=-4.793,P=0.000]; 冲击波组治疗结束后2个月的病灶体积较治疗前减小[(1.77,0.76)cm3,(1.27,0.71)cm3,Z=-4.783,P=0.000],常规组治疗前后病灶体积的差异无统计学意义[(1.74,0.77)cm3,(1.79,0.54)cm3,Z=-0.160,P=0.873]。冲击波组治疗结束后2个月的踝关节疼痛VAS评分低于常规组(Z=37.890,P=0.000),AOFAS踝与后足评分高于常规组(Z=3.944,P=0.047),病灶体积小于常规组(Z=15.134,P=0.000)。结论:采用ESWT治疗早中期OLT,有助于缓解踝关节疼痛、改善踝关节功能、控制病灶进展。
Abstract:
Objective:To evaluate the clinical efficacy of extracorporeal shock wave therapy(ESWT)in the treatment of early to mid-stage osteochondral lesions of the talus(OLT).Methods:Sixty eligible patients with Hepple I-Ⅲ OLT were enrolled and randomly divided into a control group(n=30)and an ESWT group(n=30).All patients were treated with conventional intervention therapies,such as acupuncture,ultrasound therapy,periankle strength training,oral administration of Diclofenac Sodium Enteric-coated Tablets,and protection from weight bearing of the affected limb.The patients in the ESWT group received additional ESWT.The treatment lasted five weeks for all patients.The ankle pain visual analogue scale scores,American Orthopaedic Foot and Ankle Society(AOFAS)Ankle-Hindfoot Scale scores,and the volume of lesions of the two groups were compared before treatment and two months after treatment.Results:There was no significant difference in ankle pain VAS score,AOFAS Ankle-Hindfoot Scale score,and lesion volume between the two group before treatment(Z=0.139,P=0.709; Z=0.351,P=0.554; Z=0.184,P=0.668).Two months after treatment,ankle pain VAS scores of the two groups were lower((5,2)vs(5,2)points,Z=-2.828,P=0.005;(5,2)vs(3,1)points,Z=-4.902,P=0.000)and AOFAS Ankle-Hindfoot Scale scores were higher than those before treatment((69.50,11.75)vs(72.00,11.25)points,Z=-4.450,P=0.000;(68.50,11.50)vs(78.50,13.75)points,Z=-4.793,P=0.000).In the ESWT group,the lesion volume was reduced two months after treatment((1.77,0.76)vs(1.27,0.71)cm(3),Z=-4.783,P=0.000),and there was no significant difference in lesion volume of the control group before and after treatment((1.74,0.77)vs(1.79,0.54)cm(3),Z=-0.160,P=0.873).Compared with the control group two months after treatment,the ESWT group showed reduced ankle pain VAS score(Z=37.890,P=0.000),higher AOFAS Ankle-Hindfoot Scale score(Z=3.944,P=0.047),and smaller lesion volume(Z=15.134,P=0.000).Conclusion:In the treatment of early to mid-stage OLT,ESWT can relieve ankle pain,improve ankle function,and control lesion progression.

参考文献/References:

[1] KRAUSE F,ANWANDER H.Osteochondral lesion of the talus:still a problem?[J].EFORT Open Rev,2022,7(6):337-343.
[2] TAMAM C,TAMAM M O,YILDIRIM D,et al.Diagnostic value of single-photon emission computed tomography combined with computed tomography in relation to MRI on osteochondral lesions of the talus[J].Nucl Med Commun,2015,36(8):808-814.
[3] GIANAKOS A L,YASUI Y,HANNON C P,et al.Current management of talar osteochondral lesions[J].World J Orthop,2017,8(1):12-20.
[4] VERHAGEN R A,STRUIJS P A,BOSSUYT P M,et al.Systematic review of treatment strategies for osteochondral defects of the talar dome[J].Foot Ankle Clin,2003,8(2):233-242.
[5] SUGIMOTO K,TAKAKURA Y,OKAHASHI K,et al.Chondral injuries of the ankle with recurrent lateral instability:an arthroscopic study[J].J Bone Joint Surg Am,2009,91(1):99-106.
[6] LYON R,LIU X C,KUBIN M,et al.Does extracorporeal shock wave therapy enhance healing of osteochondritis dissecans of the rabbit knee?:a pilot study[J].Clin Orthop Relat Res,2013,471(4):1159-1165.
[7] ZHANG C,HUANG H,YANG L,et al.Extracorporeal shock wave therapy for pain relief after arthroscopic treatment of osteochondral lesions of talus[J].J Foot Ankle Surg,2020,59(1):190-194.
[8] BADEKAS T,TAKVORIAN M,SOURAS N.Treatment principles for osteochondral lesions in foot and ankle[J].International orthopaedics,2013,37(9):1697-1706.
[9] VERHAGEN R A W,MAAS M,DIJKGRAAF M G W,et al.Prospective study on diagnostic strategies in osteochondral lesions of the talus:is MRI superior to helical CT?[J].J Bone Joint Surg Br,2005,87(1):41-46.
[10] HEPPLE S,WINSON I G,GLEW D.Osteochondral lesions of the talus:a revised classification[J].Foot Ankle Int,1999,20(12):789-793.
[11] KITAOKA H B,ALEXANDER I J,ADELAAR R S,et al.Clinical rating systems for the ankle-hindfoot,midfoot,hallux,and lesser toes[J].Foot Ankle Int,1994,15(7):349-353.
[12] STEELE J R,DEKKER T J,FEDERER A E,et al.Osteochondral lesions of the talus:current concepts in diagnosis and treatment[J/OL].Foot & Ankle Orthopaedics,2018,3(3):2473011418779559[2022-08-01].https://doi.org/10.1177/2473011418779559.
[13] ZACHARIAS A,NAZAL M,DAWSON A,et al.Avascular necrosis of the talus following subchondroplasty:a case report and review of literature[J/OL].Foot Ankle Spec,2022:19386400221108730[2022-08-01].https://pubmed.ncbi.nlm.nih.gov/35815428.
[14] 刘彦林.距骨形态及血液供应的解剖学研究[D].长春:吉林大学,2008.
[15] SHEPHERD D E,SEEDHOM B B.Thickness of human articular cartilage in joints of the lower limb[J].Ann Rheum Dis,1999,58(1):27-34.
[16] HAUSDORF J,LEMMENS M A,KAPLAN S,et al.Extracorporeal shockwave application to the distal femur of rabbits diminishes the number of neurons immunoreactive for substance P in dorsal root ganglia L5[J].Brain Res,2008,1207:96-101.
[17] TAKAHASHI N,OHTORI S,SAISU T,et al.Second application of low-energy shock waves has a cumulative effect on free nerve endings[J].Clin Orthop Relat Res,2006,443:315-319.
[18] WANG C J,HSU S L,WENG L H,et al.Extracorporeal shockwave therapy shows a number of treatment related chondroprotective effect in osteoarthritis of the knee in rats[J].BMC Musculoskelet Disord,2013,4:44.
[19] XU Y,WU K,LIU Y,et al.The effect of extracorporeal shock wave therapy on the treatment of moderate to severe knee osteoarthritis and cartilage lesion[J].Medicine(Baltimore),2019,98(20):e15523.
[20] CAO J,ZHANG C,HUANG H,et al.Bone marrow edema syndrome of the foot treated with extracorporeal shock wave therapy:a retrospective case series[J].J Foot Ankle Surg,2021,60(3):523-528.
[21] HSU S L,WANG C J,LEE M S,et al.Cocktail therapy for femoral head necrosis of the hip[J].Arch Orthop Trauma Surg,2010,130(1):23-29.
[22] KING J L,WALLEY K C,STAUCH C,et al.Comparing the efficacy of true-volume analysis using magnetic resonance imaging with computerized tomography and conventional methods of evaluation in cystic osteochondral lesions of the talus:a pilot study[J].Foot Ankle Spec,2021,14(6):501-508.
(收稿日期:2022-08-14 本文编辑:李晓乐)

备注/Memo

备注/Memo:
基金项目:成都中医药大学科技发展基金项目(YYZX20180017)通讯作者:张鑫 E-mail:kangfuke2008@163.com
更新日期/Last Update: 1900-01-01