跖筋膜炎病理力学概念及治疗：富含血小板血浆治疗的前景

摘要

BACKGROUND:The treatments of plantar fasci tis as an important cause of calcaneodynia are different in medical institutions, as wel as the therapeutic results. OBJECTIVE:To summarize various treatments of plantar fascia, and based on the pathogenesis and pathological mechanics of plantar fasci tis, to investigate the effect of various treatment methods and indications. METHODS:A computer-based online search of PubMed database and Wanfang database was performed for articled related to plantar fasci tis published between January 1993 and January 2014. The keywords were “plantar fasci tis, mechanism, treatment”in English and Chinese, respectively, by screening the titles and abstracts. Final y, 34 articles were included in result analysis. RESULTS AND CONCLUSION:The treatment of plantar fasci tis needs to fol ow the principle from noninvasive to invasive treatment. Stretching the plantar fascia and heel cord, using prefab-ricated orthotics, and wearing night splints are crucial for the treatment of plantar fasci tis. Local hormone injection can be used as first-line therapy for patients with acute plantar fasci tis if they can tolerate the adverse reactions due to hormone therapy. Platelet-rich plasma therapy has a promising prospect, but there is lack of experimental evidences. Extracorporeal shock wave therapy can be a choice for recurrent chronic intractable plantar fasci tis. Surgical intervention remains the last line of therapy, for which, rigorous screening is important, but it is not always effective at reducing pain.%背景：跖筋膜炎作为跟痛症的重要病因，各级医疗机构治疗方法不尽相同，治疗效果也出入较大。　　目的：总结跖筋膜的各种治疗，结合跖筋膜炎的发病机制及病理力学，探讨各种治疗方法的效果及适应证。方法：检索PubMed数据库、中国科技期刊数据库(万方)1993年1月至2014年1月有关跖筋膜炎的相关研究。英文关键词为“Plantar fasci tis，Mechanism，Treatment”；中文关键词为“跖筋膜炎；机制；治疗”。阅读标题及进行筛查，保留其中34篇归纳总结。　　结果与结论：跖筋膜炎的治疗需遵循无创到有创的原则，核心的理念为跖筋膜特殊牵引治疗、矫形器及夜间夹板的固定。对于急性期的患者，如果能够接受激素治疗带来的不良反应，局部注射激素可以作为一线治疗。富含血小板血浆注射治疗的前景看似美好，但现在还缺少大量的实验证据。对于反复发作的慢性顽固性跖筋膜炎，可以考虑体外震波治疗。手术治疗需严格筛选，因为它并不能缓解所有患者的疼痛，这是治疗跖筋膜炎的最后一道防线。