【作者】 罗斌；

【导师】 刘军；

【作者基本信息】 广州中医药大学 ， 中西医结合临床， 2009， 硕士

【摘要】 研究背景跟痛症是中老年人的常见病、多发病,由一系列疾病导致的以足跟部疼痛为主症的症候群,严重影响患者的工作与生活。本症与劳损和退化有密切关系,常见病因有跖腱膜炎、跟骨骨刺、足跟脂肪垫炎、跟下滑囊炎、足底神经卡压、跟腱炎、跟腱滑囊炎、跟骨高压症、跟骨应力骨折等。目前国内外对于本病的研究均有报道。西医通常有口服非甾体类抗炎药,局部激素封闭治疗,手术减压及各种理疗。关于这些方法的疗效,报道颇不一致,但文献表明运动疗法具有较多优势。国外学者亦有应用运动疗法的研究,主要包括跟腱、跖腱膜牵拉锻炼,目前尚缺乏针对性的防治措施。我们在临床治疗中发现顿足锻炼配合醋盐疗法对此具有很显著的效果,且具有简、便、廉的特点,其可使足跟部的压力分散,提高局部痛阈,配合热盐水和热醋交替局部浸泡,可消除静脉瘀阻,改善局部微循环,加快炎症吸收,最后达到消除疼痛的目的。目前普遍研究认为足跟部的运动疗法配合理疗或中草药熏洗对足跟痛有效,但至今仍缺乏针对其疗效的严谨的RCT。研究目的我们在临床治疗中发现顿足锻炼配合醋盐疗法对此具有很显著的效果,且具有简、便、廉的特点,但治疗机理不明。探索此疗法对跟痛症的治疗作用,为临床治疗提供科学的思路及方法,这就是本研究的目的和意义。研究方法前瞻性随机对照试验,治疗组采用顿足锻炼+醋盐疗法,对照组采用局部封闭治疗+消炎止痛药+理疗。随访3个月,采用盲法评价。顿足锻炼为每日坚持用患病足跟顿地,力量由轻到重,频率由慢而快,以患者能忍受疼痛为度,时间以自觉足底有温热感为宜。循序渐进,随时随地进行治疗。条件允许时,最好采用坐位。醋盐疗法为在稀释的热醋水中,先用热气熏患足10min,然后泡足20min,边泡边推按足跟,对压痛点强力按摩,同法配制热盐水后按上述方法进行交替治疗,2次/天,1次30min,10天为1疗程。对照组患者用热水局部熏洗,疼痛明显者服用芬必得,每次0.3g,每日2次;同时用醋酸强的松龙12.5mg加2%利多卡因2-4ml做痛点局部封闭,封闭后休息1-2d,7d后再注射1次。采用信封随机法:软件产生随机数字号与分组,并用信封密封后编号。治疗前按顺序分配和拆开信封,获得随机分配的结果,计量资料组间的比较采用方差分析(方差不齐采用秩和检验),疗效等级资料比较采用秩和检验等,检验水平α=0.05,控制混杂因素采用Logistic回归模型。结果两组治疗后均能消除或减轻疼痛,治疗组治疗前后疼痛缓解的评价较对照组有显著性差异,治疗组治愈率及总有效率与对照组比较差异无显著性意义(P＞0.05),提示治疗组疗效优于或等同于对照组。更多还原

【Abstract】 BackgroundHeel pain in the elderly is a common,frequently-occurring disease.Which caused by a series of heel pain syndrome-based disease,affect the patients seriously in their work and lives.The disease is closely related with the strain and degradation.The common plantar aponeuros is due to inflammation, calcaneal spur,heel fat pad inflammation with bursitis under,plantar nerve entrapment,inflammation of Achilles tendon,Achilles tendon bursitis, hypertension calcaneus,calcaneal stress fractures.Study of this disease have been reported at home and abroad.Western medicine usually use non-steroidal anti-inflammatory drugs、local steroid closed treatmen、surgical decompression and a variety of physiotherapy.With regard to the efficacy of these methods, reports are very inconsistent to each other,but the literatures show that exercise therapy has more advantages.Foreign scholars also study the application of exercise therapy,including the Achilles tendon,plantar fascia stretch exercise,but there is still a lack of targeted prevention and control measures,e found that stomp exercise with the vinegar and salt therapy has a significant effect in the clinical treatment,and features of simple、inexpensive、convenience.Which scatter local pressure of the heel,raise the pain threshold,with the hot brine and partial immersion alternating hot vinegar,remove the vein Stagnation,improve local micro-circulation,speed up the absorption of inflammation,and finally achieve the objective of the elimination of pain.Studies suggest that the current universal heel of exercise therapy Fumigation with Chinese herbal therapy,or effective for heel pain,but is still a lack of efficacy for its rigorous RCT. ObjectiveWe found that stomp exercise with the vinegar and salt therapy has a significant effect in the clinical treatment,and features of simple、inexpen-sive、convenience.But the treatment is of unknown mechanism.To explore the treatment of heel pain so as to provide scientific ideas and methods in clinical treatments,this is the purpose and significance of this study.MethodsProspective randomized controlled trial,treatment group:stomp exercise +vinegar and salt therapy,and the control group:Partial closure of operation+ Anti-inflammatory painkillers+Physical Therapy.Follow-up of 3 months,using blind rating.Adhere to exercise daily stomp sick heel with Dayton,the strength from light to heavy,the frequency from slow to fast,till patients can endure the pain,the appropriate time is a warm sense of the foot. Step-by-step,at any time for treatment.Vinegar and salt therapy:in hot vinegar diluted in water,hot smoked adequate risk for 10min,and then soak feet for 20 min,while the bubble side up by the heel,strong massage to tender points,with the law after the preparation of hot-saline method in accordance with the above-mentioned alternate treatment,2 times/day,30 min/time,10 days for 1 course of treatment.Control group:patients with partial Washing with hot water,who have the pain obvious taked Fenbid 0.3g in each time,2times/day;12.5mg prednisolone acetate plus 2%lidocaine 2-4ml do a partial closure of the pain points at the same time,and then make a break for 1-2d,7d after do once more the injection.Stochastic approach using the envelope:software generated random number and its division,and sealed the envelope code.according to the order of distribution and opened the envelope pre-treatment,was randomly assigned to the results of measurement data comparison between groups using analysis of variance(variance using rank sum test arrhythmia),Comparison of efficacy of the use of hierarchical information, such as rank test,testing the level ofα=0.05,control confounding factors using Logistic regression model.ResultsThe two groups can eliminate or alleviate the pain after treatment,the two groups,before and after treatment,there were significant differences in the evaluation of pain relief.The total effective cure rate compared with the treatment groupand the control group,the difference was not significant(P＞ 0.05),suggesting that the treatment group is superior or equivalent efficacy in the control group.更多还原