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目的:探讨体外冲击波（ESWT）联合牵伸训练治疗慢性足底筋膜炎的效果。方法:本研究为前瞻性病例对照研究。筛选2021年6月至2022年6月于南方医科大学南方医院骨科-创伤骨科收治的慢性足底筋膜炎患者。利用随机数字生成器随机分为试验组（接受ESWT联合牵伸训练治疗）与对照组（接受牵伸训练治疗）。采用剪切波弹性成像（SWE）技术定量评估足底筋膜的弹性模量。比较两组患者治疗后12周的疼痛视觉模拟评分（VAS）、足底筋膜厚度及弹性模量，并分析治疗12周后患者疼痛VAS评分与弹性模量的相关性。结果:本研究共纳入41例（52足）患者，男20例，女21例；年龄（49.9±8.2）岁；损伤侧别：左侧16例，右侧14例，双侧11例；病程为7.0（6.0，12.0）个月。试验组患者治疗后12周的疼痛VAS评分为1.0（1.0，2.0）分，显著低于对照组患者[3.0（2.0,3.0）分]；弹性模量为（79.48±17.65）kPa，显著高于对照组患者[（57.08±14.16）kPa]，差异均有统计学意义（ P<0.05）。而两组患者治疗后12周的足底筋膜厚度比较差异无统计学意义（ P>0.05）。治疗后12周疼痛VAS评分与弹性模量存在显著相关（ r=-0.708， P<0.001）。 结论:与单纯牵伸训练相比，ESWT联合牵伸训练治疗慢性足底筋膜炎的效果更优。

Objective:To investigate the clinical efficacy of extracorporeal shock wave (ESWT) combined with stretching training in the treatment of chronic plantar fasciitis.Methods:A prospective case-control study was conducted to include the patients with chronic plantar fasciitis who had been admitted to Department of Orthopaedic Trauma, Nanfang Hospital, Southern Medical University from June 2021 to June 2022. A SPSS random number generator was used to randomize the patients into an experimental group (receiving treatment with ESWT combined with stretching training) and a control group (receiving stretching training only). Shear wave elastography (SWE) was used to quantitatively evaluate the elastic modulus of the plantar fascia. The 2 groups were compared in terms of visual analogue scale (VAS) pain score, plantar fascia thickness, and elastic modulus of the plantar fascia in the patients at 12 weeks after treatment; the correlation between VAS pain score and elastic modulus of the plantar fascia was examined using Spearman analysis in the patients at 12 weeks after treatment.Results:This study included a total of 41 patients (52 feet), 20 males and 21 females with an age of (49.9±8.2) years. There were 16 left sides, 14 right sides and 11 bilateral sides affected. The course of the disease was 7.0 (6.0, 12.0) months. The 2 groups were comparable because there were no significant differences in the general data before treatment between them ( P>0.05). The VAS pain score at 12 weeks after treatment for the experimental group was 1.0 (1.0, 2.0) points, significantly lower than that for the control group [3.0 (2.0, 3.0) points] ( P<0.05). The elastic modulus of the plantar fascia at 12 weeks after treatment for the experimental group was (79.48 ± 17.65) kPa, significantly higher than that for the control group [(57.08 ± 14.16) kPa] ( P<0.05). However, there was no statistically significant difference between the 2 groups in the thickness of the plantar fascia at 12 weeks after treatment ( P>0.05). There was a significant correlation between VAS pain score and elastic modulus of the plantar fascia after 12 weeks of treatment ( r = -0.708, P<0.001). Conclusion:In the treatment of chronic plantar fasciitis, combination of ESWT and stretching training is more effective than stretching training only.