跟腱末端病的影像特征及与术式选择相关性研究  

Research on Correlation Between Image Features and Operation Selection of Achilles tendon’s Enthesiopathy

作　　者：白骏 胡杏珍 夏文平 王加伟[1] 徐雷鸣[1,2] BAI Jun;HU Xingzhen;XIA Wenping(Department of Radiology,The Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310000,P.R.China)

机构地区：[1]浙江大学医学院附属第二医院放射科,杭州310000 [2]浙江省宁波市鄞州区第二医院放射科,315000

出　　处：《临床放射学杂志》2019年第11期2148-2152,共5页Journal of Clinical Radiology

摘　　要：目的探讨跟腱末端病的影像学表现及其与临床手术方式的相关性。方法搜集2014年2月至2017年2月期间经4~6个月保守治疗无效且最终选择手术治疗的28例跟腱末端病患者的临床及影像学资料。所有患者均行踝关节正侧位X光摄片检查和踝关节MRI平扫检查。由2名高年资放射科医师对所有患者的临床及影像学检查资料进行分析,总结跟腱末端病影像学表现特征,探讨这些特征对临床手术方式选择的参考意义。结果 28例患者共31病足,3例是双足发病,其余单足。左15足,右16足。男20例,女8例。踝关节侧位X光片:22足(71%)表现为跟骨Haglund畸形;28足(90.3%)可见跟腱末端走行区钙化灶。MRI:跟腱增粗28足(90.3%);跟腱末端变性28足(90.3%);跟骨后上滑膜囊炎24足(77.4%);跟腱末端水肿8足(25.8%);跟骨结节骨髓水肿8足(25.8%)。跟腱末端异常磁共振信号位于跟腱中线偏胫侧11足,跟腱中线偏腓侧7足,跟腱中线区13足。31足跟腱变性灶的最上端距跟腱跟骨附着点的距离长约15.2~82 mm,平均约(35.7±14.9)mm。31足中10足进行了跟腱末端清理止点重建术;7足进行了跟骨截骨、跟腱止点重建及滑囊切除术;7足进行了跟骨截骨、跟腱修补及滑囊清理术;4足进行了跟腱滑囊切除、跟骨截骨及跟腱吻合术;2足取踇长屈肌腱转位修补跟腱、跟骨骨赘及滑囊切除术;1足进行了跟腱末端清理止点重建及跟腱滑囊清除术。结论跟腱末端增粗、变性、钙化及跟骨后上滑膜囊炎是跟腱末端病的影像学诊断要点,跟骨Haglund畸形是跟腱末端病的重要病因。跟腱末端病影像学特征对该病手术治疗方式选择有着重要参考意义。Objective To investigate the imaging findings of Achilles tendinopathy and its correlation with clinical surgical procedures. Methods The clinical and imaging data of 28 patients with Achilles tendon disease who were treated with conservative treatment for 4 to 6 months from February 2014 to February 2017 were collected. All patients had positive lateral X-ray examination of the ankle and ankle MRI plain examination. Two senior radiologists analyzed the clinical and imaging data of all patients to explore the imaging features of Achilles tendinopathy and to summarize the reference significance of these features for the choice of clinical surgical methods. Results Of the 28 patients,3 had bilateral foot disease and the remaining single foot. There were 15 cases of left foot and 16 cases of right foot. There were 20 males and 8 females. Lateral radiographs of the ankle joint: 22 cases(71%) showed calcaneus Haglund deformity;28 cases(90.3%) showed calcification of the Achilles tendon distal plantar insertion area. MRI: 28 cases(90.3%) with Achilles tendon thickening;28 cases(90.3%) with Achilles tendon degeneration;24 cases(77.4%) with posterior synovitis;8 cases(25.8%) with Achilles tendon end edema;8 cases(25.8%) of bone marrow edema of calcaneal nodules. The abnormal magnetic resonance signal at the end of the Achilles tendon was located in 11 cases on the partial tibial side of the Achilles tendon midline,7 cases of the partial fibula side of the Achilles tendon midline,and 13 cases of the Achilles tendon midline. The distance between the uppermost end of the Achilles tendon and the calcaneus attachment point in the 31 cases was about 15.2 to 82 mm,with an average of about(35.7±14.9) mm. Surgical procedure: 10 of 31 patients underwent Achilles tendonectomy and reconstruction;7 patients underwent calcaneus osteotomy,achilles tendon reconstruction and bursal resection;7 patients underwent calcaneus osteotomy and Achilles tendon Repair and bursectomy;4 cases of Achilles tendon sac resection,calcaneus osteotomy and

关 键 词：跟腱末端病 Haglund畸形 磁共振成像 

分 类 号：R687.2[医药卫生—骨科学] R445.2[医药卫生—外科学] R816.8[医药卫生—临床医学]