腓骨长短肌腱鞘造影术在跟骨骨折中的应用及临床意义

The application and clinical significance of the visualization of peroneal tendinous sheath in calcaneal fractures

目的通过影像学上客观的腓骨长短肌腱受压现象，探讨陈旧性跟骨骨折跟骨增宽引起跟骨外侧疼痛的原因。方法对2006年5-11月15例波及跟距关节面的跟骨骨折患者及15例陈旧性跟骨骨折遗留跟骨外侧疼痛的患者进行腓骨长短肌腱鞘造影术。左侧18例，右侧12例，均为单侧骨折。双侧腓骨长短肌腱鞘同时造影，然后用数字化放射影像技术进行踝关节正位、跟骨侧位和跟骨轴位x线片，再行螺旋CT二维测量和三维成像观察，并与对侧正常跟骨比较。结果30例患者均有不同程度的跟骨增宽和腓骨长短肌腱鞘受压现象。当跟骨增宽小于3mm时，造影剂可以通过；当跟骨增宽大于3mm时，造影剂通过受阻，腓骨长短肌腱鞘即出现受压现象。对于陈旧性跟骨骨折患者，跟骨增宽超过3mm以上即出现跟骨外侧疼痛。结论陈旧性跟骨骨折患者跟骨增宽对腓骨长短肌腱的压迫是引起跟骨外侧疼痛的原因。

Objective To explore the correlation between the pain at the outer calcaneal flank and the calcaneal broadening of oboslete calcaneal fractures by means of imaging verification. Methods Visualization of the tendinous sheaths of peroneal long and short muscles was done between May 2006 and November 2006 for 15 patients with calcaneal fracture involving talocalcaneal joint surface and 15 patients with lateral calcaneal pain following obsolete calcaneal fractures. They were 23 men mad 7 women. Their ages ranged from 21 to 46 years, with an average of 37. The fractures were all unilateral ones, involving 18 left feet and 12 right feet. The visualization was conducted bilaterally followed by calcaneal posterior-anterior, lateral and axial radiography with DR, measurement on the 2-dimensional CT scan and 3-dimensional CT observation. The results were compared with those of the opposite normal calcaneus. Results Various degrees of calcaneal widening and compression of the peroneal tendinous sheath were found in all the 30 patients. When the widening of the involved calcaneus was less than 3 mm, the medium could pass through. When the cal- caneal widening was larger than 3 mm, the medium could not come through and the peroneal tendinous sheath showed compression. The patients with obsolete fractures experienced lateral calcaneal pain when the calcaneal widening was greater than 3 mm. Conclusion Imageological evidence can confirm that the lateral calcaneal pain may be caused by compression of peroneal tendinous sheath which results from the calcaneal widening of oboslete fracture.