基于CT三维重建图像的跟骨结节骨赘形态学研究及其临床意义

Study of the morphology of heel spur and clinical significance： base on three-dimensional computed tomography

目的探讨基于CT三维容积重建技术的跟骨结节骨赘形态学特征及其与跟痛症的相关性。方法2005年6月至2009年4月共收治210例（254足）跟骨结节骨赘患者，根据Denis疼痛评分分为5组，即对照组42例（无疼痛）、病例1组46例（偶然轻微痛）、病例2组44例（中度疼痛）、病例3组42例（严重疼痛）、病例4组36例（持续重度疼痛）。收集病例组及对照组的跟骨结节骨赘多层螺旋CT扫描的薄层原始数据（DICOM格式），导入图像后处理软件（Superlmage orthopedics edition 1．0），重建出跟骨结节骨赘的三维形态，观察骨赘大体特征，测量并分析骨赘的基底部宽度、骨赘的长度、骨赘与跟骨底面的成角及骨赘纵轴与足中线的成角等指标的分布差异。结果在病例组内，部分患者的骨赘弧形边缘毛糙、骨赘底面凹凸不平，且附带一枚或数枚小骨赘，其数量明显高于对照组，尤其是在病例4组。形态学测量指标分析结果提示，5组间骨赘的基底部宽度差异无统计学意义（F=2．32，P〉0．05），而在骨赘的长度（F=8．23，P〈0．05）、骨赘与跟骨底面的成角（F=6．82，P〈0．05）、骨赘纵轴与足中线的成角（F=5．87，P〈0．05）等指标上的差异具有统计学意义，但差异幅度较小，且分布无明显规律。结论在跟骨结节骨赘伴跟痛症时，骨赘的表面特征可出现相应变化，但骨赘的基底部宽度、长度、朝向等指标与跟痛症严重程度无关。

Objectives To evaluate the characteristic morphology of heel spur, and to investigate the relationship of heel spur and plantar heel pain. Methods From June 2005 to April 2009, 210 cases （254 feet） with heel spur （according to Denis Pain Scale） were divided into cases group 1 （P2,n = 46）, 2 （P3,n=44）, 3（P4,n =42）,4（PS,n =-36） and controls group（Pl,n =42）. Three-dimensional reconstruction of heel spur was performed in all groups using volume rendering based on multi-slice CT data by SuperImage orthopedics edition 1.0. The characteristic morphology of heel spur was observed and the data were measured and analyzed, involving the width of basilar part, the length, the angle between heel spur and planta pedis, and the angle between the longitudinal axis of caleaneus and heel spur. Results Parts of cases groups displayed coarse arcuate edge and undersurface with one or more little heel spurs adhere to heel spur, of which the numbers were greater than controls group, especially in cases group 4. No significant difference of the width of basilar part of heel spur was found among 5 groups （ F = 2. 32, P 〉 0. 05 ）. However, obvious difference was found in the length, the angle between heel spur and planta pedis, and the angle between the longitudinal axis of calcaneus and heel spur（ F = 8.23,6. 82, 5.87, P 〈 0. 05 ）. Compared with the controls group, the angle between heel spur and planta pedis of cases groups had higher degrees, but the difference of the other data presented irregular. Conclusions The characteristic morphology of heel spur varies in patients associated with plantar heel pain. No correlation is found between the severity and the morphological data, including the width of basilar part, the length, the angle between heel spur and planta pedis, and the angle between the longitudinal axis of calcaneus and heel spur.