网球腿的MRI表现及发病机制探究

MRI presentation and pathogenesis of tennis legs

目的总结网球腿MRI特征,探索网球腿的发病机制。方法回顾性分析自2014年5月至2018年6月我院符合纳入标准并经临床诊断的38例网球腿的MRI资料。所有受检者均行MRI平扫检查,扫描序列选取FSE冠状面T1WI、T2WI及横轴面质子密度加权成像。观察并记录腓肠肌(GM)及比目鱼肌(SM)相关部位液体聚集(血肿或积液)、肌腹和肌腱撕裂、小腿浅静脉曲张征象。结果冠状面T1WI、T2WI及横轴面观察出现GM内侧头(MGM)与SM肌间液体聚集30处(75.0%),GM外侧头(LGM)与SM肌间液体聚集11处(27.5%),MGM肌腱下液体聚集7处(17.5%),SM肌腱下液体聚集2处(5.0%)。聚集液体蔓延至内测缘小腿筋膜周围17处(42.5%)。聚集液体的上下径1.7~22.3cm,厚度0.2~3.5cm。GM撕裂共37处(92.5%),其中出现MGM腱腹移行部撕裂37处、LGM腱腹移行部撕裂15处,MGM肌腱撕裂24处、内外侧头肌腱同时撕裂3处、LGM肌腱撕裂2处。肌腱撕裂破口的最大径线1.2~27.0mm。MGM肌腹撕裂1处,GM内外侧头肌腹同时撕裂1处。SM的撕裂共15处(37.5%),其中出现SM腱腹移行部撕裂15处、肌腹撕裂2处、肌腱撕裂6处,肌腱撕裂破口最大径线2.5~14.9mm。出现跖肌肌腱撕裂4处(10%),3处出现小腿浅静脉曲张。结论网球腿是小腿三头肌及跖肌共同损伤所致,且MGM腱腹移行部和肌腱的撕裂是网球腿损伤的主要责任病灶。

Objective To evaluate the imaging features of MRI of tennis legs and to explore the pathogenesis of tennis legs. Methods A retrospective analysis was made on the MRI images of 38 patients with tennis legs which met the criteria and were clinically diagnosed in our hospital from May 2014 to June 2018. All patients underwent non-enhanced MRI. Coronal T1WI、T2WI fast spin echo (TSE) and transverse proton density weighted imaging (PDWI) were performed. The signs of fluid collection between gastrocnemius muscle (GM) and soleus muscle (SM),muscle and tendon injuries, superficial vein dilatation of calf were observed and recorded. Results Coronal T1WI, T2WI TSE and transverse PDWI sequences showed 30 (75.0%) places fluid collection (hematoma or effusion) between medial head of the gastrocnemius muscle (MCM) and SM,11 (27.5%) places fluid collection (hematoma or effusion) between lateral head of gastrocnemius muscle (LGM) and SM,7 (17.5%) places fluid collection (hematoma or effusion) in MGM and 2 (5.0%) placesin SM. There were 17 (42.5%) places that hematoma or effusion spread around the fascia of the lower leg. The diameter and thickness of hematoma or effusion are about 1.7-22.3 cm and 0.2-3.5 cm,respectively. Rupture of the GM was seen in 37 (92.5%) places,including 37 places rupture of the MGM at the myotendinous junction, 15 places rupture of the LGM at the myotendinous junction, 24 places tendonrupture of MGM,3 places tendon rupture of MGM and LGM,and 2 places tendon rupture of LGM. The maximum diameter of tendon rupture was 1.2-27.0 mm. The muscle rupture of MGM was seen in one place,and muscle rupture of MGM and LGM was seen in one place at the same time. Rupture of the SM was seen in15 (37.5%) places,including 15 places rupture of the SM at the myotendinous junction, 2 places muscle rupture of SM, 6 places tendonrupture of SM. The maximum diameter of tendon rupture was 2.5-14.9 mm. Rupture of plantaris tendon (PT) was seen in 4 (10.0%) places. Superficial vein dilatation was seen in 3 (7.5%) places. Conclusion This study shows that the rupture of the MGM at the myotendinous junction and the tendon is the main responsibility of tennis leg.