腓骨肌腱正常解剖及损伤的磁共振表现

Magnetic resonance imaging of normal anatomy and injury of the peroneal tendon

目的探讨腓骨肌腱正常解剖和损伤的磁共振(MR)表现,以及MR对腓骨肌腱损伤的诊断价值。方法回顾性分析2018年2至12月北京积水潭医院20名(40侧踝关节)健康志愿者,男10名、女10名,年龄20~30(26±3)岁,62例踝关节扭伤并经手术证实的腓骨肌腱损伤患者,男34例,女28例,年龄14~78(41±14)岁,所有志愿者及患者均行MR检查。分析腓骨肌腱正常解剖结构的MRI表现特点,并根据腓骨肌腱损伤的MR诊断标准,对损伤患者进行分型,研究腓骨长、短肌腱不同损伤类型的MRI表现特点,并与手术结果进行对照分析。结果20名健康志愿者腓骨肌腱在T1WI及质子压脂序列上均表现为椭圆形和条带状均匀低信号,走形自然,边界清晰。腓骨肌腱不能在同一层面显示全长,需多层面、多方位观察。腓骨肌腱损伤患者62例,其中腓骨肌腱撕裂46例,部分层厚撕裂7例(11.3%),全层厚撕裂39例(62.9%);腓骨肌腱脱位16例,鞘内脱位15例(24.2%),鞘外脱位1例(1.6%)。其中部分层厚撕裂7例(腓骨短肌腱撕裂4例,腓骨长肌腱撕裂3例),MR表现为肌腱形态不规整,局部连续性中断。39例全层厚撕裂患者(腓骨短肌腱撕裂31例,腓骨长肌腱撕裂8例),MR表现为撕裂口由足背侧至跖侧贯穿肌腱全层,撕裂范围不一,撕裂肌腱可伴发肌腱炎或腱鞘积液。15例鞘内脱位(A型脱位3例,B型脱位12例),A型脱位MR表现为腓骨长肌腱位于腓骨短肌腱深部走行,B型脱位MR表现为腓骨长肌腱移位至腓骨短肌腱纵行撕裂口内。1例鞘外脱位(Ⅲ型),MR表现为腓骨肌上支持带连同附着的外踝骨皮质一同发生撕脱,腓骨肌腱移位至撕脱的骨折片下方。结论MR可清晰显示腓骨肌腱的精细解剖结构及损伤的影像学表现特点,对腓骨肌腱损伤的早期诊断和精准治疗具有重要的临床应用价值。

Objective To explore the MR characteristics of normal anatomy and injured peroneal tendon and the diagnostic value of MR in the peroneal tendon injuries.Methods From February 2018 to December 2018,a total of 20 healthy volunteers(40 ankle joints)were selected,10 males and 10 females,with an age range of 20-30(26±3)years.Retrospective analyzed 62 patients with ankle sprain and peroneal tendon injuries confirmed by operation,34 males and 28 females,with an age range of 14-78(41±14)years.All volunteers and patients underwent MR examination.The MRI characteristics of the normal anatomy of peroneal tendon were analyzed.The patients were classified according to the MR diagnostic criteria of injury.Then the MRI features of different types of injured peroneus longus tendon and peroneus brevis tendon were analyzed.At last,imaging findings were compared with surgical results.Results The peroneal tendon of 20 healthy volunteers showed oval and elliptical band-like structures on T1WI and PD-FS sequences,with natural alignment,clear boundary and uniform low signal.The whole length of the peroneal tendon can′t be displayed completely on the same imaging plane.It needed multi-dimensional observation combined with axial,coronal and sagittal directions.There were 62 cases of peroneal tendon injury,including 46 cases of peroneal tendon tear(7 cases of partial-thickness tear,11.3%of the total injuries,39 cases of full-thickness tear,62.9%of the total injuries),16 cases of peroneal tendon dislocation(15 cases of intrathecal dislocation,24.2%of the total injuries,1 case of extrathecal dislocation,1.6%of the total injuries).In 7 cases of partial-thickness tear(4 cases of peroneus brevis tendon tear,3 cases of peroneus longus tendon tear),MR showed irregular tendon shape and local continuity interruption.In 39 cases of full-thickness tear(31 cases of peroneus brevis tendon tear,8 cases of peroneus longus tendon tear),MR showed that the tear was penetrated through the whole layer of tendon from dorsolateral side to plantar side of foot,and the range of tear was different.The torn tendon could be accompanied by tendinitis or effusion of tendon sheath;15 cases of intrathecal dislocation(3 cases of type A,12 cases of type B),MR findings of type A dislocation showed that the peroneus longus tendon was located in the deep part of the peroneus brevis tendon,MR findings of type B dislocation showed that the peroneus longus tendon was displaced into the longitudinal tear of peroneus brevis tendon.In 1 case of extrathecal dislocation(typeⅢ),MR showed that the SPR and the attached cortex of lateral malleolus were avulsed together,and the peroneal tendon was displaced under the avulsed fracture piece.Conclusion MR can accurately demonstrate the fine anatomical structure of peroneal tendon and the imaging features of injuries.It has important clinical application value for the early diagnosis and accurate treatment of peroneal tendon injuries.