后足肌腱韧带解剖与损伤的MRI表现

MR Imaging of the Tendon and Ligament of the Hind Foot:Anatomy and Injury

目的 利用高分辨3.0 T MRI技术,探讨后足肌腱韧带解剖及损伤的影像学表现,为后足损伤的诊断与治疗提供解剖学和影像学依据。方法 回顾性分析2015年6月至2021年9月65例外伤疼痛经手术或随访证实的后足肌腱韧带损伤患者和15名健康志愿者(30足)的临床资料和影像学表现。所有志愿者及后足外伤患者均行中后足冠状位、矢状位和轴位的MRI T_1WI和质子密度加权脂肪抑脂(PD-FS)序列检查。分析后足肌腱韧带正常解剖及损伤后的MRI表现。结果 15名健康志愿者(30足)的后足肌腱韧带表现为均匀条状或线样低信号,其中腓骨长肌肌腱、腓骨短肌腱和跟腱表现为条带状均匀低信号,而跟骰韧带、足底筋膜表现为线样低信号。65例后足肌腱韧带损伤患者中,腓骨长肌肌腱损伤10例,腓骨短肌肌腱损伤17例,跟骰韧带损伤10例,足底筋膜炎12例,跟腱损伤16例。损伤的肌腱韧带T_1WI序列表现为纤维不连续、增粗、模糊,PDFS序列表现为肌腱韧带走行区内不均匀高信号,腱鞘积液,部分撕裂表现为纤维不连续、增粗。完全撕裂表现为纤维中断、回缩,断端纤维结构消失,被液体充填,其周围软组织水肿。结论 高分辨3.0 T MRI可清晰显示后足肌腱韧带的精细解剖结构和损伤的影像学表现,对后足肌腱韧带损伤的早期诊断和治疗具有重要的临床应用价值。

Objective Using high⁃resolution 3.0T MRI imaging technology,the anatomy and imaging manifestations of the tendon and ligament injury in the hindfoot were studied,providing anatomical and imaging evidence for the diagnosis and treatment of hindfoot injury.Methods From June 2015 to September 2021,65 patients with hind foot tendon and ligament injuries confirmed by surgery or clinical follow⁃up and 15 healthy volunteers(30 feet)were retrospectively analyzed.All pa⁃tients with hindfoot injury andvolunteers underwent coronal,sagittal,and axial MRI T1WI and PD⁃FS sequence examinations of the middle and hind feet.To analyze the normal anatomy and MRI findings of the tendon and ligament of the hindfoot after injury.Results The tendons and ligaments of the hind foot of 15 healthy volunteers(30 feet)showed uniform strip or lin⁃ear low signal,among which the peroneus longus tendon,peroneus brevis tendon,and achilles tendon showed uniform strip low signal,while the calcaneocuboid ligament and plantar fascia showed linear low signal.There were 65 cases of hind foot tendon and ligament injury,including 10 cases(10/65)of peroneal tendon injury,17 cases of peroneal brevis tendon inju⁃ry,10 cases of calcaneocuboid ligament injury,12 cases of plantar fasciitis,and 16 cases of Achilles tendon injury.The T1WI sequence of the injured tendon and ligament showed discontinuous,thickened,and blurred fibers,while the PD⁃FS se⁃quence showed uneven high signal in the traveling area of the tendon and ligament,fluid accumulation in the tendon sheath,and partial tears showed discontinuous,thickened fibers.Complete tears manifest as fiber disruption and retraction,with the fiber structure at the broken end disappearing,filled with fluid,and surrounding soft tissue edema.Conclusion High reso⁃lution 3.0T MRI can clearly display the fine anatomical structure of the hind foot tendon and ligament and the imaging man⁃ifestations of the injury,which has important clinical application value for the early diagnosis and treatment of hind foot ten⁃don and ligament injury.