Rand T, Trattnig S, Breitenseher M, Kreuzer S, Wagesreither S, Imhof H
Einrichtung für Magnetresonanztomographie, Universität Wien.
Radiologe. 1999 Jan;39(1):52-9.
The etiology of chronic diseases of the ankle joint comprises a wide spectrum including chronic inflammatory processes and chronic degenerative, tumorous and neuropathic processes, as well as some specific syndromes based on chronic changes of the ankle joint. Of the inflammatory processes, chronic juvenile arthritis (JVC) is the most common disease. However, also Reiter disease, psoriasis or chronic monoarthritid diseases such as gout, as well as granulomatous diseases (tuberculosis, sarcoidosis) and fungal infections, may affect the ankle joint in a chronic course. Chronic degenerative changes are usually secondary due to abnormal positioning of the joint constituents or repetitive trauma. Neuropathic changes, as frequently seen in the course of diabetes, present with massive osseous destruction and malposition of the articular constituents. Chronic osseous as well as cartilaginous and synovial changes are seen in hemophilic patients. Chronic traumatic changes are represented by pigmented villonodular synovitis (PVNS), and chondromatosis, both with a predilection for the ankle joint. Due to the possibilities of magnetic resonance imaging (MRI), diagnosis of chronic ankle changes includes chronic ligamentous, tendinous and soft tissue changes. With the use of MRI, specific syndromes can be defined which particularly affect the ankle joint in a chronic way, such as the os trigonum syndrome, the anterolateral impingement syndrome and the sinus tarsi syndrome. Nevertheless, plain film radiographs are still the basic element of any investigation. MRI, however, can be potentially used as a second investigation, saving an unnecessary cascade of investigations with ultrasound and CT. The latter investigations are used only with very specific indications, for instance CT for subtle bone structures and sonography for a limited investigation of tendons or evaluation of fluid. Particularly due to the possibilities of MRI and the development of special gradient-echo imaging or high-resolution coils, the investigation of the ankle joint still offers a wide spectrum of innovation for the next years, which is particularly enforced by the increasing demand for specific diagnosis of chronic diseases in orthopedic medicine.
踝关节慢性疾病的病因多种多样，包括慢性炎症过程、慢性退行性病变、肿瘤性病变和神经性病变，以及一些基于踝关节慢性变化的特定综合征。在炎症过程中，慢性幼年型关节炎（JVC）是最常见的疾病。然而，赖特综合征、银屑病或慢性单关节炎疾病（如痛风），以及肉芽肿性疾病（结核病、结节病）和真菌感染，也可能在慢性病程中影响踝关节。慢性退行性变化通常是由于关节组成部分的异常定位或反复创伤所致。神经性变化，如糖尿病病程中常见的情况，表现为大量骨质破坏和关节组成部分的错位。血友病患者可见慢性骨、软骨和滑膜变化。慢性创伤性变化以色素沉着绒毛结节性滑膜炎（PVNS）和滑膜软骨瘤病为代表，两者都好发于踝关节。由于磁共振成像（MRI）的应用，慢性踝关节病变的诊断包括慢性韧带、肌腱和软组织变化。通过使用MRI，可以定义一些特别以慢性方式影响踝关节的特定综合征，如距骨三角综合征、前外侧撞击综合征和跗骨窦综合征。尽管如此，普通X线平片仍然是任何检查的基本要素。然而，MRI有可能用作第二项检查，避免不必要的超声和CT检查的层层递进。后两者仅在非常特定的指征下使用，例如CT用于观察细微的骨骼结构，超声用于对肌腱进行有限的检查或评估积液。特别是由于MRI的应用可能性以及特殊梯度回波成像或高分辨率线圈的发展，未来几年踝关节检查仍有广泛的创新空间，这尤其受到骨科医学中对慢性疾病进行特异性诊断的需求不断增加的推动。
