Robinson Philip, White Lawrence M
Department of Radiology, St James University Hospital, Beckett St, Leeds LS9 7TF, England.
Radiographics. 2002 Nov-Dec;22(6):1457-69; discussion 1470-1. doi: 10.1148/rg.226025034.
Soft-tissue and osseous impingement syndromes of the ankle can be an important cause of chronic pain, particularly in the professional athlete. The main impingement syndromes are anterolateral, anterior, anteromedial, and posterior impingement. These conditions arise from initial ankle injuries, which, in the subacute or chronic situation, lead to development of abnormal osseous and soft-tissue thickening within the ankle joint. The relative contributions of the osseous and soft-tissue abnormalities are variable, but whatever component is dominant there is physical impingement and painful limitation of ankle movement. Conventional radiography is usually the first imaging technique performed and allows assessment of any potential bone abnormality, particularly in anterior and posterior impingement. Computed tomography (CT) and isotope bone scanning have been largely superseded by magnetic resonance (MR) imaging, but the accuracy and role of MR imaging in assessment of possible ankle impingement have not been clearly established. MR imaging can demonstrate osseous and soft-tissue edema in anterior or posterior impingement. Studies of conventional MR imaging have produced conflicting sensitivities and specificities in assessment of anterolateral impingement. CT and MR arthrographic techniques allow the most accurate assessment of the capsular recesses, albeit with important limitations in diagnosis of clinical impingement syndromes.
踝关节的软组织和骨撞击综合征可能是慢性疼痛的重要原因，尤其是在职业运动员中。主要的撞击综合征包括前外侧、前方、前内侧和后方撞击。这些情况源于最初的踝关节损伤，在亚急性或慢性情况下，会导致踝关节内出现异常的骨和软组织增厚。骨和软组织异常的相对作用各不相同，但无论哪个成分占主导，都会出现物理撞击以及踝关节活动的疼痛性受限。传统X线摄影通常是首先进行的成像技术，可用于评估任何潜在的骨异常，特别是在前侧和后侧撞击中。计算机断层扫描（CT）和同位素骨扫描在很大程度上已被磁共振（MR）成像所取代，但MR成像在评估可能的踝关节撞击中的准确性和作用尚未明确确立。MR成像可显示前侧或后侧撞击中的骨和软组织水肿。传统MR成像研究在评估前外侧撞击时产生了相互矛盾的敏感性和特异性。CT和MR关节造影技术能对关节囊隐窝进行最准确的评估，尽管在临床撞击综合征的诊断方面存在重要局限性。
