Freccero David M, Berkowitz Mark J
Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859-5000, USA.
Foot Ankle Int. 2006 Apr;27(4):236-9. doi: 10.1177/107110070602700402.
Anomalous distal insertion of the peroneus brevis muscle belly has been implicated as a possible etiology of tears of the peroneus brevis tendon. The purpose of this study was to assess whether patients with operatively confirmed tears of the peroneus brevis tendons have a more distally located musculotendinous junction.
A retrospective review was done to identify all patients in whom direct inspection of the peroneal tendons was done between 1999 and 2004. The operative reports were evaluated, and all in whom a peroneal tendon tear was confirmed were included in the study group, Group I (29 patients). Group II represented an operative control group and consisted of all patients who had operative inspection of the peroneal tendons but did not have a tear (30 patients). Group III represented a radiographic control group and consisted of patients who had MRI of the ankle for reasons unrelated to lateral ankle symptoms (30 patients). For each patient, the vertical distance from the musculotendinous junction of the peroneus brevis tendon to the tip of the fibula was measured on sagittal MRI. The role of gender also was examined. The average distance between the musculotendinous junction of the peroneus brevis tendon to the distal fibula was calculated solely for men and women in all three groups. Statistical comparison of the groups was performed using the Mann-Whitney test. Interobserver reliability was determined by calculating Cronbach's Alpha coefficient.
The average distance from the musculotendinous junction to the tip of the fibula was 33.1 cm, 41.2 cm, and 46.3 cm in Groups I, II, and III, respectively. The average distance in Group I was statistically significantly lower than the average distance in both Groups II and III (p < 0.05). Interestingly, the difference in the distance between Groups II and III also was statistically significant (p < 0.05). The average distances in both men and women were statistically significantly different (p < 0.05) among the three groups.
It has been hypothesized that tears of the peroneus brevis tendon result from distal insertion of the peroneus brevis muscle belly. This study provides radiographic support for this hypothesis.
腓骨短肌肌腹远端异常附着被认为可能是腓骨短肌腱撕裂的病因。本研究的目的是评估手术证实的腓骨短肌腱撕裂患者的肌骨连接处是否更靠近远端。
进行一项回顾性研究，以确定1999年至2004年间所有接受腓骨肌腱直接检查的患者。评估手术报告，所有经证实有腓骨肌腱撕裂的患者纳入研究组，即第一组（29例患者）。第二组为手术对照组，由所有接受腓骨肌腱手术检查但未发生撕裂的患者组成（30例患者）。第三组为影像学对照组，由因与外侧踝关节症状无关的原因接受踝关节MRI检查的患者组成（30例患者）。对于每位患者，在矢状面MRI上测量腓骨短肌腱肌骨连接处至腓骨尖的垂直距离。还研究了性别因素。仅计算所有三组男性和女性中腓骨短肌腱肌骨连接处至腓骨远端的平均距离。使用Mann-Whitney检验对各组进行统计学比较。通过计算Cronbach's Alpha系数确定观察者间的可靠性。
第一组、第二组和第三组中，肌骨连接处至腓骨尖的平均距离分别为33.1 cm、41.2 cm和46.3 cm。第一组的平均距离在统计学上显著低于第二组和第三组的平均距离（p < 0.05）。有趣的是，第二组和第三组之间的距离差异在统计学上也具有显著性（p < 0.05）。三组中男性和女性的平均距离在统计学上均有显著差异（p < 0.05）。
有人提出腓骨短肌腱撕裂是由腓骨短肌肌腹远端附着所致。本研究为这一假说提供了影像学支持。
