Zeiss J, Ebraheim N, Rusin J, Coombs R J
Medical College of Ohio, Department of Radiology, Toledo 43699.
Foot Ankle. 1991 Apr;11(5):264-73. doi: 10.1177/107110079101100503.
Images obtained from normal volunteers demonstrate highly detailed anatomy of the soft tissue and bony structures near the calcaneus and subtalar joint. Cortical bone, marrow, articular cartilage, ligaments, tendons, muscles, fibrous tissue, vascular bundles, and nerves can be identified. However, images obtained of acute calcaneal fractures were found to offer unsatisfactory depiction of bony anatomy. The presence of small fragments was obscured by a change in normal marrow signal by contusion, hemorrhage, and edema, and by the inability of magnetic resonance (MR) to image small pieces of cortical bone. Only in rare instances might MR be helpful in the acute setting when the location or displacement of tendons cannot be clearly ascertained with computed tomography (CT). MR may prove more useful in the long-term follow-up of healed fractures with persistent pain. In this setting it might be used in the diagnosis of complications such as residual or recurrent tendon displacement, tenosynovitis, heel fat integrity, and tarsal tunnel evaluation. However, this paper did not directly compare the efficacy of MR with that of CT in the long term. Therefore, the degree to which MR may eventually supplement or supplant CT is unclear and further study is required before the use of MR can be recommended in the routine clinical follow-up of calcaneal fractures.
从正常志愿者获得的图像展示了跟骨和距下关节附近软组织和骨结构的高度详细解剖。可以识别皮质骨、骨髓、关节软骨、韧带、肌腱、肌肉、纤维组织、血管束和神经。然而，发现急性跟骨骨折的图像对骨解剖的描绘并不理想。小骨折块的存在被挫伤、出血和水肿引起的正常骨髓信号变化以及磁共振（MR）对小块皮质骨成像的能力不足所掩盖。只有在极少数情况下，当肌腱的位置或移位无法通过计算机断层扫描（CT）清楚确定时，MR在急性情况下可能会有所帮助。MR在愈合骨折伴有持续疼痛的长期随访中可能更有用。在这种情况下，它可用于诊断并发症，如残留或复发性肌腱移位、腱鞘炎、足跟脂肪完整性以及跗管评估。然而，本文没有直接比较MR与CT在长期的疗效。因此，MR最终可能补充或取代CT的程度尚不清楚，在推荐将MR用于跟骨骨折的常规临床随访之前，还需要进一步研究。
