跟腱旋转及腓肠神经解剖结构的MRI评估：对经皮及有限切开跟腱修复术的意义
MRI Evaluation of Achilles Tendon Rotation and Sural Nerve Anatomy: Implications for Percutaneous and Limited-Open Achilles Tendon Repair.
作者信息
MacMahon Aoife, Deland Jonathan T, Do Huong, Soukup Dylan S, Sofka Carolyn M, Demetracopolous Constantine A, DeBlis Ryan
机构信息
Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA.
Department of Epidemiology and Biostatistics, Hospital for Special Surgery, New York, NY, USA.
出版信息
Foot Ankle Int. 2016 Jun;37(6):636-43. doi: 10.1177/1071100716628915. Epub 2016 Feb 3.
BACKGROUND
Limited-open and percutaneous Achilles tendon (AT) repair techniques have limited visibility, which may result in sural nerve violation and poor tendon targeting. The goal of this study was to assess the in vivo rotation of the AT and its distance to the sural nerve in ruptured and nonruptured ATs to develop guidelines to aid in limited-open and percutaneous repair techniques.
METHODS
A retrospective review was conducted to identify magnetic resonance imaging (MRI) studies of patients with ruptured and healthy (nonruptured) ATs. AT rotation and distance to the sural nerve in the anterior-posterior (A-P) and medial-lateral (M-L) planes were measured at the level of and proximal to the ankle.
RESULTS
The AT was externally rotated in both ruptured and nonruptured cohorts. Ruptured ATs showed greater external rotation than nonruptured ATs at the ankle (15.8 ± 16.2 degrees vs 5.9 ± 9.0 degrees, P = .008) but not at 10 cm proximal to the tendon's insertion (10.9 ± 10.9 degrees vs 6.1 ± 8.4 degrees, P = .139). Proximal AT rotation was negatively correlated with rupture height (r = -0.477, P = .029). At 4 cm proximal to the AT insertion, the sural nerve was closer anteriorly to and farther laterally from the AT in ruptures than in nonruptures (P < .001). At 10 cm proximal to the AT insertion, the sural nerve was farther posteriorly and laterally from the AT in ruptures than in nonruptures (P = .027 and P < .001, respectively).
CONCLUSION
We found that the AT was more externally rotated in ruptured than in nonruptured tendons at the ankle and that its distance to the sural nerve differed between the 2 cohorts in the A-P and M-L planes, likely due to increased AT rotation and swelling with ruptures. To minimize sural nerve injury and improve tendon targeting, we suggest an external rotation of 11 degrees at the proximal end of the rupture and 16 degrees at the distal end when using percutaneous and limited-open AT repair devices to try to minimize sural nerve violation and increase tendon capture, which can decrease rates of complication and rerupture.
LEVEL OF EVIDENCE
Level III, retrospective comparative study.
背景
有限切开和经皮跟腱（AT）修复技术视野有限，这可能导致腓肠神经损伤和肌腱定位不佳。本研究的目的是评估断裂和未断裂的AT在体内的旋转情况及其与腓肠神经的距离，以制定有助于有限切开和经皮修复技术的指南。
方法
进行回顾性研究，以确定断裂和健康（未断裂）AT患者的磁共振成像（MRI）研究。在踝关节水平及其近端测量AT在前后（A-P）和内外侧（M-L）平面的旋转情况以及与腓肠神经的距离。
结果
在断裂和未断裂队列中，AT均发生外旋。断裂的AT在踝关节处的外旋角度大于未断裂的AT（15.8±16.2度对5.9±9.0度，P = 0.008），但在肌腱止点近端10 cm处则不然（10.9±10.9度对6.1±8.4度，P = 0.139）。近端AT旋转与断裂高度呈负相关（r = -0.477，P = 0.029）。在AT止点近端4 cm处，与未断裂相比，断裂时腓肠神经在前方更靠近AT且在外侧离AT更远（P < 0.001）。在AT止点近端10 cm处，与未断裂相比，断裂时腓肠神经在后方和外侧离AT更远（分别为P = 0.027和P < 0.001）。
结论
我们发现，与未断裂的肌腱相比，断裂的AT在踝关节处的外旋程度更大，并且在A-P和M-L平面中，两组之间其与腓肠神经的距离不同，这可能是由于断裂时AT旋转增加和肿胀所致。为了尽量减少腓肠神经损伤并改善肌腱定位，我们建议在使用经皮和有限切开AT修复装置时，在断裂近端进行11度的外旋，在远端进行16度的外旋，以尽量减少腓肠神经损伤并增加肌腱捕捉，从而降低并发症和再断裂的发生率。
证据水平
III级，回顾性比较研究。
Zotero 插件