Andersson Gustav, Backman Ludvig J, Christensen Jens, Alfredson Håkan
Department of Integrative Medical Biology, Section for Anatomy, Umeå University, Umeå, Sweden.
Department of Surgical and Perioperative Science, Section for Hand and Plastic Surgery, Umeå University, Umeå, Sweden.
Histol Histopathol. 2017 Mar;32(3):263-270. doi: 10.14670/HH-11-790. Epub 2016 Jun 20.
BACKGROUND/AIM: In a condition of pain in the Achilles tendon insertion there are multiple structures involved, such as the Achilles tendon itself, the retrocalcaneal bursa and a bony protrusion at the calcaneal tuberosity called Haglund's deformity. The innervation patterns of these structures are scarcely described, and the subcutaneous calcaneal bursa is traditionally not considered to be involved in the pathology. This study aimed at describing the innervation patterns of the four structures described above to provide a better understanding of possible origins of pain at the Achilles tendon insertion.
Biopsies were taken from 10 patients with insertional Achilles tendinopathy, which had pathological changes in the subcutaneous and retrocalcaneal bursae, a Haglund deformity and Achilles tendon tendinopathy as verified by ultrasound. The biopsies were stained using immunohistochemistry in order to delineate the innervation patterns in the structures involved in insertional Achilles tendinopathy.
Immunohistochemical examinations found that the subcutaneous bursa scored the highest using a semi-quantitative evaluation of the degree of innervation when compared to the retrocalcaneal bursa, the Achilles tendon, and the calcaneal bone.
These findings suggest that the subcutaneous bursa, which is traditionally not included in surgical treatment, may be a clinically important factor in insertional Achilles tendinopathy.
背景/目的：在跟腱止点疼痛的情况下，涉及多种结构，如跟腱本身、跟腱后滑囊以及跟骨结节处的骨性突起，即Haglund畸形。这些结构的神经支配模式鲜有描述，且传统上认为皮下跟骨滑囊不参与该病理过程。本研究旨在描述上述四种结构的神经支配模式，以便更好地理解跟腱止点疼痛的可能起源。
对10例跟腱止点性肌腱病患者进行活检，经超声证实其皮下和跟腱后滑囊有病理改变、存在Haglund畸形及跟腱肌腱病。对活检组织进行免疫组织化学染色，以描绘跟腱止点性肌腱病所涉及结构的神经支配模式。
免疫组织化学检查发现，与跟腱后滑囊、跟腱和跟骨相比，皮下滑囊在神经支配程度的半定量评估中得分最高。
这些发现表明，传统上不包括在手术治疗中的皮下滑囊，可能是跟腱止点性肌腱病的一个重要临床因素。
