Bullock Mark J, Mourelatos Jan, Mar Alice
Surgeon, Saginaw Valley Bone and Joint Center, Saginaw, MI.
Doctor, Eastpointe Radiologists, PC, Grosse Pointe Woods, MI.
J Foot Ankle Surg. 2017 May-Jun;56(3):555-563. doi: 10.1053/j.jfas.2017.01.024. Epub 2017 Feb 28.
Haglund's syndrome is impingement of the retrocalcaneal bursa and Achilles tendon caused by a prominence of the posterosuperior calcaneus. Radiographic measurements are not sensitive or specific for diagnosing Haglund's deformity. Localization of a bone deformity and tendinopathy in the same sagittal section of a magnetic resonance imaging scan can assist with the diagnosis in equivocal cases. The aim of the present cross-sectional study was to determine the prevalence of Haglund's syndrome in patients presenting with Achilles tendinopathy and note any associated findings to determine the criteria for a diagnosis of Haglund's syndrome. We reviewed 40 magnetic resonance imaging scans with Achilles tendinopathy and 19 magnetic resonance imaging scans with Achilles high-grade tears and/or ruptures. Achilles tendinopathy was often in close proximity to the superior aspect of the calcaneal tuberosity, consistent with impingement (67.5%). Patients with Achilles impingement tendinopathy were more often female (p < .04) and were significantly heavier than patients presenting with noninsertional Achilles tendinopathy (p = .014) or Achilles tendon rupture (p = .010). Impingement tendinopathy occurred medially (8 of 20) and centrally (10 of 20) more often than laterally (2 of 20) and was associated with a posterior prominence or hyperconvexity with a loss of calcaneal recess more often than a superior projection (22 of 27 versus 8 of 27; p < .001). Haglund's deformity should be reserved for defining a posterior prominence or hyperconvexity with loss of calcaneal recess because this corresponds with impingement. Achilles impingement tendinopathy might be more appropriate terminology for Haglund's syndrome, because the bone deformity is often subtle. Of the 27 images with Achilles impingement tendinopathy, 10 (37.0%) extended to a location prone to Achilles tendon rupture. Given these findings, insertional and noninsertional Achilles tendinopathy are not mutually exclusive and impingement might be a subtle, unrecognized cause of Achilles tendinopathy and subsequent rupture.
Haglund综合征是由跟骨后上方突出导致的跟腱后滑囊和跟腱受到撞击。X线测量对于诊断Haglund畸形并不敏感或特异。在磁共振成像扫描的同一矢状面中定位骨畸形和肌腱病可有助于诊断不明确的病例。本横断面研究的目的是确定患有跟腱病的患者中Haglund综合征的患病率，并记录任何相关发现以确定Haglund综合征的诊断标准。我们回顾了40例患有跟腱病的磁共振成像扫描和19例患有跟腱严重撕裂和/或断裂的磁共振成像扫描。跟腱病常紧邻跟骨结节的上缘，符合撞击表现（67.5%）。患有跟腱撞击性肌腱病的患者女性更为常见（p < 0.04），且明显比患有非附着点性跟腱病（p = 0.014）或跟腱断裂（p = 0.010）的患者体重更重。撞击性肌腱病发生在内侧（20例中的8例）和中央（20例中的10例）比外侧（20例中的2例）更常见，并且与后方突出或过度凸隆伴跟骨隐窝消失相关的情况比上方突出更常见（27例中的22例对27例中的8例；p < 0.001）。Haglund畸形应保留用于定义后方突出或过度凸隆伴跟骨隐窝消失，因为这与撞击相对应。跟腱撞击性肌腱病对于Haglund综合征可能是更合适的术语，因为骨畸形通常很细微。在27例患有跟腱撞击性肌腱病的图像中，10例（37.0%）延伸至易于发生跟腱断裂的部位。基于这些发现，附着点性和非附着点性跟腱病并非相互排斥，撞击可能是跟腱病及随后断裂的一个细微、未被认识到的原因。
