跟腱腱内撕裂——一种新的病理情况？一项为期4年的大型队列研究分析
Intratendinous tears of the Achilles tendon - a new pathology? Analysis of a large 4-year cohort.
作者信息
Chan Otto, Morton Sarah, Pritchard Mel, Parkes Tina, Malliaras Peter, Crisp Tom, Padhiar Nat, Maffulli Nicola, King John, Morrissey Dylan
机构信息
BMI London Independent Hospital, London, UK.
Centre for Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, London, UK.
出版信息
Muscles Ligaments Tendons J. 2017 May 10;7(1):53-61. doi: 10.11138/mltj/2017.7.1.053. eCollection 2017 Jan-Mar.
BACKGROUND
Achillodynia is common and includes Achilles tendinopathy, partial Achilles tears and Achilles tendon ruptures. However, we believe an additional pathology should be considered for Achillodynia differentials - the intratendinous tear (ITT).
METHODS
Examinations of 740 achillodynic patients in one specialist centre were reviewed. ITTs were defined as a clearly visualised echopoor area situated centrally and extending to, but not through the tendon periphery, with pain on palpation and no clinical findings consistent with Achilles rupture. Descriptive statistics were used to analyse differences between pathological sub-groups, and images described qualitatively.
RESULTS
5% (29 males, 8 females) of 740 patients had an ITT. Patients typically presented with a history of sudden onset localised pain and the ability to train but not reach maximal loading. Average age was 36.3 years (range 20-64), significantly lower than mid-tendon tendinopathy (8.48 years; <0.01). 92% had concurrent Achilles tendinopathy. Elite sportspeople were more highly represented in the ITT than mid-tendon tendi nopathy groups (86.2% ITT group 13.8% mid-tendon AT group; <0.01).
CONCLUSIONS
ITTs should be actively searched for in patients with Achilles pathology, especially in elite male athletes with a history of high-impact pain. Prospective research is warranted concerning diagnosis and management.
LEVEL OF EVIDENCE
IV.
背景
跟腱痛很常见，包括跟腱病、跟腱部分撕裂和跟腱断裂。然而，我们认为在鉴别跟腱痛时应考虑另一种病理情况——肌腱内撕裂（ITT）。
方法
回顾了一家专科中心对740例跟腱痛患者的检查情况。ITT被定义为在肌腱中央清晰可见的低回声区，延伸至但未穿透肌腱周边，触诊时有疼痛，且无与跟腱断裂相符的临床发现。采用描述性统计分析病理亚组之间的差异，并对图像进行定性描述。
结果
740例患者中有5%（29例男性，8例女性）存在ITT。患者通常表现为突然发作的局部疼痛病史，能够进行训练但无法达到最大负荷。平均年龄为36.3岁（范围20 - 64岁），显著低于肌腱中部肌腱病患者（8.48岁；<0.01）。92%的患者同时患有跟腱病。ITT组中精英运动员的比例高于肌腱中部肌腱病组（ITT组86.2%，肌腱中部跟腱病组13.
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