Departments of Physical Medicine & Rehabilitation, Radiology, and Anatomy, Mayo Clinic Sports Medicine Center, Mayo Clinic, 200 1st St, SW, Rochester, MN 55905.
Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.
PM R. 2019 Jan;11(1):56-63. doi: 10.1016/j.pmrj.2018.05.024. Epub 2019 Jan 15.
The plantaris tendon (PT) has been implicated in the pathogenesis of symptoms in a subset of patients with Achilles region pain syndromes and traditionally has been managed via open surgical resection. Although the PT can be visualized on ultrasound, a minimally invasive technique for sonographically guided PT release has not been formally described.
To validate a technique to perform sonographically guided PT release in an unembalmed cadaveric model.
Prospective, cadaveric laboratory investigation.
Procedural skills laboratory in a tertiary medical center.
Twenty unembalmed cadaveric knee-ankle-foot specimens (10 right, 10 left) obtained from 16 donors (6 male, 10 female) ages 55-96 years (mean 82.6 years) with body mass indexes of 14.1-33.2 kg/m (mean 23.3 kg/m ).
After simulated local anesthesia and sonographically guided hydrodissection of the plantaris tendon-Achilles tendon interval, a single experienced operator performed sonographically guided PT release on each specimen using an in-plane, lateral-to-medial approach, a commercially available, disposable 3.0-mm hook knife, and either a 17-5 MHz or 15-7 MHz linear array transducer. Each specimen was subsequently dissected to assess for PT release and iatrogenic injury.
Status of the PT, Achilles tendon, and regional neurovascular structures as determined by dissection.
All 20 PT releases were completed in a single attempt through a 3- to 5-mm incision. Dissection confirmed complete PT release in all specimens without damage to the adjacent Achilles tendon or regional neurovascular structures.
Sonographically guided PT release is technically feasible and can be performed while avoiding injury to the Achilles tendon and regional neurovascular structures. Additional research is warranted to further define the role of sonographically guided PT release in patients with suspected PT-mediated Achilles region pain syndromes.
IV.
植筋（PT）被认为与跟腱区域疼痛综合征患者的部分症状的发病机制有关，传统上通过开放式手术切除来治疗。尽管在超声上可以看到 PT，但尚未正式描述一种用于超声引导下 PT 释放的微创技术。
在未防腐的尸体模型中验证一种用于超声引导下 PT 释放的技术。
前瞻性、尸体实验室研究。
三级医疗中心的程序技能实验室。
20 个来自 16 个供体（6 名男性，10 名女性）的未防腐的膝关节-踝关节-足部标本（10 个右侧，10 个左侧），年龄 55-96 岁（平均 82.6 岁），体重指数为 14.1-33.2kg/m（平均 23.3kg/m）。
在模拟局部麻醉和超声引导下水分离植筋-跟腱间隙后，一名经验丰富的操作人员使用平面内、从外侧到内侧的方法，使用一种商业上可获得的、一次性 3.0mm 钩刀和 17-5MHz 或 15-7MHz 线性阵列换能器，对每个标本进行超声引导下的 PT 释放。然后对每个标本进行解剖，以评估 PT 释放和医源性损伤的情况。
通过解剖确定的 PT、跟腱和区域神经血管结构的状态。
所有 20 个 PT 释放都在一个 3-5mm 的切口内通过一次尝试完成。解剖证实所有标本的 PT 释放完全，没有损伤相邻的跟腱或区域神经血管结构。
超声引导下的 PT 释放在技术上是可行的，可以在避免损伤跟腱和区域神经血管结构的情况下进行。需要进一步的研究来进一步确定超声引导下 PT 释放在疑似由 PT 引起的跟腱区域疼痛综合征患者中的作用。
IV。
