Ernat Justin J, Johnson John D, Anderson Claude D, Ryan Paul M, Yim Duke G
Orthopedic Surgeon, Blanchfield Army Community Hospital, Fort Campbell, KY.
Orthopedic Surgery Resident, Tripler Army Medical Center, Honolulu, HI.
J Foot Ankle Surg. 2019 Jan;58(1):161-164. doi: 10.1053/j.jfas.2018.06.008. Epub 2018 Oct 9.
The purpose of this study was to determine if clinical palpation and ultrasound determination of apposition compares with magnetic resonance imaging (MRI) findings in patients with an acute Achilles tendon rupture. A review of 18 consecutive patients presenting with an acute Achilles tendon tear was performed. All tears were diagnosed by clinical exam and confirmed by ultrasound. Ankles were then plantarflexed to a point where tendon apposition was achieved as determined by palpation and ultrasound. Dorsally based equinus splints were applied, and approximation was reconfirmed by palpation and ultrasound. MRI was performed on all patients for comparison to the exam/ultrasound for any residual gapping after splinting. Demographic and clinical comparisons were made between those with <0.5 cm and ≥0.5 cm of residual gapping found on MRI. Eighteen patients with acute Achilles tears were splinted at a mean of 41° ± 11°, with presumed, complete tendon approximation confirmed with palpation and ultrasound. Post-splinting MRI demonstrated that 9/18 (50%) of these patients had residual gapping at a mean of 2.2 ± 1 cm. Mean time to MRI from splinting was not different between those with gapping (1.3 ± 2 days) and those without (1.2 ± 1 days). No other clinical or demographic differences were observed between these groups. In conclusion, clinical exam and ultrasound did not routinely relate to MRI in assessing tendon approximation after splinting of an acute Achilles tendon tear. For surgeons who use approximation as a determination of nonoperative treatment, varying results can be obtained depending on the clinical utility used.
本研究的目的是确定急性跟腱断裂患者中，临床触诊和超声测定的断端对合情况与磁共振成像（MRI）结果相比如何。对18例连续出现急性跟腱撕裂的患者进行了回顾性研究。所有撕裂均通过临床检查诊断，并经超声确认。然后将踝关节跖屈至通过触诊和超声确定达到肌腱对合的位置。应用背侧马蹄形夹板，并通过触诊和超声再次确认对合情况。对所有患者进行MRI检查，以与夹板固定后检查/超声结果比较，看是否存在任何残留间隙。对MRI显示残留间隙<0.5 cm和≥0.5 cm的患者进行人口统计学和临床比较。18例急性跟腱撕裂患者以平均41°±11°进行夹板固定，通过触诊和超声推测肌腱完全对合。夹板固定后的MRI显示，这些患者中有9/18（50%）存在残留间隙，平均为2.2±1 cm。有间隙的患者（1.3±2天）和无间隙的患者（1.2±1天）从夹板固定到进行MRI检查的平均时间无差异。这些组之间未观察到其他临床或人口统计学差异。总之，在评估急性跟腱撕裂夹板固定后的肌腱对合情况时，临床检查和超声结果与MRI结果通常不相关。对于将对合情况作为非手术治疗判定依据的外科医生来说，根据所使用的临床方法不同，可能会得到不同的结果。
