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[跟腱后滑囊炎的诊治进展]

[Advance of diagnosis and treatment of Haglund syndrome].

作者信息

Wang Jie, Zeng Xiantie, Ma Xinlong

机构信息

Department of Orthopaedics, Tianjin Hospital, Tianjin, 300211, P.R.China.

Department of Orthopaedics, Tianjin Hospital, Tianjin, 300211, P.R.China;Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, 300052, P.R.China.

出版信息

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2020 Apr 15;34(4):518-523. doi: 10.7507/1002-1892.201907130.

Abstract

OBJECTIVE

To review the current research on the diagnosis and treatment of Haglund syndrome.

METHODS

The domestic and foreign literature about Haglund syndrome in recent years was extensively reviewed to summarize and analyze the etiology, anatomy, clinical manifestations, diagnosis, and treatment of Haglund syndrome.

RESULTS

The etiology of Haglund syndrome is not very clear, and it may be related to local friction and high gastrocnemius muscle tension, and there may be a certain genetic tendency. The local anatomy is more complex and there are many adjacent tissue structures. Haglund malformation may cause the impingement of the posterior heel bursa and Achilles tendon insertion, lead to wear of the posterior heel bursa and the Achilles tendon insertion, and finally result in pain. The FPA (Fowler-Philipp angle), CPA (calcaneal pith angle), PPL (parallel pitch lines), CLA (Chauveaux-Liet angle), and X/Y ratios (ratio of total calcaneal length to calcaneal tuberosity length) measured on X-ray film can be used for the diagnostic measurement of Haglund malformation. Treatment includes conservative and surgical treatment (open Haglund ostectomy, dorsal closed wedge osteotomy of the calcaneus, and arthroscopic Haglund osteotomy).

CONCLUSION

Both open and arthroscopic Haglund ostectomy and dorsal closed wedge osteotomy of the calcaneus can achieve satisfactory results, but minimally invasive treatment is the current development trend. Surgeons should pay attention to the management of the calcification of Achilles tendon insertion and reconstruction of Achilles tendon insertion.

摘要

目的

综述当前关于Haglund综合征诊断与治疗的研究。

方法

广泛查阅近年来国内外有关Haglund综合征的文献,对Haglund综合征的病因、解剖结构、临床表现、诊断及治疗进行总结分析。

结果

Haglund综合征的病因尚不完全明确,可能与局部摩擦及腓肠肌肌张力增高有关,且可能存在一定的遗传倾向。局部解剖结构较为复杂,毗邻组织结构众多。Haglund畸形可导致足跟后滑囊及跟腱止点受到撞击,引起足跟后滑囊及跟腱止点磨损,最终导致疼痛。X线片测量的FPA(Fowler-Philipp角)、CPA(跟骨髓角)、PPL(平行间距线)、CLA(Chauveaux-Liet角)及X/Y比值(跟骨总长度与跟骨结节长度之比)可用于Haglund畸形的诊断测量。治疗方法包括保守治疗和手术治疗(开放性Haglund截骨术、跟骨背侧闭合楔形截骨术及关节镜下Haglund截骨术)。

结论

开放性及关节镜下Haglund截骨术以及跟骨背侧闭合楔形截骨术均可取得满意疗效,但微创治疗是当前的发展趋势。外科医生应重视跟腱止点钙化的处理及跟腱止点的重建。

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本文引用的文献

5
Risk Factors for Lower Extremity Tendinopathies in Military Personnel.军事人员下肢腱病的危险因素。
Orthop J Sports Med. 2013 Jun 11;1(1):2325967113492707. doi: 10.1177/2325967113492707. eCollection 2013 Jan-Jun.
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Endoscopic calcaneoplasty.内镜下跟骨成形术。
Foot Ankle Clin. 2015 Mar;20(1):149-65. doi: 10.1016/j.fcl.2014.10.004. Epub 2014 Dec 30.
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The anatomical footprint of the Achilles tendon: a cadaveric study.跟腱的解剖足迹:一项尸体研究。
Bone Joint J. 2014 Oct;96-B(10):1344-8. doi: 10.1302/0301-620X.96B10.33771.
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Can We Measure the Heel Bump? Radiographic Evaluation of Haglund's Deformity.我们能测量足跟肿块吗?Haglund畸形的影像学评估。
J Foot Ankle Surg. 2015 May-Jun;54(3):338-40. doi: 10.1053/j.jfas.2014.07.006. Epub 2014 Aug 30.

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