Zhang W, Bai R J, Qian Z H, Wang S M, Zhan H L, Li Y X
Department of Radiology, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing 100035, China.
Zhonghua Yi Xue Za Zhi. 2020 May 5;100(17):1305-1309. doi: 10.3760/cma.j.cn112137-20191125-02559.
To explore the MR characteristics of normal anatomy and injured peroneal tendon and the diagnostic value of MR in the peroneal tendon injuries. From February 2018 to December 2018, a total of 20 healthy volunteers (40 ankle joints) were selected, 10 males and 10 females, with an age range of 20-30 (26±3) years. Retrospective analyzed 62 patients with ankle sprain and peroneal tendon injuries confirmed by operation, 34 males and 28 females, with an age range of 14-78(41±14) years. All volunteers and patients underwent MR examination. The MRI characteristics of the normal anatomy of peroneal tendon were analyzed. The patients were classified according to the MR diagnostic criteria of injury. Then the MRI features of different types of injured peroneus longus tendon and peroneus brevis tendon were analyzed. At last, imaging findings were compared with surgical results. The peroneal tendon of 20 healthy volunteers showed oval and elliptical band-like structures on T(1)WI and PD-FS sequences, with natural alignment, clear boundary and uniform low signal. The whole length of the peroneal tendon can't be displayed completely on the same imaging plane. It needed multi-dimensional observation combined with axial, coronal and sagittal directions. There were 62 cases of peroneal tendon injury, including 46 cases of peroneal tendon tear (7 cases of partial-thickness tear, 11.3% of the total injuries, 39 cases of full-thickness tear, 62.9% of the total injuries), 16 cases of peroneal tendon dislocation (15 cases of intrathecal dislocation, 24.2% of the total injuries, 1 case of extrathecal dislocation, 1.6% of the total injuries). In 7 cases of partial-thickness tear (4 cases of peroneus brevis tendon tear, 3 cases of peroneus longus tendon tear), MR showed irregular tendon shape and local continuity interruption. In 39 cases of full-thickness tear (31 cases of peroneus brevis tendon tear, 8 cases of peroneus longus tendon tear), MR showed that the tear was penetrated through the whole layer of tendon from dorsolateral side to plantar side of foot, and the range of tear was different. The torn tendon could be accompanied by tendinitis or effusion of tendon sheath; 15 cases of intrathecal dislocation (3 cases of type A, 12 cases of type B), MR findings of type A dislocation showed that the peroneus longus tendon was located in the deep part of the peroneus brevis tendon, MR findings of type B dislocation showed that the peroneus longus tendon was displaced into the longitudinal tear of peroneus brevis tendon. In 1 case of extrathecal dislocation (type Ⅲ), MR showed that the SPR and the attached cortex of lateral malleolus were avulsed together, and the peroneal tendon was displaced under the avulsed fracture piece. MR can accurately demonstrate the fine anatomical structure of peroneal tendon and the imaging features of injuries. It has important clinical application value for the early diagnosis and accurate treatment of peroneal tendon injuries.
探讨正常解剖及损伤的腓骨肌腱的磁共振(MR)特征以及MR在腓骨肌腱损伤中的诊断价值。2018年2月至2018年12月,共选取20名健康志愿者(40个踝关节),男10名,女10名,年龄20 - 30(26±3)岁。回顾性分析62例经手术证实的踝关节扭伤合并腓骨肌腱损伤患者,男34名,女28名,年龄14 - 78(41±14)岁。所有志愿者及患者均接受MR检查。分析腓骨肌腱正常解剖的MRI特征。根据损伤的MR诊断标准对患者进行分类。然后分析不同类型的腓骨长肌腱和腓骨短肌腱损伤的MRI特征。最后将影像表现与手术结果进行比较。20名健康志愿者的腓骨肌腱在T(1)WI和PD - FS序列上呈椭圆形及椭圆带状结构,走行自然,边界清晰,信号均匀呈低信号。腓骨肌腱全长无法在同一成像平面完整显示,需结合轴位、冠状位及矢状位进行多维度观察。62例腓骨肌腱损伤中,包括46例腓骨肌腱撕裂(部分厚度撕裂7例,占总损伤的11.3%,全层厚度撕裂39例,占总损伤的62.9%),16例腓骨肌腱脱位(鞘内脱位15例,占总损伤的24.2%,鞘外脱位1例,占总损伤的1.6%)。7例部分厚度撕裂(腓骨短肌腱撕裂4例,腓骨长肌腱撕裂3例),MR表现为肌腱形态不规则,局部连续性中断。39例全层厚度撕裂(腓骨短肌腱撕裂31例,腓骨长肌腱撕裂8例),MR表现为撕裂从足背外侧向足底侧贯穿肌腱全层,撕裂范围各异。撕裂的肌腱可伴有腱鞘炎或腱鞘积液;15例鞘内脱位(A型3例,B型12例),A型脱位的MR表现为腓骨长肌腱位于腓骨短肌腱深部,B型脱位的MR表现为腓骨长肌腱移位至腓骨短肌腱的纵行撕裂内。1例鞘外脱位(Ⅲ型),MR表现为距腓后韧带及外踝附着皮质一同撕脱,腓骨肌腱移位至撕脱骨折块下方。MR能准确显示腓骨肌腱的精细解剖结构及损伤的影像特征。对腓骨肌腱损伤的早期诊断及精准治疗具有重要的临床应用价值。