Corbu Andrei, Cosma Dan Ionut, Vasilescu Dana Elena, Vasilescu Dan, Cristea Stefan
University of Medicine and Pharmacy Carol Davila Bucharest, Romania, Department of Orthopaedics and Traumatology, Bucharest, Romania.
Clinical Rehabilitation Hospital Cluj-Napoca, Department of Orthopaedics and Traumatology, Cluj-Napoca, Cluj, Romania.
Int J Gen Med. 2021 Jun 23;14:2763-2775. doi: 10.2147/IJGM.S320115. eCollection 2021.
One of the main features of congenital idiopathic clubfoot is the increased stiffness of soft tissues. With the growing popularity and availability of sonoelastography as a method to assess the stiffness of different tissues, we considered applying it to congenital clubfeet in order to to determine whether sonoelastography can be a useful imaging method for the evaluation of clubfeet, to assess whether there are any differences in stiffness of specific tendons between clubfeet and normal contralateral feet and to observe which treatment methods have an impact on the aspect of these structures on the elastograms.
A case-control study was performed involving 10 adolescent patients with unilateral idiopathic congenital clubfeet who were treated either with the Ponseti method or surgically with posteromedial release (PMR) during early infancy. Using compression sonoelastography, we obtained semi-quantitative data expressed as fat to tendon ratios in treated clubfeet and normal contralateral feet. The tendons of the following muscles were examined: tibialis anterior, tibialis posterior, flexor hallucis longus, peroneus longus and Achilles tendon at three levels (calcaneal insertion, lengthened zone and musculotendinous junction).
The only statistically significant difference in the strain ratio (p = 0.023) between clubfeet and normal feet was at the level of the calcaneal insertion of the Achilles tendon, which was stiffer in clubfeet. Although other differences were not statistically significant, they may reflect some of the pathological modifications of clubfeet.
Overall, sonoelastography may be a useful examination tool in the quantitative and qualitative assessment of soft tissue stiffness in clubfeet, but further research is necessary.
先天性特发性马蹄内翻足的主要特征之一是软组织僵硬程度增加。随着超声弹性成像作为一种评估不同组织硬度的方法越来越普及且易于获得，我们考虑将其应用于先天性马蹄内翻足，以确定超声弹性成像是否可以成为评估马蹄内翻足的有用成像方法，评估患足与对侧正常足之间特定肌腱的硬度是否存在差异，并观察哪些治疗方法会对弹性图上这些结构的表现产生影响。
进行了一项病例对照研究，纳入10例单侧特发性先天性马蹄内翻足的青少年患者，这些患者在婴儿早期接受了Ponseti方法治疗或后内侧松解术（PMR）手术治疗。使用压迫性超声弹性成像，我们获得了患足和对侧正常足以脂肪与肌腱比值表示的半定量数据。检查了以下肌肉的肌腱：胫骨前肌、胫骨后肌、拇长屈肌、腓骨长肌以及跟腱在三个水平（跟骨附着点、延长区和肌肉肌腱交界处）的情况。
患足与正常足之间应变比值唯一具有统计学意义的差异（p = 0.023）出现在跟腱跟骨附着点水平，患足在此处更僵硬。尽管其他差异无统计学意义，但它们可能反映了马蹄内翻足的一些病理改变。
总体而言，超声弹性成像可能是定量和定性评估马蹄内翻足软组织硬度的有用检查工具，但仍需进一步研究。
