Lee Brian, Parellada Antoni J, Gorbachova Tetyana
Department of Radiology, Einstein Healthcare Network, Part of Jefferson Health, Sidney Kimmel Medical College at Thomas Jefferson University, 5501 Old York Rd, Philadelphia, PA, 19141, USA.
Skeletal Radiol. 2024 Jan;53(1):179-185. doi: 10.1007/s00256-023-04407-3. Epub 2023 Jul 24.
Painful os peroneum syndrome encompasses a spectrum of disorders associated with lateral foot and ankle pain. In the setting of an os peroneum fracture or diastasis of a partitioned os peroneum, marked displacement of the proximal fragment on radiographs is often used as an imaging surrogate for detection of a complete peroneus longus tendon tear. We present a case of a displaced proximal fragment of the os peroneum above the level of the ankle joint on radiographs and MRI associated with incomplete tear of the peroneus longus tendon. We hypothesize that such an injury pattern results from an anatomic prerequisite where the os peroneum occupies a portion of the cross-sectional diameter of the tendon. We suggest that the retracted proximal moiety of the sesamoid bone is the result of elastic recoil of delaminated fibers of the peroneus longus directly inserting on the os, whereas eccentric bundles of the tendon draping over the os remain in continuity. Although treatment implications are debatable, the case questions the assumption of a complete peroneus longus tear based on a retracted os peroneum on radiography and highlights the role of MRI in providing a full description.
腓籽骨疼痛综合征包括一系列与足外侧和踝关节疼痛相关的病症。在腓籽骨骨折或分裂的腓籽骨分离的情况下，X线片上近端骨折块的明显移位常被用作检测腓骨长肌腱完全撕裂的影像学替代指标。我们报告一例X线片和磁共振成像（MRI）显示踝关节水平以上腓籽骨近端骨折块移位且伴有腓骨长肌腱不完全撕裂的病例。我们推测这种损伤模式是由一种解剖学先决条件导致的，即腓籽骨占据了肌腱横截面积的一部分。我们认为籽骨近端回缩部分是直接附着于籽骨的腓骨长肌分层纤维弹性回缩的结果，而跨过籽骨的肌腱偏心束仍保持连续。尽管治疗意义存在争议，但该病例对基于X线片上籽骨回缩而诊断腓骨长肌完全撕裂的假设提出了质疑，并突出了MRI在全面描述病情方面的作用。
