Ricci Vincenzo, Mezian Kamal, Chang Ke-Vin, Tamborrini Giorgio, Jačisko Jakub, Naňka Ondřej, Özçakar Levent
Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy.
Department of Rehabilitation Medicine, First Faculty of Medicine and General University Hospital, Charles University in Prague, Prague, Czech Republic.
Foot Ankle Surg. 2024 Jun;30(4):313-318. doi: 10.1016/j.fas.2024.01.005. Epub 2024 Jan 20.
Injections around the Achilles tendon (AT) are commonly performed in clinical practice to manage non-insertional Achilles tendinopathy, but the presence/distribution of the injectate with relation to its sheath has not been assessed specifically. Accordingly, the aim of this cadaveric investigation was to demonstrate the feasibility of Achilles paratenon injection under ultrasound guidance - by confirming the exact needle positioning as well as the dye distribution inside the paratenon lumen.
A descriptive laboratory study with three human cadaveric specimens (one fresh cadaver and two cadavers embalmed using the Fix for Life (F4L) method) was performed in a tertiary-care academic institution. The interventional technique and the related anatomical findings were illustrated. During the injection, the needle was advanced inside the Achilles paratenon under ultrasound guidance i.e. in-plane medial-to-lateral approach. With the objective to confirm its correct placement, the needle was kept in situ on the right AT of the fresh cadaver. Likewise, to demonstrate the location of the dye inside the lumen of Achilles paratenon, the other five ATs - four on the embalmed cadavers and one on the fresh cadaver - were injected with 5 mL of green color dye. After removal of the needle, a layer-by-layer anatomical dissection was performed on all three cadavers.
On the right AT of the fresh cadaver, the position of the needle's tip within the Achilles paratenon was confirmed. Accurate placement of the dye inside the paratenon lumen was confirmed in four (80%) ATs, one of the fresh and three of the embalmed cadavers. No spread inside the crural fascia compartment or between the AT and the Kager's fat pad was observed. Herewith, unintentional spilling of the dye within the superficial soft tissues of the posterior leg was reported in the left AT of one of the two embalmed cadavers (20%).
Ultrasound-guided injection using the in-plane, medial-to-lateral approach can accurately target the lumen of Achilles paratenon.
在临床实践中，跟腱周围注射常用于治疗非插入性跟腱病，但尚未对注射剂在其腱鞘内的存在情况/分布进行专门评估。因此，本尸体研究的目的是通过确认超声引导下跟腱旁腱膜注射的确切针位置以及腱鞘腔内染料的分布，来证明该注射的可行性。
在一家三级医疗学术机构对三具人体尸体标本（一具新鲜尸体和两具使用“生命定格”（F4L）方法防腐处理的尸体）进行了描述性实验室研究。阐述了介入技术及相关解剖学发现。注射过程中，在超声引导下，即采用平面内从内侧到外侧的进针方法，将针推进到跟腱旁腱膜内。为确认针的正确位置，将针留在新鲜尸体的右侧跟腱处。同样，为了展示染料在跟腱腱鞘腔内的位置，向另外五条跟腱（四具防腐尸体上的四条和一具新鲜尸体上的一条）注射了5毫升绿色染料。拔出针后，对所有三具尸体进行了逐层解剖。
在新鲜尸体的右侧跟腱上，确认了针尖在跟腱旁腱膜内的位置。在四例（80%）跟腱中确认了染料在腱鞘腔内的准确注入，其中一例新鲜尸体和三例防腐尸体的跟腱。未观察到染料在小腿筋膜间隙内或跟腱与Kager脂肪垫之间扩散。在此，报告在两具防腐尸体之一的左侧跟腱（20%）中，染料意外溢出到小腿后部的浅表软组织内。
采用平面内从内侧到外侧进针方法的超声引导注射能够准确靶向跟腱腱鞘腔。
