Ricci Vincenzo, Chang Ke-Vin, Naňka Ondřej, Özçakar Levent
Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy.
Department of Physical Medicine and Rehabilitation and Community and Geriatric Research Center, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan.
Clin Anat. 2025 Jan;38(1):29-34. doi: 10.1002/ca.24193. Epub 2024 Jun 11.
The pertinent literature widely describes ultrasound-guided procedures targeting the retrocalcaneal bursa and the tendon tissue to manage insertional Achilles tendinopathy. Synovial bursae and cutaneous nerves of the superficial retrocalcaneal pad are often overlooked pain generators and are poorly considered by clinicians and surgeons. A layer-by-layer dissection of the superficial soft tissues in the retrocalcaneal region of two fresh frozen cadavers was matched with historical anatomical tables of the textbook Traite d'Anatomie Topographique Avec Applications Médico-Chirurgicales (1909 by Testut and Jacob). An accurate and detailed description of the superficial retrocalcaneal pad with its synovial bursae and cutaneous nerves was provided. Cadaveric dissections confirmed the compartmentalized architecture of the superficial retrocalcaneal fat pad and its histological continuum with the superficial lamina of the crural fascia. Superficial synovial tissue islands have been demonstrated on the posterior aspect of the Achilles tendon in one cadaver and on the posterolateral surface of the tendon in the other one. Digitalization of the original anatomical tables of the textbook Traite d'Anatomie Topographique Avec Applications Médico-Chirurgicales (1909 by Testut and Jacob) showed five potential locations of the superficial calcaneal bursa and a superficial retrocalcaneal nerve plexus within the Achilles tendon-fat pad interface. In clinical practice, in addition to the previously described interventions regarding the retrocalcaneal bursa and the tendon tissue, ultrasound-guided procedures targeting the synovial and neural tissues of the superficial retrocalcaneal pad should be considered to optimize the management of insertional Achilles tendinopathy.
相关文献广泛描述了针对跟腱后滑囊和肌腱组织进行超声引导下的操作，以治疗跟腱止点性肌腱病。跟腱后浅表滑囊和皮神经常常是被忽视的疼痛源，临床医生和外科医生对此考虑甚少。对两具新鲜冷冻尸体跟腱后区域的浅表软组织进行逐层解剖，并与《Traite d'Anatomie Topographique Avec Applications Médico-Chirurgicales》（1909年由Testut和Jacob编写）教科书中的历史解剖图谱进行比对。提供了对跟腱后浅表脂肪垫及其滑囊和皮神经的准确而详细的描述。尸体解剖证实了跟腱后浅表脂肪垫的分隔结构及其与小腿筋膜浅表层的组织学连续性。在一具尸体的跟腱后侧和另一具尸体的跟腱后外侧表面发现了浅表滑膜组织岛。对《Traite d'Anatomie Topographique Avec Applications Médico-Chirurgicales》（1909年由Testut和Jacob编写）教科书原始解剖图谱的数字化显示，在跟腱-脂肪垫界面内浅表跟骨滑囊和跟腱后浅表神经丛有五个潜在位置。在临床实践中，除了先前描述的针对跟腱后滑囊和肌腱组织的干预措施外，还应考虑针对跟腱后浅表脂肪垫的滑膜和神经组织进行超声引导下的操作，以优化跟腱止点性肌腱病的治疗。
