Nehrer S, Breitenseher M, Brodner W, Kainberger F, Fellinger E J, Engel A, Imhof F
Department of Orthopedics, University of Vienna, Wien, Austria.
Arch Orthop Trauma Surg. 1997;116(1-2):14-8. doi: 10.1007/BF00434093.
Chronic pain in the region of the Achilles tendon is a common problem and often a sign of progressive degeneration of the tendon which may lead to its rupture. We studied the clinical course and sonograms in 36 patients with achillodynia to find a prognostic parameter enabling us to estimate the risk of rupture. The patients were evaluated clinically for swelling and tenderness and by high-resolution real-time sonography. The sonograms were graded according to the tendon thickness as normal (< 6 mm), minimal (6-8 mm), moderate (8-10 mm) to high-grade (> 10 mm) in the sagittal diameter of the transverse section, and alterations of echotexture were described as diffuse, circumscribed, or inhomogenous. At the time of the primary investigation, we found thickening and alterations of the echotexture in 33 of 72 tendons. In 48 tendons we found pain and local or diffuse swelling in the Achilles tendon region (sensitivity 0.58, specificity 0.79). After a follow-up of 48 +/- 8 months, 7 tendons had ruptured spontaneously. Analysis of the sonograms of the patients taken prior to the rupture showed a high-grade thickening in 4 cases, moderate thickening in 2 cases, and a diameter between 6 and 8 nm in one patient. In no case did we find a rupture of a tendon primarily classified as normal. Patients without sonographic changes exhibited a significantly better clinical outcome following conservative treatment. Sonography was found to be a valuable tool for determination of the tendon's thickness and echotexture. In 28% of our patients with thickening, circumscribed lesions of the echotexture, and chronic pain, a spontaneous rupture occurred.
跟腱区域的慢性疼痛是一个常见问题，通常是肌腱进行性退变的征兆，可能导致肌腱断裂。我们研究了36例跟腱痛患者的临床病程和超声图像，以寻找一个能够帮助我们评估断裂风险的预后参数。对患者进行了临床肿胀和压痛评估，并采用高分辨率实时超声检查。超声图像根据肌腱厚度分级，横切面矢状径正常（<6mm）、轻度增厚（6 - 8mm）、中度增厚（8 - 10mm）至高等级增厚（>10mm），回声纹理改变描述为弥漫性、局限性或不均匀性。在初次检查时，我们发现72条肌腱中有33条存在增厚和回声纹理改变。在48条肌腱中，我们发现跟腱区域有疼痛以及局部或弥漫性肿胀（敏感性0.58，特异性0.79）。经过48±8个月的随访，有7条肌腱自发断裂。对断裂前患者的超声图像分析显示，4例为高等级增厚，2例为中度增厚，1例直径在6至8mm之间。我们未发现最初分类为正常的肌腱发生断裂。超声检查无改变的患者在保守治疗后临床结果明显更好。超声检查被认为是确定肌腱厚度和回声纹理的有价值工具。在我们28%的肌腱增厚、回声纹理有局限性病变且伴有慢性疼痛的患者中，发生了自发断裂。
