Abrahim-zadeh R, Klein R M, Leslie D, Norman A
Department of Radiology, New York Medical College, Valhalla 10595, USA.
Skeletal Radiol. 1998 Jun;27(6):321-4. doi: 10.1007/s002560050389.
Bone infarction (BI) of the calcaneus is an uncommon entity which has received little mention in the recent literature. In this paper, we review the MR images of six calcanei with BI, which demonstrate a pattern of presentation that may explain the etiology of BI at this unusual location.
A retrospective review was performed of the transcribed reports of the foot or ankle MR examinations at our institution. MR images of examinations with any marrow signal abnormality were reviewed for presence of BI and its distribution.
Based on MRI criteria, four patients had calcaneal BI (none biopsy proven); they ranged in age from 37 to 51 years old. Two patients were diagnosed with systemic lupus erythematosus, one with fibrositis, and another with polymyositis. All were treated with corticosteroids.
Six calcanei (in four patients) contained a region of calcaneal BI. In five of the six, the lesions were entirely or predominantly located in the posterior half of the calcaneus.
Two theories are proposed which may explain why BI predominantly occurs in the posterior half of the calcaneus. First, the convergence of the recurrent intraosseous calcaneal vessels may occasionally produce the equivalent of a single dominant vessel that is more prone to vascular accidents. Secondly the region between the recurrent and the epiphyseal vessels may act as a watershed zone, increasing its susceptibility to ischemia.
跟骨骨梗死（BI）是一种罕见的病症，近期文献中鲜有提及。在本文中，我们回顾了6例跟骨BI的磁共振成像（MR），其显示出一种表现模式，这可能解释了在这个不寻常部位发生BI的病因。
对我们机构足部或踝关节MR检查的转录报告进行回顾性研究。对任何骨髓信号异常检查的MR图像进行BI及其分布情况的评估。
根据MRI标准，4例患者有跟骨BI（均未经活检证实）；年龄在37至51岁之间。2例患者诊断为系统性红斑狼疮，1例为纤维炎，另1例为多发性肌炎。所有患者均接受了皮质类固醇治疗。
4例患者的6个跟骨中有跟骨BI区域。6个中有5个病变完全或主要位于跟骨后半部。
提出两种理论来解释为什么BI主要发生在跟骨后半部。第一，跟骨骨内返支血管的汇合偶尔可能产生相当于单一优势血管的情况，更容易发生血管意外。第二，返支血管和骨骺血管之间的区域可能作为一个分水岭区域，增加其对缺血的易感性。
