腓骨肌腱脱位与跟骨骨折类型的关系△

Relationship between peroneal tendon dislocation and type of calcaneal fracture

摘要:

[目的] 应用CT 评估跟骨骨折并发腓骨肌腱脱位与跟骨骨折类型的关系。[方法] 回顾性分析2016 年6 月—2022年6 月421 例闭合性跟骨骨折病例资料，应用影像归档和通信系统（picture archiving and communication system, PACS） 于踝关节水平近端1 cm 重建CT 横截面图像，以腓骨前外侧弧形面画最佳拟合圆，如腓骨肌腱影圆心越过圆圈，则判定腓骨肌腱“逃逸征”阳性，以此比较不同类型跟骨骨折腓骨肌腱脱位阳性病例数之间差异。[结果] 421 例跟骨骨折患者中，34 例在术前CT报告中描述或诊断腓骨肌腱脱位，发生率为8.1%。病历资料记录腓骨肌腱脱位诊断51 例，发生率为12.1%。通过CT 图像审查“逃逸征”，共76 例腓骨肌腱“逃逸征”阳性，以此得出的跟骨骨折伴腓骨肌腱脱位的发生率为18%。以“逃逸征”作为评判标准诊断腓骨肌腱脱位，与CT 诊断报告相比，新增42 例（P＜0.001），与临床诊断相比，新增15 例（P=0.021）。腓骨肌腱脱位组与未脱位组年龄、性别比较的差异无统计学意义（P＞0.05），脱位组后关节面塌陷型骨折合并腓骨肌腱脱位的发生率[例, 塌陷/舌形, (65/11) vs (256/89), P=0.039] 显著高于未脱位组。[结论] 应用CT 横截面图像上“逃逸征”作为评判标准，塌陷型跟骨骨折更易合并腓骨肌腱脱位。

Abstract:

[Objective] To evaluate the relationship between peroneal tendon dislocation and type of calcaneal fracture by CT. [Methods] A retrospective case series study was conducted to analyze the data of 421 patients with closed calcaneal fractures treated from June2016 to June 2022. The CT cross-sectional images were reconstructed at 1cm proximal to the level of the ankle joint by using the picture ar-chiving and communication system (PACS). Drawing the best fitting circle to fit the anterolateral curved surface of the fibula, the peronealtendon shadow straddled or crossed the circle was termed as positive the "escape sign" of the tendon. The number of positive cases of pero-neal tendon dislocation in different types of calcaneal fractures was compared. [Results] Of 421 patients with calcaneal fractures, 34 weredescribed or diagnosed in preoperative CT reports accounted for 8.1% , and dislocation of peroneal tendon was mentioned in medical recordin 51 cases (12.1%), while the positive "escape sign" of peroneal tendon was noted in 76 cases by this CT image analysis, with the inci-dence of calcaneal fracture complicated with peroneal tendon dislocation of 18%. Forty two more cases compared with original CT diagnosis(P＜0.001), and 15 more cases compared with clinical diagnosis (P=0.021) were found in this study based on "escape sign" as the criterion.Although there were no significant differences in age or gender between the dislocation group and nondislocation groups (P＞0.05), the dis-location group had significantly higher ratio of posterior articular surface collapse than the non-dislocation group [collapse/tongue shape,(65/11) vs (256/89), P=0.039]. [Conclusion] Collapse calcaneus fracture is more likely to be associated with peroneal tendon dislocation byusing the "escape sign" on CT cross-section image as the criterion.