足副舟骨与胫后肌腱MRI表现的观察△

MRI findings of foot accessory navicular bone and posterior tibialis tendon in the foot

摘要:

[目的] 应用胫骨后肌腱（posterior tibial tendon, PTT） 厚度指标从量化角度验证副舟骨（accessory navicular bone,AN） 对早期胫骨后肌腱功能障碍（posterior tibial tendon dysfunction, PTTD） 中PTT 损伤程度的影响。[方法] 2019 年1 月—2022 年8 月本院116 例对PTT 行MRI 检查患者纳入本研究。将足内侧疼痛且MRI 显示PTT 损伤或鞘旁积液者定义为异常组；将无症状且MRI 正常者定义为正常组。再另将两组按AN 类型不同定义4 个亚组，既无AN 组、I 型AN 组、II 型AN 组、III型AN 组，比较两组测量结果，以是否异常与PTT 厚度行ROC 分析。[结果] 正常组内各亚组PTT 厚度无显著变化（P＞0.05）；异常组内II 型AN 组PTT 厚度显著增大（P＜0.05），与正常组比较，异常组II 型AN 亚组中PTT 厚度[(4.1±1.2) mm vs(5.5±0.6 ) mm, P＜0.001] 显著增大，而其他各亚组两组间PTT 厚度的差异均无统计学意义（P＞0.05）。II 型AN 亚组PTT 横截面短径厚度判断是否异常ROC 曲线，最佳截点是PTT 厚度为4.7 mm 时，敏感度为87.5%，特异度为85.7%，AUC 为0.875。[结论] 在PTTD 中，II 型AN 的存在可导致PTT 厚度增加，加重其损伤程度。

Abstract:

[Objective] To verify the impact of accessory navicular bone of foot (AN) on posterior tibialis tendon dysfunction (PTTD) byquantitative measurement of posterior tibialis tendon (PTT) thickness with MRI. [Methods] From January 2019 to August 2022, 116 pa-tients who received MRI examination of PTT in our hospital were included in this study. The patients with medial foot pain and MRI presen-tation of PTT injury or effusion around the tendon insertion were defined as the abnormal group, while those with no symptoms and normalMRI were defined as normal group. In addition, the two groups were further defined into 4 subgroups according to different AN types, in-cluding non AN group, type I AN group, type II AN group and type III AN group. The measurement results of the two groups were com-pared, and ROC analysis was performed according to whether abnormality and PTT thickness. [Results] There was no significant change inPTT thickness of all subgroups in normal group (P＞0.05). PTT thickness of type II AN subgroup in abnormal group was significantly in-creased (P＜0.05). Compared with the normal group, the type II AN subgroup in abnormal group had significantly greater PTT thickness of[(4.1±1.2) mm vs (5.5±0.6) mm, P＜0.001], despite of the fact that no significant difference in PTT thickness between the two groups in othersubgroups was noted (P＞0.05). As results of ROC analysis PTT thickness of type II AN subgroup predicting whether abnormality, the bestcut-off point was of 4.7 mm, sensitivity of 87.5%, specificity of 85.7%, with area under curve (AUC) of 0.875. [Conclusion] In PTTD, thepresence of type II AN can increase the thickness of PTT and aggravate the lesion.