磁共振成像在闭合性跟腱损伤诊断中的应用

目的 探讨磁共振成像在合性跟腱损伤中的应价值,为临床诊断提供影像学生依据.方法 地经手术证实的7例闭合性跟腱损伤病例的磁共振成像表现进行回顾性分析.结果 术前7例的磁共振成像诊断分别为跟腱完全断裂2例,不完全断裂5例,手术结果显示跟腱断裂部位位于跟腱中段2例,下段5例,表现为跟腱完全性或部分性分离,跟腱周围软组织肿账、出血.结论 磁共振成像能够直接显示跟腱和周围软组织解剖形态和病理改变,对闭合性跟腱损伤的术前诊断具有重要价值.     

磁共振成像在闭合性跟腱损伤诊断中的价值

目的探讨磁共振成像(MRI)在闭合性跟腱损伤中的诊断价值,包括判断损伤性质、损伤程度和疗效随访。方法2003年4月～2005年5月24例闭合性跟腱断裂伤患者经低场强MRI扫描,MRI采用矢状面T1WI、T2WI、GE-STIR和横断面TME,层厚和层距各为4mm。并根据MRI分级诊断标准确定是部分性损伤还是完全性损伤。其中4例4～8周后复查MRI。结果MRI能准确判断跟腱撕裂的程度、部位,跟腱撕裂主要发生在跟腱中部。16例跟腱完全断裂患者在所有序列上显示跟腱连续性中断,跟腱增粗,T2WI断端间呈高信号;8例跟腱部分断裂患者T2WI显示条状高信号。术后随访4例患者见跟腱变细,信号降低。结论MRI能对跟腱撕裂程度及部位做出准确判断,直接显示跟腱内的信号变化并提供丰富的信息,对临床治疗具有重要参考价值。     

高频彩色多普勒超声联合宽景成像在股前外侧穿支皮瓣术前导航中的应用

目的探讨高频彩色多普勒超声(high frequency color Doppler ultrasound,HFCDU)联合宽景成像在股前外侧动脉穿支皮瓣术前导航中的应用价值。方法 2017年1月—2018年3月,收治28例皮肤软组织缺损患者。男22例,女6例;年龄17～66岁,平均33.5岁。致伤原因:烫伤瘢痕2例,重物砸伤7例,交通事故伤12例,摔伤4例,机器绞伤2例,感染溃疡1例。损伤部位:手、腕部6例,小腿12例,足10例。清创后创面范围为6.0 cm×3.5 cm～24.0 cm×9.0 cm,均行游离旋股外侧动脉穿支皮瓣修复术。术前利用HFCDU结合宽景成像探测旋股外侧动脉穿支血供来源、数量、走行、体表位置、血流动力学特点及与体区关系等,根据源动脉的宽景成像显示的穿支信息确定优势穿支作为血管蒂设计皮瓣。皮瓣切取范围为7.0 cm×4.5 cm～26.0 cm×7.0 cm。供瓣区直接拉拢缝合。结果 28例患者术前利用HFCDU结合宽景成像均成功探测到优势穿支,术中证实该穿支存在,定位准确,走行特点与宽景成像结果一致。术后27例皮瓣完全成活;1例皮瓣边缘局部坏死,经换药后愈合。患者均获随访,随访时间3～12个月,平均9个月。皮瓣血运佳、弹性好,供区及受区外形、功能均良好。结论股前外侧皮瓣术前利用HFCDU结合宽景成像导航,可显示其穿支特点、血流动力学信息及与体区关系,使术者能更加准确、直观了解穿支情况,提高了皮瓣切取的成功率及手术效率。     

彩色多普勒超声在手屈指肌腱损伤急诊手术中的应用

目的探讨高频彩色多普勒超声在手屈指肌腱损伤急诊手术中的应用价值。方法采用高频探头对21例急诊手屈指肌腱损伤患者行术中探查,观察肌腱损伤程度、回缩部位及血运状况。结果高频探头可以准确清晰判断肌腱损伤程度、判定断裂部位和两端肌腱的位置,完全断裂表现为连续的肌腱纤维层状高回声和腱周腱鞘薄层低回声在伤口处连续性完全中断,为低回声、无回声所替代。结论肌腱损伤术中超声对缩短手术时间、减少对周围组织的损伤、减轻局部粘连、确保术后血管再通有重要意义。     

跟腱损伤的MR诊断价值

目的探讨低场MR在跟腱损伤中的诊断价值。方法15例跟腱损伤患者经低场磁共振,四肢专用线圈,多序列检查,分析其低场MRI表现。结果8例正常跟腱矢状面各序列显示呈条带状均匀低信号。3例不完全撕裂,显示跟腱增粗,内部信号不均匀,部分纤维束连续。4例完全性断裂,表现为跟腱局部增粗、断裂,断端回缩呈“杵”状改变或扭曲,T2WI、FS—T2WI上中断处呈高信号。结论低场磁共振能够明确地显示跟腱损伤的部位、范围及程度,其形态及信号的改变对跟腱损伤的诊断具有重要价值。     

跟腱断裂48例临床分析

目的　探讨跟腱断裂的治疗方法及误诊原因、预防措施。方法　回顾 4 8例跟腱断裂的手术方法 ,分析其中 17例误诊的原因并提出预防对策。结果　急性跟腱断裂 2 5例 ,陈旧性跟腱断裂 2 3例 ,其中因误诊导致陈旧性跟腱断裂 17例、术后再次跟腱断裂合并感染及软组织缺损 2例。 17例中误诊为踝部软组织挫伤 8例、踝关节扭伤 9例。 4 8例患者采用不同的方法进行修复重建 ,疗效优 2 8例 ,良 18例 ,差 2例。结论　跟腱断裂后早期手术治疗效果良好 ,应根据跟腱断裂部位、缺损多少选择不同的手术方法。对疑有跟腱断裂的患者未进行认真的体检是导致跟腱断裂误诊的重要原因。避免误诊、尽早手术及循序渐进的术后康复锻炼是提高疗效的有效措施。     

超声在聚丙烯酰胺水凝胶填充术后取出治疗中的应用

目的 探讨高频彩色多普勒血流显像(CDFI)超声及超声扩展成像技术在颌面部及乳房聚丙稀酰胺水凝胶注射填充术后并发症治疗前后的应用价值.方法 应用高频CDFI超声及超声扩展成像技术对15例颌面部及乳房注射填充术后患者行抽吸前检查,观察填充物的不同超声表现,根据超声结果确定手术方式,并将超声检查结果与手术结果相对照,抽吸术后定期随访.9例隆乳者中,注射位置正常但要求取出者4例,注射位置异常(填充物出现于乳房皮下层、腺体层、胸肌层)者5例;6例颌面部填充者中,填充物异位(填充物出现于预注射部位以外)形成硬结者5例,感染者1例.结果 术后经6～18个月的跟踪随访,超声显示,9例隆乳者中,有4例患者无注射材料残留,切口瘢痕细小,乳房无明显变形;5例患者乳房不同程度的萎缩变形,超声显示有凝胶残留.6例颌面部填充者中,超声均显示有不同程度的凝胶残留.结论 高频CDFI超声检查及超声扩展成像技术能清晰显示填充物的层次、位置及不同表现,为注射填充术后并发症抽吸治疗方案的选择提供良好的影像学依据,并可无创、动态、跟踪监测抽吸术后的变化,有一定的临床应用价值.     

跟腱损伤误诊5例报告

本组均为闭合性损伤,男4例,女1例,年龄17～50岁,平均33岁。运动性损伤4例,均为单侧,其中完全性断裂3例,不完全性断裂1例。病理性损伤1例,为双侧,其右侧为完全断裂,左侧为不全断裂。5例患者就诊时均行患侧小腿及踝关节正侧位Ｘ线摄片,未发现异常。误诊时间:2ｄ～6月不等,平均为40ｄ。误诊疾病:踝关节扭伤2例,小腿肌肉拉伤1例,跟腱陈旧性完全断裂误诊为不完全断裂1例,跟腱腱鞘炎1例。5例均依据病史、症状、体征和Ｂ超检查而确诊。其中手术治疗4例,非手术治疗1例。讨　　论跟腱损伤是一种常见的运动性损伤,根据病史、跟腱处凹陷和空虚感、Ｔｈ…     

肌骨超声在跟腱断裂筛查中的应用价值

目的探讨肌骨超声在跟腱断裂筛查中的应用价值。方法选取2016年1月至2018年1月疑似跟腱肌腱断裂75例,所有患者均给予肌骨超声、普通超声检查,以手术结果为对照,分析比较肌骨超声、普通超声对跟腱肌腱断裂的筛查价值。。结果选取2016年1月至2018年1月疑似跟腱断裂75例,所有患者均给予肌骨超声、普通超声检查,以手术结果为对照。手术结果显示跟腱断裂65例,在诊断跟腱断裂的效能分析中,肌骨超声检查明显优于超声检查,差异有统计学意义(P0.05)。肌骨超声钙化灶的检出率优于超声检查,差异有统计学意义(P0.05)。肌骨超声血流信号异常优于普通超声检查,差异有统计学意义(P0.05)。结论肌骨超声能够清晰显示钙化灶和血流信号,对跟腱断裂具有较高的诊断鉴别价值,值得临床作进一步推广。     

保留止点自体跖肌腱编织缝合修复跟腱损伤

目的 探讨修复跟腱损伤的手术方法.方法 应用保留止点自体跖肌腱编织缝合修复跟腱损伤17例.结果 17例创口Ⅰ期愈合,平均随访20个月.疗效评价依Amer-lindllohn评定法:优12例,良5例.结论 应用保留止点自体跖肌腱编织缝合修复跟腱损伤断裂,疗效满意.     

Ossification of a ruptured achilles tendon: a case report in a diabetic patient.

Ossification of the Achilles tendon is a rare condition to be distinguished from the more frequently occurring tendon calcification. Achilles tendon ossification is more common in males and is usually associated with prior surgery or trauma to the tendon. A case history of a ruptured ossified Achilles tendon in an elderly diabetic female is presented. Although Achilles tendon rupture with subsequent ossification and fracture of the ossified Achilles tendon have been reported individually, there is evidence to suggest that this patient may have both ruptured and fractured an ossified Achilles tendon.     

An Uncomplicated Method for Minimally Invasive Achilles Tendon Repair

The Achilles tendon is the largest palpable tendon in the human body, and rupture of this tendon is not an uncommon injury encountered by foot and ankle surgeons. A number of different minimally invasive methods have been described for repair of the ruptured Achilles tendon. In this article, we describe a relatively simple, minimally invasive technique of Achilles tendon repair that does not require special instrumentation, the key requirement being that of a sponge forceps.     

Achilles tendon rupture: an underrated complication of corticosteroid treatment.

Ten patients attending outpatient clinics who were taking oral corticosteroids ruptured their Achilles tendon in the course of 12 years. It is suggested that Achilles tendon rupture is a complication of corticosteroid treatment.     

Achilles tendon disorders: etiology and epidemiology

The Achilles tendon is the strongest tendon in the human body. Because most Achilles tendon injuries take place in sports and there has been a general increase in popularity of sporting activities, the number and incidence of the Achilles tendon overuse injuries and complete, spontaneous ruptures has increased in the industrialized countries during the last decades. The most common clinical diagnosis of Achilles overuse injuries is tendinopathy. The basic etiology of the Achilles tendinopathy is known to be multi-factorial. Although histopathologic studies have shown that ruptured Achilles tendons have clear degenerative changes before the rupture, many Achilles tendon ruptures take place suddenly without any preceding signs or symptoms.     

Rupture of the achilles tendon and eversion fracture of the inner malleolus - a typically combined injury in alpin skiing (author's transl)

5.3% of all ruptures of the Achilles tendon occurring during alpin skiing are accompanied by an eversion fracture of the inner malleolus. The frequency of this type of combined trauma has not changed in the last fifteen years. A typical eversion trauma resulting in the inner malleolus being torn off, but not involving a rotation motion, occurs in the second phase of an acute angle foreward fall, in which in the first phase, the Achilles tendon has already been ruptured. Simply catching an edge, for the most part of the outer ski edge, does not lead to an eversion fracture as has formerly been supposed.     

Reconstruction of skin and tendon defects from wound complications after Achilles tendon rupture.

Four patients who developed combined tendon and overlying skin defects following operative repair of ruptured Achilles tendon were presented. Three patients had an infected wound. The average interval from the first operation for repairing the ruptured Achilles tendon and the reconstructive procedure was 46.2 days (range, 5-65 days). All patients were treated with a one-stage operation including radical debridement, reconstruction of the Achilles tendon defects using vascularized or nonvascularized tendon grafts, transfer of peroneus brevis for augmentation, and skin coverage with a free flap. The patients recovered uneventfully. The average follow-up period was 39.2 months (range, 18-79 months). In all patients, an evaluation of the clinical outcome, the performance of the calf muscles using a computerized dynamometer, and structural changes of the reconstructed Achilles tendon using magnetic resonance (MR) imaging were made. The clinical outcome was excellent in three patients and good in one. In isokinetic testing (Cybex-Norm), strength was found to be normal in one patient and abnormal in three patients. MR images revealed an intratendinous area of homogenous and normal intensity signal, and a significant increase in thickness and width in all levels of the reconstructed Achilles tendon. The authors conclude that it is possible to obtain satisfactory function in patients with complex wounds in the region of the Achilles tendon.     

Operative Behandlung der Achillessehnenruptur

The open tendon suture is the most commonly used method of treatment for Achilles tendon rupture in Germany. Over the last decade the therapeutic spectrum of operative methods has been further enlarged by the development of new minimally invasive surgical techniques. Important criteria for planning treatment are the location and age of the rupture and comorbidities. For recent Achilles tendon ruptures minimally invasive suturing is indicated but for older ruptures a reconstruction often has to be carried out. The decisive disadvantage of an open tendon suture is the relatively high risk of infection. Using minimally invasive surgical techniques the frequency of postoperative infection could be significantly reduced. The suture methods without opening the ruptured region can be collectively grouped under the term percutaneous suture techniques and the minimally invasive methods with opening of the rupture region as combined open percutaneous techniques. Documented problems with the Ma-Griffith technique, such as injury of the sural nerve, low stability of the suture and insufficient adaption of the tendon stumps have been minimized by new minimally invasive operation techniques. Achilles tendon ruptures which nearly always arise without any external influence or accidents can have substantial psychological consequences regarding the integrity of one’s own body especially for people actively engaged in sport. This aspect should be considered and accepted in particular during postoperative treatment.     

Bilateral achilles tendon ruptures in a patient with ochronosis: a case report

We report the case of a 67-year-old man with ochronosis who had bilateral Achilles tendon ruptures. We reconstructed the Achilles tendon using pull-out wiring for the right side and an anchoring system for the left side, and reinforced the repair site using the peroneus brevis tendon for both sides. He could walk without a cane at 3 months postoperatively. Tendon ruptures in patients with ochronosis should be treated as pathologic ruptures because histologic examination reveals that both ends of the ruptured tendon and the insertion site at the calcaneus have extensive black pigment depositions where homogentisic acid and its metabolites have accumulated, and there are no normal collagen bundles present. Even if an Achilles tendon rupture is clinically diagnosed as an acute injury, the ruptured Achilles tendon should be primarily repaired and reinforced with autologous tissue because there are a few viable cells at the ruptured site, and because the tendon ruptures mainly at the insertion site of the calcaneus. Although this is a preliminary report, the short-term result is good and the reconstructed sites have showed no rerupture.     

Achilles tendon suture deteriorates tendon capillary blood flow with sustained tissue oxygen saturation – an animal study

Background  

Treatment of ruptured Achilles tendons currently constitutes of conservative early functional treatment or surgical treatment either by open or minimal invasive techniques. We hypothesize that an experimental Achilles tendon suture in an animal model significantly deteriorates Achilles tendon microcirculation immediately following suturing.