跟骨关节内骨折合并腓骨肌腱脱位的多层螺旋CT诊断

目的：探讨多层螺旋CT(multi-slice computed tomography，MSCT)诊断跟骨关节内骨折合并腓骨肌腱脱位的临床价值。方法：选择新乐市中医医院2013年1月至2015年6月收治的跟骨关节内骨折患者142例，共154足，对所有患者进行MSCT扫描，并进行附带肌腱的容积再现(virtual reality， VR)和多平面重组(multiple planar reconstruction，MPR)，测量足跟骨结节外侧突后缘至载距突内侧面的距离、载距突后缘的跟骨宽度。结果：128只足不存在腓骨肌腱脱位(未脱位组)，轴位及冠状位MPR及VR图显示腓骨肌腱位于腓骨肌腱沟内；26只足存在腓骨肌腱脱位(脱位组)，MSCT显示腓骨肌腱从腓骨肌腱沟内脱出，并向外侧移位。脱位组跟骨结节外侧突后缘至载距突内侧面的距离、载距突后缘的跟骨宽度均大于未脱位组[(5.08±0.61) vs.(4.78±0.59) cm；(4.18±0.47) vs.(3.83±0.50) cm；P<0.05]。脱位组均行骨折切开复位、钢板内固定治疗，未对腓骨肌腱脱位进行处理。术后对15只足随访12个月，其中3只足腓骨肌腱复位，另外12只仍处于脱位状态。结论：MSCT可多角度观察腓骨肌腱和腓骨肌腱沟的位置，准确判断跟骨关节内骨折是否合并腓骨肌腱脱位，对于腓骨肌腱脱位的临床诊断和治疗具有重要意义。

MSCT in diagnosis of peroneal tendon dislocation accompanying intra-articular calcaneal fractures

Objective:To explore the clinical value of multi-slice CT (MSCT) in the diagnosis of peroneal tendon dislocation accompanying intra-articular calcaneal fractures.Methods:One hundred and forty-two patients with intra-articular calcaneal fractures, a total of 154 feet in patients admitted to Traditional Chinese Medicine Hospital of Xinle from January, 2013 to June, 2013 underwent MSCT scanning, carried out the volume virtual reality (VR) and multi planar reconstruction (MPR) of supplementary tendons, and the calcaneal width of posterior edge of sustentaculum and the width of the tuberosity posterior to the sustentaculum in calcaneal fractures were measured.Results:One hundred and twenty-eight feet without peroneal tendons dislocation (group without dislocation), axial position and coronal position in MPR and VR diagram showed that the peroneal tendons were located in the peroneal tendons groove; Peroneal tendons displacement was in 26 cases (dislocation group), MSCT showed that peroneal tendons were out of peroneal tendons groove, and lateral displacement. hTe width of posterior edge of sustentaculum and tuberosity posterior to the sustentaculum in calcaneal fractures of the dislocation group was greater than that of the group without dislocation [(5.08±0.61) vs. (4.78±0.59) cm, (4.18±0.47) vs. (3.83±0.50) cm,P<0.05]. hTe dislocation group underwent open reduction and steel plate internal ifxation, and peroneal tendons dislocation was not to deal with. Fitfeen feet were followed up for 12 months atfer operation, three feet with dislocated peroneal tendons were back to the normal location, and 12 feet were still in dislocation.Conclusion:hTe multi-angle peroneal tendons and the location of the peroneal tendons ditch can be observed by MSCT, and it has an accurate judgment in the intra-articular calcaneal fractures ifbula tendon dislocation or not, so it has a great signiifcance in clinical diagnosis and treatment of dislocation of the peroneal tendons.