超音波於跟骨後滑液囊炎之臨床應用

Clinical Applications of Ultrasonography in Retrocalcaneal Bursitis

跟骨後滑液囊炎是造成後足跟痛常見的原因之一，常合併有跟腱炎，足底肌膜炎等。而跟骨後滑液囊炎也是許多風濕免疫疾病的臨床表徵之一，單憑臨床病史及理學檢查並不易正確鑑別診斷。本研究利用高解析度超音波來診斷跟骨後滑液囊炎，並施行超音波導引積液抽取術，配合手術發現及病理報告，以評估超音波於跟骨後滑液囊炎的臨床應用價值。本研究共收集116例主訴為後足跟痛的病患，其中有19例被診斷出跟骨後滑液囊炎。跟骨後滑液囊炎在超音波下顯示為膨大的低回音區域且邊界不規則。在19位患者中有8位接受了超音波導引積液抽取術，1位接受了滑囊切除術及部分跟骨切除術，10名僅接受保守療法。結果顯示，超音波的診斷與手術發現及病理報告皆相吻合。8位接受超音波導引積液抽取術的病患術後皆達到完全的疼痛緩解。我們認為超音波對於跟骨後滑液囊炎同時具有診斷上與治療上的價值，在臨床應用上，堪稱是相當實用的工具，值得未來繼續廣泛發展。

Retrocalcaneal bursitis is a common cause of posterior heel pain. It tends to coexist with Achilles tendinitis, plantar fasciitis and various rheumatic diseases. The purpose of this study was to investigate the clinical value of ultrasonography in the diagnosis and management of retrocalcaneal bursitis. One hundred and nineteen patients with posterior heel pain during 5 years’period were enrolled in this study. Nineteen patients of them had a sonographic diagnosis of retrocalcaneal bursitis. The image of retrocalcaneal bursitis on sonograms revealed a bulging hypoechoic shadow, with an irregular border located between the posterior calcaneus and the Achilles tendon. Eight of the 19 patients received ultrasound-guided aspiration, and one received bursectomy with partial calcanectomy. There was good consistency between the ultrasonographic images and surgical findings. The 8 patients receiving ultrasound-guided aspiration had full pain relief immediately after the procedure. One patient who underwent surgical intervention had recurrent retrocalcaneal bursitis, rheumatoid arthritis that later. We conclude that retrocalcaneal bursitis can be accurately diagnosed by high resolution ultrasonography and it can also provide differential diagnosis of soft tissue problems of posterior heel pain. In addition, aspiration for retrocalcaneal bursitis can be performed more precisely under ultrasound-guidance to achieve a better result.