跟腱炎的超音波診斷

Ultrasonographic Diagnosis of Achilles Tendinitis

跟腱炎是造成後足跟疼痛及失能的常見原因。雖然其診斷不難藉由詳細的病史與理學檢查獲得，然而過去對於跟腱炎的診斷—直缺乏客觀的證據。由於臨床上少有病患因為跟腱炎而接受手術治療，因此缺乏有力的病理報告來確定診斷。軟組織超音波不具侵襲性，方便簡單又可做動態檢查，加上近年來高頻率探頭的發展與研究使其解像力不斷地提高，因此適合於表淺肌腱與韌帶疾病的檢查。本研究乃利用10MHz高頻率超音波探頭來檢查臨床上臆診為跟腱炎之跟腱，以觀察其厚度及回音的變化，作為診斷及治療之參考。研究方法乃採回溯性病例研究，收集民國85年3月至民國89年3月接受跟腱超音波檢查的患者87人。正常的跟腱在超音波下為一由跟骨向上延伸之均質、低至中回音且具平行排列纖維結構之構造；而相較下，出現症狀的跟腱則會有厚度增加及呈現局部或較廣泛的低回音區域；但有時會出現異常的高回音訊號且具回音後陰影。研究結果發現患側跟腱的厚度（7.19±2.02mm）比健側（5.18±1.16mm）來得厚；87例中共有72例（83%）其患側跟腱出現異常低回音或異常高回音訊號，較健側的15例（17%）高；且患側合併出現跟骨後滑液囊炎的有24例（28%），也較健側出現的比例（0例）來得高。其中4例跟腱炎合併跟骨後滑液囊炎的患者，在超音波的引導下接受針穿刺抽吸治療後，症狀明顯獲得改善。由本研究得知，軟組織超音波可清楚顯示跟腱炎之結構異常，故可做為跟腱炎診斷及評估的工具。

A 10MHz linear array ultrasound transducer was used to evaluate the sonographic appearance of Achilles tendon. In this retrospective study, we reviewed the sonographic findings of Achilles tendons in 87 patients with symptoms involving the unilateral posterior heel. The patients had all undergone a previous clinical examination, resulting in a suspicion of unilateral Achilles tendinitis. The normal Achilles tendon is a homogeneously echogenic band with thin echogenic margins, lying under a very thin layer of skin and subcutaneous tissue. The retrocalcaneal bursa, which separates the superior third of the calcaneus from the Achilles tendon, was also examined, and retrocalcaneal bursitis was diagnosed based on an enlarged hypoechoic bursa. The mean thickness of Achilles tendon on the symptomatic side was greater(7.19mm) compared with the asymptomatic side(5.18mm). Echogenicity change could be found on the symptomatic side in 72 cases(83%) and on the asymptomatic side in 15 cases(17%). Decreased echogenicity occurred in 57 cases on the symptomatic side and 9 cases on the asymptomatic side. Compared with the asymptomatic side, the symptomatic Achilles tendon demonstrated significant thickening and decreased in echogenicity. Four of these patients underwent U/S-guided aspiration of the in inflammed retrocalcaneal bursa, resulting in excellent and sustained improvement after the procedure. The pathological diagnoses were consistent with the ultrasonographic diagnoses in these 4 cases. We concluded that high-resolution ultrasonography is a useful tool in the diagnosis of Achilles tendinits.