Insertional Achilles Tendinitis and Haglund's Deformity
Insertional Achilles Tendinitis and Haglund's Deformity
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DOI：
10.3113/fai.2012.0487
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发表时间：
2012-06-01
影响因子：
2.7
通讯作者：
Charlton, Timothy P.
中科院分区：
文献类型：
--
作者：
Kang, Steve;Thordarson, David B.;Charlton, Timothy P.
背景资料：Haglund畸形是跟骨后上方隆起的扩大，常与跟腱炎有关。据我们所知，还没有研究成功地将Haglund畸形的特征与附着处跟腱炎联系起来。我们研究的目的是分析有和没有跟腱附着点炎患者的Haglund畸形的特征，看看是否存在相关性。方法：本研究是对2005年至2008年由一名外科医生治疗的止点性跟腱炎患者的回顾性影像学检查。我们的研究人群包括44名患者，48个足跟（22名男性，22名女性），平均年龄为52岁（范围，23至79岁）。我们的对照人群包括50名患者（25名男性，25名女性）和50个足跟，平均年龄为55.6岁（范围，18至89），没有插入性跟腱炎。在本研究中，我们介绍了两个新的测量Haglund畸形：Haglund畸形的高度和峰角。分析每例患者的站立侧足或踝关节X线片，并进行以下测量：Haglund畸形高度和峰角; Bohler角; Fowler-Philip角;和平行俯仰征。我们还观察了研究组中钙化的存在以及钙化的长度和宽度。采用非配对t检验分析组间测量值。对10例患者的X线片进行重新测量，并获得相关系数，以评估测量技术的可靠性。结果如下：对于止点跟腱炎组，平均Haglund畸形高度为9.6（范围，5.3至15.3）mm，平均Haglund畸形峰角为105（范围，87至123）度。48例患者中有35例（73%）存在钙化，平均长度为13.3（范围：3.2 - 41.9）mm，平均宽度：4.5在对照组中，平均Haglund畸形高度为9.0（范围，5.2至12.1）mm，峰值角为105（范围，91至124）度。两组之间的Bohler角和Fowler-Philip角也相似，并且正平行音高征在对照组中实际上更普遍（60%对41.7%）。两组之间的测量差异均未达到统计学显著性。结论：哈格伦德畸形并不表明插入性跟腱炎，并且存在于无症状患者中。此外，大多数跟腱炎患者在肌腱附着处有钙化。我们认为，在手术治疗止点性跟腱炎时，可能不需要切除Haglund畸形。
Background: Haglund's deformity is an enlargement of the posterosuperior prominence of the calcaneus, which is frequently associated with insertional Achilles tendinitis. To our knowledge, no study has been done successfully correlating the characteristics of a Haglund's deformity with insertional Achilles tendinitis. The purpose of our study was to analyze the characteristics of a Haglund's deformity in patients with and without insertional Achilles tendinitis to see if there was a correlation. Methods: The study was a retrospective radiographic review of a single surgeon's patients with insertional Achilles tendinitis from 2005 to 2008. Our study population consisted of 44 patients, 48 heels (22 male, 22 female) with insertional Achilles tendinitis, with a mean age of 52 (range, 23 to 79) years. Our control population consisted of 50 patients (25 males, 25 females) and 50 heels without insertional Achilles tendinitis with a mean age of 55.6 (range, 18 to 89) years. We introduced two new measurements of the Haglund's deformity in this study: the Haglund's deformity height and peak angle. A standing lateral foot or ankle radiograph was analyzed for each patient and the following measurements were made: Haglund deformity height and peak angle; Bohler's angle; Fowler-Philip angle; and parallel pitch sign. We also looked for the presence of calcification in the study group and the length and width of the calcification. Unpaired t-test was used to analyze the measurements between the groups. Ten patients' radiographs were re-measured and correlation coefficients were obtained to assess the reliability of the measuring techniques. Results: For the insertional Achilles tendinitis group, the mean Haglund's deformity height was 9.6 (range, 5.3 to 15.3) mm and the mean Haglund's deformity peak angle was 105 (range, 87 to 123) degrees. Calcification was present in 35 of 48 or (73%) of patients with a mean length of 13.3 (range, 3.2 to 41.9) mm and mean width of 4.5 (range, 1.0 to 10.4) mm. In the control group, the mean Haglund's deformity height was 9.0 (range, 5.2 to 12.1) mm and the peak angle was 105 (range, 91 to 124) degrees. Bohler's angle and Fowler-Philip angle were also similar between the groups and the positive parallel pitch sign was actually more prevalent in the control group (60% versus 41.7%). None of the differences in measurements between the groups achieved statistical significance. Conclusion: A Haglund's deformity was not indicative of insertional Achilles tendinitis and was present in asymptomatic patients. Also, a majority of the insertional Achilles tendinitis patients had calcification at the tendon insertion. We believe it is possible removing the Haglund's deformity may not be necessary in the operative treatment of insertional Achilles tendinitis.