Sever's Injury A Clinical Diagnosis
Sever's Injury A Clinical Diagnosis
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DOI：
10.7547/1030361
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发表时间：
2013-09-01
影响因子：
0.7
通讯作者：
Norlin, Rolf
中科院分区：
文献类型：
--
作者：
Perhamre, Stefan;Lazowska, Dagmara;Norlin, Rolf
背景：以前对Sever‘s损伤(跟骨隆起炎)的诊断部分是基于跟骨隆起处的放射学表现。由于跟腱的牵拉，硬化症和碎裂被认为是炎症的迹象。临床表现、诊断标准和研究人群往往定义不清。我们试图通过分析Sever‘s损伤人群的临床和放射学特征来确定诊断标准，并将结果与匹配的无症状儿童对照组进行比较。方法：我们评估了连续30名Sever损伤儿童，这些儿童在运动活动中疼痛程度高，但体力活动水平高。结果：单腿脚跟站立对Sever’s损伤的敏感性为100%；挤压试验为97%；触诊试验为80%。三种试验均显示出100%的特异性。所有患者和对照组均表现为隆起密度增加。无痛对照组中有一半出现骨折，而有足跟痛的儿童中几乎有90%。结论：Sever损伤的诊断是临床的，而不是放射学的。在体力活动水平高的无痛对照组中，也可以发现密度增加和碎裂的放射学表现，因此，可能代表正常的生长和发育。我们建议Sever‘s损伤的诊断应基于病史和两项特定临床检查的结果。
Background: The diagnosis of Sever's injury (apophysitis calcanei) has previously been partly based on radiographic findings in the calcaneal apophysis. Sclerosis and fragmentation have been supposed to represent signs of inflammation due to tractions from the Achilles tendon. The clinical findings, diagnostic criteria, and studied population are often poorly defined. We sought to define diagnostic criteria by analyzing clinical and radiographic characteristics in a population with Sever's injury and to compare the findings with those of a control group of matched, symptom-free children.Methods: We assessed 30 consecutive children with Sever's injury with high levels of pain but high physical activity levels in sports activities and 15 pain-free matched controls.Results: One-leg heel standing showed 100% sensitivity; the squeeze test, 97%; and the palpation test, 80%. All three tests showed 100% specificity. All of the patients and controls showed increased density of the apophysis. Half of the pain-free controls showed fragmentation versus almost 90% of children with heel pain.Conclusions: The diagnosis of Sever's injury is clinical, not radiologic. Radiologic findings of increased density and fragmentation are found also in pain-free controls with high levels of physical activity and may, therefore, represent normal growth and development. We suggest that the diagnosis of Sever's injury should be based on patient history and the results of two specific clinical tests.