中国组织工程研究 ›› 2020, Vol. 24 ›› Issue (18): 2906-2910.doi: 10.3969/j.issn.2095-4344.2587

• 骨与关节图像与影像Bone and joint imaging • 上一篇    下一篇

跟骨骨刺定位与病因学特点的X射线片评价

武  凯,廖立青,李义凯   

  1. 南方医科大学中医药学院,广东省广州市   510515
  • 收稿日期:2019-07-20 修回日期:2019-07-26 接受日期:2019-10-26 出版日期:2020-06-28 发布日期:2020-04-03
  • 通讯作者: 李义凯,博士,主任医师,南方医科大学中医药学院,广东省广州市 510515
  • 作者简介:武凯,男,1994年生,江西省高安市人,汉族,南方医科大学在读硕士,主要从事临床解剖生物力学研究。

X-ray evaluation of the location and etiology of calcaneal spurs 

Wu Kai, Liao Liqing, Li Yikai    

  1. College of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, Guangdong Province, China
  • Received:2019-07-20 Revised:2019-07-26 Accepted:2019-10-26 Online:2020-06-28 Published:2020-04-03
  • Contact: Li Yikai, MD, Chief physician, College of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, Guangdong Province, China
  • About author:Wu Kai, Master candidate, College of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, Guangdong Province, China

摘要:

文题释义:

骨刺“垂直压缩”假说:骨刺突起是在病变局部受到持续的高强度的压力而引发的。具体是指由于受到持续压力,受压部位有发生应力性骨折的风险,出于机体自身的保护机制,此处的纤维软骨异常生长,最终形成骨刺。

骨刺“纵向牵拉”假说:肌腱或韧带附着与骨质上的反复牵拉引起骨刺。附着在骨质上的肌腱或韧带对骨质局部形成持续的牵引或摩擦,诱发局部无菌性炎症,最终肌腱或韧带发生反应性的骨化而形成骨刺。

背景:国内外大量研究已经证实跟骨骨刺的发生与足底筋膜炎和骨关节炎等疾病存在联系,对于跟骨骨刺的病因,目前已经提出“垂直压缩”和“纵向牵拉”两大假说,但都未得到证实。

目的:对跟骨骨刺的形态和位置进行统计,分析跟骨骨刺的病因。

方法:随机选取完整干燥跟骨标本831例和跟骨侧位X射线片222例(其中18-30岁33例,31-50岁97例,51-70例83例,71-90例9例),观察跟骨骨刺的形态和位置,游标卡尺直接测量标本中跟骨骨刺的长度和宽度,运用相关软件在跟骨侧位X射线片上测量骨刺长度。研究方案的实施符合南方医科大学的相关伦理要求,试验所用跟骨标本由南方医科大学解剖教研室提供,为供者自愿捐赠。

结果与结论:①跟骨标本有142例存在骨刺;跟骨侧位X射线片中有82例存在骨刺;跟腱骨刺最长处88.1%位于跟骨外侧缘,足底骨刺全部位于跟骨内侧结节;②X射线片无骨刺人群的平均年龄为(42.9±14.2)岁,有骨刺人群的平均年龄为(54.0±13.4)岁,单纯跟腱骨刺人群的平均年龄为(42.3±14.9)岁,有骨刺人群平均年龄显著大于无骨刺人群(P < 0.05);无骨刺人群与单纯跟腱骨刺人群的平均年龄差异无显著性意义(P > 0.05);③跟骨标本显示跟腱骨刺的形态为竖嵴状,足底骨刺为片状;④结果说明:跟骨侧位X射线片中跟骨骨刺发生率大于跟骨标本中跟骨骨刺发生率;跟腱骨刺多发生在跟腱附着处外侧,足底骨刺发生在跟骨内侧结节;不同年龄段人群中跟骨骨刺的发生率不同;提示跟腱骨刺可能由纵向牵拉引起,足底骨刺可能由垂直压缩引起。

ORCID: 0000-0003-0316-5954(武凯)

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程

关键词: 跟骨, 骨刺, 跟腱, 形态, 位置, 病因学, 垂直压缩, 纵向牵拉

Abstract:

BACKGROUND: A large number of studies in and outside China have confirmed that the occurrence of calcaneus spur is related to plantar fasciitis, osteoarthritis and other diseases. For the etiology of calcaneus spur, two hypotheses have been proposed, which are “vertical compression” and “vertical traction”, but they have not been confirmed.

OBJECTIVE: To analyze morphology and location of calcaneal spurs so as to analyze the etiology of calcaneal spurs.

METHODS: Totally 831 complete dry calcaneal specimens and 222 cases of X-ray films were randomly selected, including 33 cases aged 18-30 years, 97 cases aged 31-50 years, 83 cases aged 51-70 years, and 9 cases aged 71-90 years. Morphology and location of calcaneal spurs were observed. The length and width of the calcaneal spurs were measured directly by vernier caliper. The length of the calcaneal spurs was measured by using the related software in the calcaneus lateral X-ray film. The implementation of the research program was in line with the ethical requirements of Southern Medical University. The calcaneal specimens used in the experiment were provided by the Department of Anatomy of Southern Medical University and were donated voluntarily by the donors.

RESULTS AND CONCLUSION: (1) There were 142 specimens of calcaneal spur in the calcaneal specimens and 82 cases of calcaneal spurs in the lateral X-ray films. The highest point of 88.1% of achilles tendon spurs was in lateral edge of the calcaneus, and the plantar spurs were all located in the medial nodule of the calcaneus. (2) X-ray films showed that the average age of the spur-free population was (42.9±14.2) years, and the average age of the population with spurs was (54.0±13.4) years. The average age of patients with Achilles tendon spur was (42.3±14.9) years. The difference between spur-free population and population with spurs was statistically significant (P < 0.05). The difference between the average age of the spur-free population and the individuals with Achilles tendon spurs was not statistically significant (P > 0.05). (3) Calcaneal specimen showed that the shape of Achilles tendon spur was vertical ridge, and the plantar spur was lamellar. (4) Results indicated that the incidence rate of spurs in X-ray films was significantly higher than that in specimens. The calcaneal spur was mainly in lateral edge of the Achilles tendon attachment, and the plantar spurs were all located in the medial nodule of the calcaneus. The incidence of calcaneal spur is different in different age groups, suggesting that the Achilles tendon spur may be caused by longitudinal traction and the plantar spur may be caused by vertical compression.

Key words:

calcaneus, spur, Achilles tendon, morphology, location, etiology, vertical compression, longitudinal traction

中图分类号: