目的 对Karger脂肪垫(Karger fat pad, KFP)的影像形态特征进行分类，并探讨其与后踝撞击综合征(posterior ankle impingement syndrome, PAIS)的关系。 方法 对2018年8月至2021年8月间的194例中国人的踝关节磁共振成像(MRI)扫描进行观察。在T1加权MRI上测量与KFP相关的FHL长度、KFP高度、与KFP相关的跟腱长度、距后三角骨长度、胫骨后下突长度、KFP与胫骨的最短水平距离、KFP矢状面面积、三角骨-跟骨-胫骨角等解剖参数。 结果 本研究共纳入194例三角籽骨综合征患者，其中对照106例(无PAIS)， PAIS患者88例。根据KFP的形状、长度、高度和矢状面积将其分为3种类型：Ⅰ型（三角形）、Ⅱ型（长梯形）、Ⅲ型（短梯形）。3种KFP类型中，PAIS中Ⅲ型(72, 81.8%)最多，对照组中Ⅰ型(43, 40.6%)和Ⅱ型(55, 51.9%)所占比例较大。 结论 PAIS患者与非PAIS患者的KFP形态存在显著差异。KFP的变化在PAIS的进展中是至关重要的，正确理解不同类型的KFP有助于研究PAIS的特点，可以为临床诊断早期PAIS提供一定依据。
Abstract
Objective To classify the imaging morphologic features of the Karger fat pad (KFP) and to investigate its relationship with posterior ankle impingement syndrome (PAIS). Methods A total of 194 Chinese patients with ankle magnetic resonance imaging (MRI) scans between August 2018 and August 2021 were observed. Anatomical parameters included flexor hallucis longus-related length of KFP, KFP height, achilles-related length of KFP, the length of os trigonum, length of posterior inferior tibial process, the shortest distance between KFP and tibia, KFP sagittal area, and os trigonum-calcaneus-tibia angle were measured in T1-weighted MRI. Results A total of 194 subjects with os trigonum syndrome were enrolled in this study and there were 106 patients without PAIS (control group) and 88 patients with PAIS. KFP was categorized into 3 types based on its shape, length, height and sagittal area: type I (triangular), type II (long trapezoidal), type III (short trapezoidal). Among the three KFP types, Type Ⅲ (72, 81.8%) accounted for the greatest number in PAIS group, while Type Ⅰ (43, 40.6%) and Type Ⅱ (55, 51.9%) accounted for the larger proportion in the control group. Conclusion There is significant difference in the morphology of the KFP between individuals with and without PAIS. It is assumed that the change of KFP is crucial in the progression of PAIS, and a better understanding of different types of KFP is helpful to study the characteristics of PAIS, which can provide certain basis for clinical diagnosis of PAIS in the early stage.
关键词
/
Kager脂肪垫 /
/
/
后踝撞击征 /
/
/
三角籽骨综合征 /
/
/
踝关节 /
/
/
磁共振成像
Key words
Kager fat pad /
/
/
Posterior ankle impingement syndrome /
/
/
Os trigonum syndrome /
/
/
Ankle /
/
/
MRI
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Szaro P, Polaczek M, Ciszek B. The Kager's fat pad radiological anatomy revised [J]. Surg Radiol Anat,2021,43(1):79-86.DOI: 10.1007/ s00276-020-02552-1.
[2] Wiegerinck JI, Zwiers R, van Sterkenburg MN, et al. The appearance of the pre-Achilles fat pad after endoscopic calcaneoplasty [J]. Knee Surg Sports Traumatol Arthrosc,2015,23(8):2400-2405.DOI：10.1007/s00167- 014-2908-6.
[3] Ballal MS, Walker CR, Molloy AP. The anatomical footprint of the Achilles tendon: a cadaveric study [J]. Bone Joint J, 2014, 96-B(10): 1344-1348. DOI: 10.1302/0301-620X.96B10.33771
[4] Takumi O, Hirofumi T, Hiroshi A, et al. Presence of adipose tissue along the posteromedial tibial border[J]. J Exp Orthop, 2021, 8(1): 92. DOI: 10.1302/0301-620X.96B10.33771.
[5] Chang CD, Wu JS. MR Imaging Findings in Heel Pain [J]. Magn Reson Imaging Clin N Am,2017,25(1):79-93. DOI: 10.1016/j.mric. 2016. 08.011.
[6] Malagelada F, Stephen J, Dalmau-Pastor M, et al. Pressure changes in the Kager fat pad at the extremes of ankle motion suggest a potential role in Achilles tendinopathy [J]. Knee Surg Sports Traumatol Arthrosc, 2020, 28(1): 148-154. DOI: 10.1007/s00167-019-05585-1.
[7] Gupta A, Mulvihill E, Turner D. Is Real-Time Ultrasound Reliably Able to Determine Kager's Fat Pad Motion during Walking [J]? Ultrasound Med Biol,2022, 48(2):217-222. DOI: 10.1016/j.ultrasmedbio.2021. 09.024.
[8] Nery C, Baumfeld D. Anterior and Posterior Ankle Impingement Syndromes: Arthroscopic and Endoscopic Anatomy and Approaches to Treatment [J]. Foot Ankle Clin, 2021, 26(1): 155-172. DOI: 10.1016/j.fcl.2020.07.002.
[9] LiMarzi GM, Khan O, Shah Y, et al. Imaging Manifestations of Ankle Impingement Syndromes [J]. Radiol Clin North Am, 2018, 56(6): 893-916. DOI: 10.1016/j.rcl.2018.06.005
[10]Baillie P, Mayes S, Lam J, et al. Associations between clinical and imaging findings in posterior ankle impingement syndrome: a systematic review [J]. Acta Radiol, 2022, 63(5): 652-657. DOI: 10.1016/j.rcl.2018.06.005.
[11]Maffulli N, Aicale R, Migliorini F, et al. The double posteromedial portals endoscopy for posterior ankle impingement syndrome in athletes [J]. J Orthop Traumatol, 2022, 23(1): 28. DOI: 10.1186/s10195-022-00651-w.
[12] Gheno R, Nico MA, Buck FM, et al. Edematous processes within Kager fat pad: magnetic resonance imaging, gross anatomical, and histological studies in cadavers with clinical correlation [J]. J Comput Assist Tomogr,2010, 34(4): 621-625. DOI: 10.1097/RCT.0b013e3181 d275cc.
[13] Rodríguez-Sanz D, Losa-Iglesias ME, de Bengoa-Vallejo RB, et al. A New Test for Achilles Tendinopathy Based on Kager's Fat Pad Clinical Assessment Predictive Values [J]. J Clin Med, 2023, 12(16): 5183. DOI: 10.3390/jcm12165183.
[14] Ok N, Agladioglu K, Gungor HR, et al. Strain Ratio Measurements of Patellar and Achilles Tendons With Different Reference Regions in Healthy Volunteers [J]. Ultrasound Med Biol, 2019, 45(8): 2027-2033. DOI: 10.1016/j.ultrasmedbio.2019.04.025.
[15]Romero-Morales C, Martín-Llantino PJ, Calvo-Lobo C, et al. Comparison of the sonographic features of the Achilles Tendon complex in patients with and without Achilles tendinopathy: A case-control study [J]. Phys Ther Sport, 2019, 35: 122-126. DOI: 10.1016/j.ptsp.2018.12.003
[16] Kokulu K, Akça HS. The Kager's Fat Pad Sign [J]. J Emerg Med, 2017, 53(5): 760-761. DOI: 10.1016/j.ptsp.2018.12.003.
[17]Kinugasa K, Shimomura K, Tachibana Y, et al. Posterior Ankle Impingement Caused by Hyaline-Like Cartilage Generation in Ballet Dancers-A Report of 2 Cases [J]. J Foot Ankle Surg, 2022, 61(4): e9-e14. DOI: 10.1053/j.jfas.2021.10.015.
[18]Micheli LJ, Solomon R, Solomon J, et al. Posterior Ankle Decompression With Os Trigonum or Stieda Process Resection in Dancers: Case Series Report and Review of the Literature [J]. J Foot Ankle Surg, 2021, 60(4): 706-711. DOI: 10.1053/j.jfas.2020.10.011.
[19] Özer M, Yıldırım A. Evaluation of the Prevalence of Os Trigonum and Talus Osteochondral Lesions in Ankle Magnetic Resonance Imaging of Patients With Ankle Impingement Syndrome [J]. J Foot Ankle Surg, 2019, 58(2): 273-277. DOI: 10.1053/j.jfas.2018.08.043.
[20] Kalbouneh HM, Alajoulin O, Alsalem M, et al, Al-Muhtaseb MH. Incidence of symptomatic os trigonum among nonathletic patients with ankle sprain [J]. Surg Radiol Anat, 2019, 41(12): 1433-1439. DOI: 10.1007/s00276-019-02354-0.
[21]Tokgöz MA, Ataoğlu MB, Ergişi Y, et al. Is there any effect of presence and size of os trigonum on flexor hallucis longus tendon lesions [J]? Foot Ankle Surg, 2020, 26(4): 469-472. DOI: 10.1007/s00276-019-02354-0.
[22] Theobald P, Bydder G, Dent C, et al. The functional anatomy of Kager's fat pad in relation to retrocalcaneal problems and other hindfoot disorders [J]. J Anat, 2006, 208(1): 91-97. DOI: 10.1111/j.1469-7580.2006.00510.x.
[23] Pingel J, Petersen MC, Fredberg U, et al. Inflammatory and Metabolic Alterations of Kager's Fat Pad in Chronic Achilles Tendinopathy [J]. PLoS One,2015,10(5): e0127811.DOI: 10.1371/journal.pone. 0127811.
[24] Sharpe BD, Steginsky BD, Suhling M, et al. Posterior Ankle Impingement and Flexor Hallucis Longus Pathology [J]. Clin Sports Med, 2020, 39(4): 911-930. DOI: 10.1016/j.csm.2020.06.001.
[25] Russell JA, Shave RM, Yoshioka H, et al. Magnetic resonance imaging of the ankle in female ballet dancers en pointe [J]. Acta Radiol, 2010, 51(6): 655-61. DOI: 10.3109/02841851.2010.482565.
[26] Bureau, NJ, Cardinal É, et al. Posterior Ankle Impingement Syndrome: MR Imaging Findings in Seven Patients [J]. Radiology, 2000, 215(2): 497-503. DOI: 10.1148/radiology.215.2.r00ma01497.
[27] Calder JD, Sexton SA, Pearce CJ. Return to training and playing after posterior ankle arthroscopy for posterior impingement in elite professional soccer [J]. Am J Sports Med, 2010, 38(1):120-124. DOI: 10.1177/0363546509346390.
[28] Ghazzawi A, Theobald P, Pugh N, et al. Quantifying the motion of Kager's fat pad [J]. J Orthop Res, 2009, 27(11): 1457-1460. DOI: 10.1002/jor.20900.
基金
2022年四川省科技计划联合创新专项项目(2022YFS0609)；2022年西南医科大学附属中医医院科研团队培育项目(2022-CXTD-08)；2023年度四川省中医药管理局中医药科研专项课题面上项目（中医药基础）(2023MS248)；2023年度泸州市科技计划项目（科技创新领军人才）(2023RCX172)；2023年西南医科大学中西医结合专项（优基计划）(2023ZYYJ03)
PDF(1719 KB)
京ICP备08002354号-3
