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业余马拉松运动员踝关节损伤的MRI特征及相关因素分析

MRI features and related factors of ankle injury in amateur marathoners

摘要:

目的 探讨业余马拉松运动员(未参加过正规训练,不以马拉松为职业)踝关节损伤原因、特点和影像表现.方法 2018年12月至2019年3月按研究纳入和排除标准,收集广东珠海地区业余马拉松运动员作为受试对象.通过问卷调查收集相关资料,并对受试者行踝关节MRI平扫检查,采用踝关节专用相控阵线圈,分别行快速自旋回波序列(TSE)冠状面T1WI,质子密度加权抑脂序列(PDWI?FS)横断面、冠状面及矢状面扫描,三维?双回波稳态序列(3D?DESS)及三维?可变反转角快速自旋回波序列(3D?SPACE)扫描.检查结果由2名医师(分别从事影像诊断工作5、17年)对韧带、肌腱、骨髓等踝关节影像表现进行综合分析,两者意见不一致时由第3名医师(从事影像诊断工作27年)进行判定作为最终诊断;分析不同跑姿、参加马拉松的次数及训练强度与踝关节损伤的关系,统计采用独立样本χ2检验,2名医师的一致性采用Kappa检验.结果 根据纳入及排除标准,最终纳入受试者39名,64侧踝关节,右踝35侧、左踝29侧.MRI显示:(1)韧带损伤:距腓前韧带损伤28侧;距腓后韧带损伤50侧;跟腓韧带损伤60侧;三角韧带损伤54侧,均为部分损伤.(2)肌腱周围积液及损伤:以腱鞘周围积液较常见,踇长屈肌腱47侧、胫骨后肌腱49侧、趾长屈肌腱37侧、腓骨长肌腱7侧、腓骨短肌腱5侧、跟腱损伤1侧.(3)滑膜炎积液:后踝滑膜炎和局部积液43侧.(4)其他:软骨损伤2侧,骨髓水肿8侧,其中2侧有应力性骨折.2名放射科医师的阅片结果有较好的一致性,Kappa值为0.91.跑姿中,后脚掌着地较前、中脚掌着地韧带损伤发生率明显增加,差异有统计学意义(χ2值为6.191,P=0.013).前、中脚掌着地较后脚掌着地肌腱损伤发生率目明显增加,差异有统计学意义(χ2值为4.775, P=0.029);训练量较大者(训练跑步量≥300 km/月)踝关节损伤较显著(χ2值为7.844,P=0.005).结论 业余马拉松志愿者踝关节运动损伤的MRI影像表现特征与不同的跑姿及训练强度有关.

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abstracts:

Objective To explore the factors, characteristics and imaging manifestations of ankle joint injury in amateur marathoners (no formal training and no marathon career). Methods From December 2018 to March 2019, the amateur marathon runners in Guangdong Zhuhai had been recruited as research subjects according to the study inclusion and exclusion criteria. The questionnaires were used to collect relevant data, and the subjects underwent MRI scans of the ankle joint. The ankle joint special phased array coils were used to perform fast spin echo sequence (TSE) coronal T1WI and proton density?weighted fat?suppression sequence (PDWI?FS). Axial, coronal and sagittal scans, three?dimensional?double echo steady?state sequence (3D?DESS) and three?dimensional variable flip angle fast spin echo sequence (3D?SPACE) scans were also acquired. The results of the examination were independently analyzed by two radiologists (5 and 17 years of work experience, respectively) on the ligament, tendon, bone marrow and ankle joint injuries. When they had inconsistent views, the diagnosis provided by the third radiologist (27 years of work experience) was considered a final diagnosis. The relationship between ankle injury and different running postures, the number of participating in marathons and training intensity was analyzed, and the independent sample χ2 was used for statistical analysis. The consistency of two radiologists was tested by Kappa test. Results According to the inclusion and exclusion criteria, 39 subjects were included, with 64 ankles totally, 35 right ankles and 29 left ankles. MRI showed that (1) Ligament injuries: 28 ankles were anterior talofibular ligament injuriy;50 ankles were posterior talofibular ligament injury; 60 ankles the calcaneofibular ligament injuries and 54 ankles were deltoid ligament injuries, without complete injury. (2) Tendon sheath effusion and injuries: peritendinous effusion was common, with 47 flexor hallucis longus tenosynovitis, 49 posterior tibialis tenosynovitis, 37 flexor digitorum longus tenosynovitis, 7 peroneus longus tenosynovitis and 5 peroneus brevis tenosynovitis. (3) Synovitis effusion: 43 posterior ankle synovitis and local effusion. (4) Others: cartilage injury in 2 ankles, bone marrow edema in 8 ankles, and among them stress fracture in 2 ankles. The two radiologists had good consistency with the Kappa value of 0.91. Regarding the running posture, the incidence of ligaments injuries was obviously higher in those who landed on the hind foot than in those landed on front and middle foot,and the difference was statistically significant(P=0.013, χ2 value was 6.191).The incidence of tendon injuries was higher in those who landed on the front middle foot than in those landed on the hind foot, and the difference was statistically significant (P=0.029, χ2 value was 4.775). Those with larger training (training running ≥300 km/month) had significant ankle injury (P=0.005, χ2 value was 7.844). Conclusion The MRI features of ankle joint injuries in amateur marathon volunteers are related to different running postures and training intensity.

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