Achilles腱断裂に試みた造影術の経験
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概要
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A new roentgenographic diagnosis for subcutaneous rupture of the acilles tendon with a contrast medium was reported by Arner et al. in 1960. The method was evaluated in our clinic.<BR>The study were performed on eleven occasions on ten patients who had visited the Orthopedic clinic of Showa University Medical Center between May, 1961 and October, 1962. As to the rupture of the achilles tendon, nine cases were fresh subcutaneous and two long-standing, whose time interval between the injury and examination ranging one day to fifteen years.<BR>The contrast medium was composed of 5 ml. of 76% Urografin and 5ml. of 1% Hostacaene. The medium was injected into the mid-line of the dorsal surface of the tendon near the upper corner of the calcaneus in a prone position on the fluoroscopic table. When injected slowly into the space between the superficial paratenon and achilles tendon, the medium will spread over the dorsal surface of the tendon up to the rupture site, filling the gap or leaking out of the paratenon. Recognizing the ascending path of the medium fluoroscopically by continued injection, X-ray photographs were taken from two directions.<BR>A normal feature was represented by smooth contour along the achilles tendon (Fig. 2) .In the fresh cases of the rupture, the medium was distributed in a H-form between the both ends of the severed tendon (Fig. 3, 4), if the paratenon was fairly well preserved and in a triangle-form as an insuficient type of a H-form (Fig. 6) . When the ruptured ends were fringed or layered, the medium distributed into the irregular shaped spaces and then the shape of the ends may become obvious prior to the operation (Fig. 6) . In general, the extent and nature of the rupture could be estimated by the disribution of the medium. However, interpretatin should be done very carefully, when blood-clot was present in the rupture site, since it came out as a radio-opaque defect (Fig. 5) .<BR>In long-standing cases with cicatrization and marked adhesion, the medium was not distributed around the tendon (Fig. 9) . The complication of the rupture of the long plantaris muscle tendon might be able to be suggested.<BR>In conclusion, this method was useful not only for the diagnosis of clinically apparent rupture, but also for a supplementary diagnosis for long-standing cases or partial rupture (Fig. 8) .
- 昭和大学・昭和医学会の論文