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Title 8 アキレス腱症・付着部症の診断・治療・手術
Subtitle FEATURE アキレス腱断裂・損傷 ガイドライン改訂 確認・実践・応用 [応用編]
Authors 松井智裕, 熊井司
Authors (kana)
Organization 済生会奈良病院整形外科部長, 早稲田大学スポーツ科学学術院教授
Journal 整形外科サージカルテクニック
Volume 10
Number 6
Page 687-695
Year/Month 2020 /
Article 報告
Publisher メディカ出版
Abstract 「はじめに」 アキレス腱のオーバーユース障害は踵骨付着部から2cmを境界としてアキレス腱症とアキレス腱付着部症に大別される. これらのアキレス腱障害は, 若年スポーツ選手(愛好家)のオーバーユース障害として発症するケースと中高年の退行性変化(変性)として発症するケースがある. 「診断」 アキレス腱部および踵骨付着部の疼痛, 腫脹, 熱感が主な症状である. 初期には運動開始時の疼痛が特徴的であるが, 進行すると運動中および運動後まで疼痛が継続するようになる. 踵骨後部外側にpump bumpと呼ばれる隆起を皮膚上から触れることもある. 画像検査では, 超音波が第一選択である. アキレス腱症ではアキレス腱実質の紡錘状肥厚, fibrillar patternの不整・消失を伴う腱内部の異常高or低エコー像, 異常血流などの所見を認める. アキレス腱付着部症では, アキレス腱症と同様の所見を付着部近傍のアキレス腱内に認めるほかに, 踵骨後部滑液包内の水腫貯留, アキレス腱付着部の骨棘形成を認める.
Practice 臨床医学：外科系
Keywords
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