英汉对照骨科患者指南031：腓骨肌腱疾病（上）

Peroneal Tendon

腓骨肌腱

A Patient’s Guide to Peroneal Tendon Problems

腓骨肌腱病变患者指南

                    

 

Introduction

引言

 

Problems affecting the two peroneal tendons that lie behind the outer ankle bone (the lateral malleolus) are common in athletes. These problems mainly occur in the area where the two tendons glide within a fibrous tunnel behind the lateral malleolus.

　　在外侧踝关节的骨头（外踝）后方，有腓骨长短肌腱经过。累及这两条肌腱的疾患在运动员中很常见，主要发生在外踝后面该两条肌腱滑动的纤维隧道内。

This guide will help you understand

· how peroneal tendon problems develop

· how doctors diagnose the condition

· what can be done to treat this problem

　　本指南将帮助您了解：

　　　·腓骨肌腱疾患是如何发生的？

　　　·医生如何诊断？

　　　·如何进行治疗？

Anatomy

解剖

What part of the ankle is involved?

　　病变累及踝关节哪部分？

The peroneals are two muscles and their tendons that lie along the outside of the lower leg bone (the fibula) and cross behind the lateral malleolus (the outer ankle bone). The term medial refers to a point closer to the center of the body. So the ankle bump on the inside edge of the ankle (closest to your other ankle) is the medial malleolus. The term lateral refers to structures furthest from the center. Major muscles that support the lateral part of the ankle are the peroneus longus and the peroneus brevis.

　　腓骨肌是由两块肌肉构成，这两块肌肉和它们的肌腱位于小腿骨(腓骨)的外侧并从外踝(外踝骨)的后方穿过。“内侧”这个术语指的是更接近身体中央的位置。所以踝的内侧缘隆起的关节部位（最靠近对侧踝关节）叫做内踝。“外侧”这个术语指的是离身体中央最远的结构。支持踝关节外侧部分的主要肌肉是腓骨长短肌。

The tendons of these two muscles pass together in a groove behind the lateral malleolus. (Tendons attach muscles to bones.) The tendons are kept within the groove by a sheath that forms a tunnel around the tendons. The surface of the tunnel is reinforced by a band of tissue called a retinaculum. Contracting the peroneal muscles makes the tendons glide in the groove like a pulley. The pulley action causes the foot to point downward (plantarflexion) and outward (eversion).

　　这两块肌肉的肌腱一同穿过外踝后方的肌腱沟。（肌腱将肌肉附着到骨头上。）在腱鞘形成的隧道沟中的肌腱被腱鞘包裹束缚在沟中。隧道的表面由叫做支持带的一束组织加强。收缩腓骨肌使得肌腱可以在沟中象滑轮一样滑动。这个滑轮动作使得足向下（跖屈）和向外（外翻）。

View animation of plantarflexion

　　观看跖屈的动画

 

View animation of eversion

　　观看外翻的动画

 

The peroneus brevis tendon connects to a bump on the base of the fifth metatarsal. This spot can be felt midway down the outer edge of the foot.

　　腓骨短肌的肌腱附着在第５跖骨基底部的隆起处。该附着点可顺着足的外侧缘中点处被触及。

The peroneus longus tendon lies behind and below the peroneus brevis tendon. It wraps down and under the foot by way of the cuboid bone, the outer tarsal bone just in front of the heelbone (the calcaneus). The peroneus longus tendon angles forward under the sole of the foot and connects to the bottom of the main bone of the big toe. This tendon stabilizes the arch of the foot when walking.

　　腓骨长肌肌腱位于腓骨短肌肌腱的后方下方。腓骨长肌腱就在跟骨的前部包绕向下，途经骰骨、外侧跗骨绕到足的下方。腓骨长肌腱在足底折向前附着于第一跖骨基底跖面。当行走时腓骨长肌腱稳定了足弓。

Related Document: A Patient’s Guide to Ankle Anatomy

相关阅读：英汉对照骨科患者指南001：踝关节解剖

警告：请在有WIFI的场所观看视频，土豪请随意。

本视频由张正阳翻译，更多解剖视频，请关注微信公众平台《张正阳Thomas》

Causes

病因

Why do I have this problem?

　　为什么我有这样的问题?

Peroneal tendon problems mostly occur where the tendons glide within the pulley behind the lateral malleolus. Their movement can cause irritation of the lining of the tendons. This condition is called tenosynovitis. The irritation can also occur after an ankle injury, such as a blow to the outside of the ankle or an ankle sprain.

　　腓骨肌腱的病变大部分发生在外踝后方肌腱滑动的骨纤维沟中。肌腱的滑动引起对肌腱腱鞘的刺激。这种状况就是所谓的腱鞘炎。这个刺激也可发生在踝关节损伤后，比如踝关节外侧受到打击或踝关节扭伤。

Repetitive ankle motions in sports, such as running and jumping, can lead to wear and tear on the tendons inside the groove. A high arch puts extra tension on the peroneal tendons within the groove and has also been found to cause peroneal tendon problems.

　　在体育运动中反复的踝关节运动，比如跑和跳，会导致在骨纤维沟中的肌腱的磨损和撕裂。足弓高的话会对骨纤维沟中的腓骨肌腱施加一个额外的张力，因而高弓足也会引起腓骨肌腱的疾患。

Peroneal tendon problems commonly occur from an ankle sprain. During the typical inversion ankle sprain, the foot rolls in. This type of injury sprains or tears the ligaments that support the lateral part of the ankle. The forceful stretch on the peroneals when the foot rolls in can also cause a lengthwise tear in the peroneal tendons.

　　腓骨肌腱的问题通常起因于踝关节扭伤。在典型的踝关节内翻扭伤，足向内翻滚。这个类型损伤致扭伤或撕裂了踝关节外侧韧带。当足向内翻滚时，踝关节腓侧受到强力的拉伸会导致腓骨肌腱的纵向撕裂。

An inversion ankle sprain can also cause the peroneal tendons to momentarily slip out of the groove. This is calledsubluxation. Peroneal tendonitis often occurs during the recovery period after an ankle sprain. Because the ankle is unstable, the peroneals may need to work harder to give needed support to the damaged lateral ankle ligaments. The overwork sets them up for subluxation.

　　踝关节内翻扭伤也可以导致腓骨肌腱从沟中一过性滑出。这种状况叫做半脱位。在踝关节扭伤的康复期间腓骨肌腱炎经常会发生。因为康复期间踝关节不稳定，为了稳定踝关节腓骨肌腱需要更加努力工作来对损伤的腓侧韧带功能的弥补。超负荷工作使得腓骨肌腱半脱位。

Related Document: A Patient’s Guide to Peroneal Tendon Subluxation

相关阅读：腓骨肌腱半脱位患者指南（翻译招募中，有意者请留言）

 

In some patients, a peroneal tendon problem is caused by degenerative changes in the tendons themselves rather than by inflammation around the tendons. The tendon itself becomes abnormal. Doctors call this condition tendonosis.

　　在一些病人中，腓骨肌腱病变是由肌腱本身退行性改变所导致，而不是肌腱周围的炎症所致。医生将这种肌腱本身的异常称为肌腱炎。

In tendonosis, the tendon becomes weakened. Tendons are made up of strands of a material called collagen. (If you think of a tendon as a nylon rope, the collagen is the nylon strands.)Degeneration in a tendon causes a loss of the normal arrangement of the collagen fibers that join together to form the tendon. Some of the individual strands of the tendon become jumbled due to the degeneration, some fibers break, and the tendon loses strength.

　　发生肌腱炎时，肌腱变得脆弱。肌腱由胶原链所构成。（如果你把肌腱当作尼龙绳，那么胶原就是尼龙线。）胶原纤维通过链接形成肌腱，而退变的肌腱导致胶原纤维失去正常的链接。由于肌腱退变致一些肌腱中单个的胶原纤维链变得乱七八糟，一些纤维断裂，肌腱失去强度。

 

Over time, the tendon thickens as scar tissue tries to repair the damaged tendon. The area of tendonosis in the tendon is weaker than normal tendon. The weakened, degenerative tendon may tear. This usually causes a lengthwise split in the peroneal tendons rather than a rupture. These splits or tears are most common in the peroneus brevis tendon, probably because it lies in front of the peroneus longus. It is more vulnerable to friction because it rubs against the groove in the fibula bone.

　　随着时间的推移，当疤痕组织试图修复损伤的肌腱时，肌腱变厚。肌腱炎区域的肌腱强度弱于正常的肌腱。脆弱的、退变的肌腱可能撕裂。这种情况通常导致腓骨肌腱纵向的劈裂，而不是断裂。这些劈裂或撕裂在腓骨短肌中非常普遍，可能与腓骨短肌腱位于腓骨长肌腱的前方有关。因为腓骨短肌腱对骨纤维隧道的摩擦，正由于这样摩擦使腓骨短肌腱变得更加脆弱。

Symptoms

症状

What do peroneal tendon problems feel like?

　　腓骨肌腱疾患会出现什么感觉？

Patients with peroneal tendon problems usually describe pain in the outer part of the ankle or just behind the lateral malleolus. This pain commonly worsens with activity and eases with rest. Patients may have swelling behind or under the lateral malleolus. They may notice more pain when pressure is applied along the tendons.

　　腓骨肌腱有问题的病人常常描述踝关节外侧部分或紧邻外踝后方的区域疼痛。这个疼痛通常随着活动加重和休息后缓解。病人可有外踝后方或下方肿胀。当沿着肌腱施压，病人会产生更加疼痛。

Diagnosis

诊断

How do doctors diagnose the condition?

　　医生如何诊断本病？

The diagnosis of peroneal tendonitis is usually made by examination of the ankle. X-rays may be ordered to make sure there is no fracture or other problem. The physical examination helps determine where the tendons are inflamed, ruptured, or degenerated. The doctor will move your ankle into different positions. The peroneal tendons are checked by holding your foot up and out against the doctor’s downward pressure. Stretching the foot up and in can also be used test whether the tendons hurt.

　　腓骨肌腱炎通常通过踝关节的体格检查来诊断。X线检查用来排除骨折和其他的问题。物理检查是用来帮助确诊哪个位置的肌腱发炎、断裂、或退变。医生会在各个方向活动您的踝关节。通过对抗医生对足向下的压力来做足向上向外的活动来检查腓骨肌腱。将足向上向内做拉伸活动也可以用来检查肌腱是否有受伤。

Your doctor may order a magnetic resonance imaging (MRI) scan of your ankle. These images can show if there is abnormal swelling or scar tissue in the tendons. MRI scans can also show lengthwise tears in the tendons.

　　你的医生可以安排你进行踝关节的磁共振（MRI）检查。磁共振图像可以显示肌腱中存在的异常水肿或疤痕。磁共振扫描也可以显示肌腱中存在的纵向撕裂。

（沈是铭　译）

 

沈是铭，主任医师，宁波市镇海龙赛医院副书记、副院长，硕士。浙江医科大学第一届临床医学七年制，浙医大附属第二医院骨科毕业。宁波市领军和拔尖人才第二层次，宁波市医学会骨科分会委员。镇海区121人才第一层次，镇海区学科带头人。2015年获镇海区优秀人才奖。曾在香港威尔逊亲王医院矫形外科、奥地利维也纳盖尔斯特侯夫骨科医院进修学习。擅长复杂危重的骨科创伤救治与后期修复重建，及足踝外科领域疾病的诊治。