軽微な外傷で生じた踵骨骨棘の裂離骨折を合併したアキレス腱断裂の1例

Rupture of the Achilles Tendon with Avulsion Fracture of an Osteophyte of the Calcaneus after a Minor Injury. Case Report

　踵骨裂離骨折を合併したアキレス腱断裂は，稀とされている．われわれは，軽微な外傷で生じたアキレス腱断裂に踵骨骨棘裂離骨折を合併した症例を経験したので報告する．本症例は，約1mの段差から降りた際に疼痛と歩行困難を認め，X線写真でアキレス腱断裂部に小骨片が認められた．手術所見では，小骨片を付着させた浅層部が短縮し，深層部で横断裂が認められた．術後6カ月において可動域制限，再断裂・骨折は認められていない．一時的に浅層部を介した牽引力が踵骨骨棘に働いたため裂離骨折を生じ，同時に深層部に収縮力が働いたため横断裂が起こったと考えられる．

　Achilles tendon rupture is a common injury, but rupture of the tendon combined with avulsion fracture of the calcaneus is rare. We report the case of a 42-year-old woman who experienced pain in the right foot after jumping down from an approximately 1m height. She had always been healthy and had no history of trauma. Examination revealed tenderness and a defect in contour 5cm proximal to the site of tendon insertion. A radiograph of the right ankle showed an area of ossification in the Achilles tendon, and rupture of the tendon with an avulsion fracture of an osteophyte of the calcaneus were diagnosed at surgery. The ruptured tendon was repaired, and the avulsed fragment of the calcaneus was removed. At the 6-month postoperative follow-up examination the patient had no complaints regarding the right foot and no limitation of motion.