【摘要】 目的 分析跟腱黄色瘤与跟腱病的临床及超声影像特征，总结其鉴别诊断要点。方法 回顾性分析经病理证实的23例46条跟腱黄色瘤、64例经病理或磁共振成像及随访证实的跟腱病患者的临床资料与高频超声表现，分析总结两者鉴别诊断要点。结果 临床特征：跟腱黄色瘤组中，91.3%的患者伴有高脂血症，高于腱病组的29.7%(P<0.001);黄色瘤组跟腱区域疼痛发生率为39.1%,低于腱病组的89.1%(P<0.001)。影像特征：两组在附着端钙化、Kager脂肪垫改变、血供丰富度及跟腱纤维连续性方面差异有统计学意义(P<0.001)。黄色瘤多表现为双侧对称性增厚且纤维结构消失，而腱病以单侧受累为主，纤维结构大多保留。结论 高脂血症、跟腱明显增厚及纤维结构消失是鉴别黄色瘤与腱病的关键临床与超声特征。超声多参数评估具有重要筛查价值，联合超声引导穿刺活检可进一步提高诊断准确度。更多还原

【Abstract】 Objective To analyze the clinical and ultrasonic imaging features of Achilles tendon xanthoma and tendinopathy, and to summarize the key points for their differential diagnosis. Methods A retrospective analysis was conducted on the clinical data and high-frequency ultrasound features of 23 cases(46 tendons) of pathologically confirmed Achilles tendon xanthomas and 64 cases of tendinopathy of Achilles tendon(confirmed by histopathology, MRI, or follow-up observation), aiming to analyze and summarize the key diagnostic differentiators between these two conditions. Results Clinical features: in the xanthoma group, 91.3% of the patients had hyperlipidemia, higher than the 29.7% in the tendinopathy group(P<0.001). The incidence of pain in the Achilles tendon region was 39.1% in the xanthoma group, lower than the 89.1% in the tendinopathy group(P<0.001). Imaging features: significant differences were observed between the two groups in terms of calcification at the insertion site, changes in Kager’s fat pad, blood supply richness, and tendon fiber continuity(P<0.001). Xanthoma typically presented with bilateral symmetric thickening and loss of fiber structure, while tendinopathy was mainly unilaterally involved with preserved fiber structure. Conclusions Hyperlipidemia, marked Achilles tendon thickening, and loss of fibrous structure are key clinical and sonographic features for differentiating xanthoma from tendinopathy. Multiparameter ultrasound evaluation holds significant screening value, and its combination with ultrasound-guided needle biopsy can further improve diagnostic accuracy.更多还原