选择性胫神经切断术治疗痉挛性马蹄内翻足：3例患者的2年随访
Selective tibial neurotomy in the treatment of spastic equinovarus foot: a 2-year follow-up of three cases.
作者信息
Deltombe Thierry, Detrembleur Christine, Hanson Philippe, Gustin Thierry
机构信息
Spasticity Group, Department of Physical Medicine and Rehabilitation, University Hospital of Mont-Godinne, Université Catholique de Louvain, Yvoir, Belgium.
出版信息
Am J Phys Med Rehabil. 2006 Jan;85(1):82-8. doi: 10.1097/01.phm.0000193506.70371.cf.
OBJECTIVE
To objectively assess the decrease in spasticity and the improvement in gait after tibial nerve neurotomy performed to treat spastic equinovarus foot.
DESIGN
Before-after trial with a 2-yr follow-up. Three hemiplegic patients with spastic equinovarus foot were treated with a selective peripheral neurotomy of the tibial motor nerve branches (soleus, lateral and medial gastrocnemius and tibialis posterior nerves). Evaluation included clinical assessment of spasticity (Ashworth scale), maximal Hoffmann reflex (H(max))/compound muscle action potential (M(max)) ratio measurement, gait analysis, and muscle stiffness evaluation performed before and 2 mos, 1 yr, and 2 yrs after the neurotomy.
RESULTS
Spasticity, muscle stiffness, and H(max)/M(max) ratio decreased after neurotomy. The kinematic (ankle dorsal flexion and knee recurvatum) and kinetic variables (maximum ankle muscle moment and external work) of the gait were permanently improved after neurotomy. Interestingly, kinetic variables seemed to gradually improve with time after the neurotomy.
CONCLUSION
Tibial neurotomy is an effective and durable treatment for spastic equinovarus foot.
目的
客观评估为治疗痉挛性马蹄内翻足而进行胫神经切断术后痉挛的减轻情况及步态的改善情况。
设计
进行为期2年随访的前后对照试验。对3例患有痉挛性马蹄内翻足的偏瘫患者实施了胫神经运动分支（比目鱼肌、腓肠肌外侧头和内侧头以及胫后神经）的选择性周围神经切断术。评估内容包括在神经切断术前以及术后2个月、1年和2年进行的痉挛临床评估（Ashworth量表）、最大霍夫曼反射（H(max)）/复合肌肉动作电位（M(max)）比值测量、步态分析以及肌肉僵硬度评估。
结果
神经切断术后痉挛、肌肉僵硬度及H(max)/M(max)比值均降低。神经切断术后，步态的运动学变量（踝关节背屈和膝反屈）和动力学变量（最大踝关节肌肉力矩和外部功）得到了永久性改善。有趣的是，动力学变量在神经切断术后似乎随时间逐渐改善。
结论
胫神经切断术是治疗痉挛性马蹄内翻足的一种有效且持久的治疗方法。
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