Mullick Tarun, Dellon A Lee
Division of Plastic Surgery, Department of Surgery, Department of Neurological Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland 21218, USA.
J Reconstr Microsurg. 2008 Feb;24(2):119-26. doi: 10.1055/s-2008-1076089. Epub 2008 Feb 29.
Controversy surrounds the surgical approach and efficacy for tibial nerve compression at the ankle. The hypotheses tested are that the poor published results are due to failure to recognize that the tarsal tunnel is analogous to the forearm, not the carpal tunnel, and that postoperative ankle immobilization contributes to poor results by permitting fibrosis of the tibial nerve branches. From January of 1987 through December of 1994, a consecutive series of 77 patients with tarsal tunnel syndrome was accrued, 10 of whom had the condition bilaterally. The surgical approach included a neurolysis of the tibial nerve in the tarsal tunnel and the medial, lateral plantar, calcaneal nerves in their own tunnels. Postoperatively, immediate weight bearing and ambulation were permitted in a bulky cotton dressing. The dressing was removed at 1 week. For the 87 legs, mean follow-up after surgery was 3.6 years. Utilizing the traditional postoperative assessment, there were 82% excellent, 11% good, 5% fair, and 2% poor results. Utilizing a numerical grading scale, there was a statistically significant improvement at the P<0.001 level for sensory and also for motor impairment. Recognition that decompression of four medial ankle tunnels and immediate postoperative mobilization of the tibial nerve through ambulation is necessary results in a high level of success for patients with tarsal tunnels syndrome.
踝关节处胫神经受压的手术入路和疗效存在争议。所检验的假设是，已发表的不良结果是由于未能认识到跗管类似于前臂而非腕管，以及术后踝关节固定因导致胫神经分支纤维化而致使结果不佳。从1987年1月至1994年12月，连续收治了77例跗管综合征患者，其中10例为双侧患病。手术入路包括对跗管内的胫神经以及足底内侧、外侧神经和跟骨神经在各自通道内进行神经松解。术后，允许患者在厚实的棉制敷料包扎下立即负重行走。敷料在1周后拆除。87条腿术后的平均随访时间为3.6年。采用传统的术后评估方法，结果为优的占82%，良的占11%，中平的占5%，差的占2%。采用数字评分量表，感觉和运动功能障碍在P<0.001水平上有统计学显著改善。认识到对四个踝关节内侧通道进行减压以及术后通过行走立即活动胫神经对跗管综合征患者取得高成功率是必要的。
