Rosson Gedge D, Larson Allison R, Williams Eric H, Dellon A Lee
Baltimore, Md. From the Division of Plastic, Reconstructive, and Maxillofacial Surgery, Department of Surgery, The Johns Hopkins University, and the Dellon Institute for Peripheral Nerve Surgery.
Plast Reconstr Surg. 2009 Oct;124(4):1202-1210. doi: 10.1097/PRS.0b013e3181b5a3c3.
The anatomical basis for the surgical techniques used to treat tarsal tunnel syndrome is not well studied. The authors sought to evaluate their hypotheses that (1) pronation and pronation with plantar flexion of the intact foot would have higher pressures than the intact foot in other positions; (2) decompression surgery would significantly lower the pressure in all three tunnels in all foot positions, and roof incision plus septum excision would lower the pressure further in some positions; and (3) the pressures in symptomatic patients would be significantly higher than those in an analogous cadaver study.
In 10 patients with tarsal tunnel syndrome, the authors intraoperatively measured pressures in the tarsal, medial plantar, and lateral plantar tunnels in multiple foot positions before and after excision of the tunnel roofs and intertunnel septum.
The authors found that (1) pronation and plantar flexion significantly increased pressures in the medial and lateral plantar tunnels, to levels sufficient to cause chronic nerve compression; (2) tunnel release and septum excision significantly decreased those pressures; and (3) compared with cadaver pressures, patients had similar tarsal tunnel pressures but higher lateral plantar tunnel pressures in some positions.
Many surgeons operating on patients with tarsal tunnel syndrome do not decompress the respective medial plantar and lateral plantar nerves and excise the septum. The authors' study validates the hypotheses that patients who are clinically suspected of having chronic compression of the tibial nerve and its branches at the ankle have higher tunnel pressures and that releasing these structures decreases the pressures.
用于治疗跗管综合征的手术技术的解剖学基础尚未得到充分研究。作者试图评估他们的假设：（1）完整足部的旋前以及旋前伴跖屈时，其压力会高于足部处于其他位置时；（2）减压手术会显著降低所有足部位置下三个通道的压力，并且在某些位置，切除顶壁加切除隔膜会进一步降低压力；（3）有症状患者的压力会显著高于类似尸体研究中的压力。
对10例跗管综合征患者，作者在切除通道顶壁和通道间隔膜前后，术中测量了多个足部位置下跗管、足底内侧和足底外侧通道的压力。
作者发现：（1）旋前和跖屈显著增加了足底内侧和外侧通道的压力，达到足以引起慢性神经压迫的水平；（2）通道松解和隔膜切除显著降低了这些压力；（3）与尸体压力相比，患者的跗管压力相似，但在某些位置足底外侧通道压力更高。
许多为跗管综合征患者手术的外科医生并未对相应的足底内侧和外侧神经进行减压，也未切除隔膜。作者的研究验证了以下假设：临床上怀疑在踝关节处胫神经及其分支受到慢性压迫的患者，其通道压力更高，并且松解这些结构会降低压力。
