Seyyed Hosseinzadeh Hamid Reza, Eajazi Alireza, Kazemi Seyyed Morteza, Daftari Besheli Laleh, Hassas Yeganeh Mehrnoush, Aydanloo Ali
Akhtar Orthopaedic Hospital, Elahieh, Tehran, Iran.
Orthopedics. 2009 Dec;32(12):920. doi: 10.3928/01477447-20091020-23.
Peroneal nerve palsy has been reported in association with traumatic and nontraumatic causes. We encountered a 75-year-old man whose peroneal nerve palsy developed suddenly following varus deformity of the arthritic knee. A review of the literature found 1 other report describing a progressive peroneal nerve palsy associated with a varus deformity of the knee due to arthritis. Our patient had progressive intractable knee pain; 3-compartment, severe degenerative changes in the knees; varus knee malalignment and laxity; right peroneal nerve palsy; and decreased sensation to light touch and pinprick on the dorsum of the right foot. The preoperative WOMAC score was 36. Nerve conduction studies confirmed acute peroneal neuropathy with conduction block at the fibular neck and secondary axonal degeneration. Magnetic resonance imaging of the knee showed osteophytes and cysts surrounding the fibular neck. Although their compression could be responsible for the nerve palsy, the sudden process made this less possible. Thus, the patient underwent total knee arthroplasty of both knees without exploration of the nerve. At 5-month follow-up, the WOMAC score was 78. The patient walked with a cane with no varus thrust, and his right knee had no varus laxity in full extension. The peroneal nerve did not retain its function. Sensory examination and postoperative nerve conduction studies showed no improvement.
腓总神经麻痹已被报道与创伤性和非创伤性病因有关。我们遇到一名75岁男性，其腓总神经麻痹在患有关节炎的膝关节内翻畸形后突然出现。文献回顾发现另一篇报告描述了一例因关节炎导致膝关节内翻畸形相关的进行性腓总神经麻痹。我们的患者有进行性顽固性膝关节疼痛；膝关节三个间室均有严重退行性改变；膝关节内翻畸形和松弛；右侧腓总神经麻痹；以及右足背轻触觉和针刺觉减退。术前WOMAC评分为36分。神经传导研究证实为急性腓总神经病变，在腓骨小头处有传导阻滞及继发性轴索变性。膝关节磁共振成像显示腓骨小头周围有骨赘和囊肿。虽然它们的压迫可能是导致神经麻痹的原因，但病程突然使得这种可能性降低。因此，该患者接受了双膝全膝关节置换术，未对神经进行探查。在术后5个月的随访中，WOMAC评分为78分。患者拄拐杖行走，无内翻推力，右膝关节在完全伸直时无内翻松弛。腓总神经功能未恢复。感觉检查和术后神经传导研究均显示无改善。
