Kremer T, Riedel K, Germann G, Heitmann C, Sauerbier M
BG-Unfallklinik Ludwigshafen, Hand-, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Plastische und Handchirurgie, Universität Heidelberg, Ludwigshafen.
Handchir Mikrochir Plast Chir. 2011 Apr;43(2):95-101. doi: 10.1055/s-0030-1269930. Epub 2011 Apr 20.
Patients with persistent peroneal palsy may require treatment for gait disturbances if conservative treatment is not tolerated. Transfer of the tibialis posterior tendon can restore foot extension and improve the patients gait pattern.
Retrospective analysis (mean follow-up 40.8 months) of 13 patients. (7♀, 6♂; 1998-2005) after tibialis posterior tendon transfer through the interosseous membrane to the tibialis anterior and peroneus longus tendons. Evaluation focussed on hospitalisation periods, perioperative morbidity, functional outcome (range of motion, strength, pain and gait), return to work rate and self assessment with the Funktionsfragebogen Hannover (FFbH).
7 iatrogenic, 5 posttraumatic and 1 congenital peroneal palsy were treated. The patients presented after an average of 8.3 months (hospitalisation 11 days). Perioperative morbidity was 38.4% (15.4% reoperation rate). The mean active range of motion of the ankle was 3°/0°/56° (extension/flexion), the average strength was 3 (MRC) and pain was 4 (visual analogue scale 1-10). 12 patients were evaluated with normal or improved gait pattern without ortheses. The mean FFbH score was 70.9%.
If conservative treatment for peroneal palsy fails to improve functional outcome tendon transfers such as the tibialis posterior tendon transfer are a considerable treatment option. However, significant morbidity rates have to be anticipated. Consecutive patients should be referred in good time to specialised units.
对于保守治疗无法耐受的持续性腓总神经麻痹患者，若存在步态障碍，可能需要进行治疗。胫后肌腱转移可恢复足部背伸功能并改善患者的步态模式。
对13例患者（7例女性，6例男性；1998 - 2005年）进行回顾性分析（平均随访40.8个月），这些患者接受了胫后肌腱通过骨间膜转移至胫前肌腱和腓骨长肌腱的手术。评估重点包括住院时间、围手术期发病率、功能结果（活动范围、力量、疼痛和步态）、重返工作率以及使用汉诺威功能问卷（FFbH）进行自我评估。
治疗了7例医源性、5例创伤后和1例先天性腓总神经麻痹患者。患者平均在8.3个月后就诊（住院11天）。围手术期发病率为38.4%（再次手术率为15.4%）。踝关节平均主动活动范围为3°/0°/56°（背伸/跖屈），平均力量为3级（医学研究委员会（MRC）分级），疼痛评分为4分（视觉模拟评分1 - 10分）。12例患者在未使用矫形器的情况下步态模式正常或改善。FFbH平均评分为70.9%。
如果腓总神经麻痹的保守治疗未能改善功能结果，诸如胫后肌腱转移等肌腱转移术是一种重要的治疗选择。然而，必须预见到较高的发病率。应及时将连续的患者转诊至专科单位。
