Department of Surgery, Section of Plastic Surgery, Pan Am Clinic, University of Manitoba, 75 Poseidon Bay, Winnipeg, MB R3ME4, Canada.
Clin Orthop Relat Res. 2012 Mar;470(3):779-90. doi: 10.1007/s11999-011-1924-9.
Injuries to the deep peroneal nerve result in tibialis anterior muscle paralysis and associated loss of ankle dorsiflexion. Nerve grafting of peroneal nerve injuries has led to poor function; therefore, tendon transfers and ankle-foot orthotics have been the standard treatment for foot drop.
QUESTIONS/PURPOSES: We (1) describe an alternative surgical technique to obtain ankle dorsiflexion by partial tibial nerve transfer to the motor branch of the tibialis anterior muscle; (2) evaluate ankle dorsiflexion strength using British Medical Research Council grading after nerve transfer; and (3) qualitatively determine factors that influence functional success of surgery.
We retrospectively reviewed 11 patients treated with partial tibial nerve transfers after peroneal nerve injury. Pre- and postoperative motor strength was measured. Patients completed questionnaires regarding pre- and postoperative gait and disability.
One patient regained Grade 4 ankle dorsiflexion, three patients regained Grade 3, one patient regained Grade 2, and two patients regained Grade 1 ankle dorsiflexion. Four patients did not regain any muscle activity. Clinically apparent motor recovery occurred an average 7.6 months postoperatively. A majority of patients (nine) could walk and participate in activities. Seven patients did not wear ankle-foot orthotics and four patients did not limp. The donor deficits included weak toe flexion (two patients) and reduced calf circumference (seven patients).
Our observations suggest nerve transfers to the deep peroneal nerve provide inconsistent ankle dorsiflexion strength, possibly related to the mechanism of peroneal nerve injury or delays in surgery. Despite variable strength, four patients achieved M3 or greater motor recovery, which enabled them to walk without assistive devices.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
腓深神经损伤可导致胫骨前肌瘫痪和踝关节背屈功能丧失。腓总神经损伤后的神经移植导致功能不良；因此，肌腱转移和踝足矫形器一直是治疗足下垂的标准方法。
问题/目的：我们（1）描述一种替代手术技术，通过部分胫神经转移到胫骨前肌的运动支来获得踝关节背屈；（2）通过神经转移后英国医学研究理事会分级评估踝关节背屈力量；（3）定性确定影响手术功能成功的因素。
我们回顾性分析了 11 例腓总神经损伤后接受部分胫神经转移的患者。测量术前和术后的运动力量。患者完成了关于术前和术后步态和残疾的问卷调查。
1 例患者恢复了 4 级踝关节背屈，3 例患者恢复了 3 级，1 例患者恢复了 2 级，2 例患者恢复了 1 级踝关节背屈。4 例患者没有恢复任何肌肉活动。术后平均 7.6 个月出现明显的运动恢复。大多数患者（9 例）能够行走和参与活动。7 例患者不穿踝足矫形器，4 例患者不跛行。供体缺陷包括脚趾屈曲无力（2 例）和小腿周长减小（7 例）。
我们的观察结果表明，神经转移到腓深神经提供的踝关节背屈力量不一致，这可能与腓总神经损伤的机制或手术延迟有关。尽管力量不同，但有 4 例患者获得了 M3 或更高的运动恢复，使他们能够在没有辅助设备的情况下行走。
IV 级，治疗研究。有关证据水平的完整描述，请参见作者指南。
