Baltimore, Md.; and St. Louis, Mo. From the Department of Plastic, Reconstructive, and Maxillofacial Surgery, The Johns Hopkins University; the Dellon Institute for Peripheral Nerve Surgery; and St. Louis Plastic and Hand Surgery.
Plast Reconstr Surg. 2012 Feb;129(2):454-462. doi: 10.1097/PRS.0b013e31823aeb21.
Although distal tibial nerve compression is well recognized, proximal tibial nerve compression remains a rarely recognized clinical condition. This report defines the presentation, diagnosis, surgical decompression technique, and clinical outcome of neurolysis of the tibial nerve at this soleal sling compression site.
Forty-nine patients with 69 proximal tibial nerves (20 bilateral) were stratified retrospectively into three groups: neuropathy (n = 10), failed tarsal tunnel syndrome (n = 25), and trauma (n = 14). Pain level, strength of the flexor hallucis longus muscle, neurosensory testing of the hallux, and subjective sensory improvement were evaluated. Each proximal tibial nerve compression was subjected to neurolysis with division of the soleal sling.
Results were stratified into poor, fair, good, and excellent based on the amount of pain relief and improvement in motor and sensory function. In all groups combined, there were 13 excellent (26.5 percent), 13 good (26.5 percent), 18 fair (36.7 percent), and five poor (10.2 percent) results. Results in the neuropathy group were excellent in two patients, good in three, fair in four, and poor in one (mean follow-up, 18.7 months). Results in the failed tarsal tunnel syndrome group were excellent in two, good in six, fair in 13, and poor in four patients (mean follow-up, 13.9 months). The trauma subgroup had the best outcomes: excellent in nine patients, good in four, fair in one, and poor in zero (mean follow-up, 13.4 months).
Regardless of cause, if a proximal tibial nerve compression beneath the soleal sling is identified, neurolysis may improve pain and sensory and motor function.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
尽管远端胫神经受压已得到广泛认识，但近端胫神经受压仍然是一种很少被认识到的临床情况。本报告定义了在这个比目鱼肌吊带压迫部位进行胫骨神经松解术的表现、诊断、手术减压技术和临床结果。
49 例患者的 69 条近端胫神经（20 条双侧）被回顾性分层分为三组：神经病变（n = 10）、失败的跗管综合征（n = 25）和创伤（n = 14）。评估疼痛程度、比目鱼肌长屈肌肌力、大脚趾神经感觉测试和主观感觉改善。每个近端胫神经受压都进行了神经松解术，切开比目鱼肌吊带。
根据疼痛缓解程度以及运动和感觉功能的改善情况，将结果分为差、一般、好和优。在所有组中，有 13 例（26.5%）为优、13 例（26.5%）为良、18 例（36.7%）为可和 5 例（10.2%）为差。神经病变组有 2 例优、3 例良、4 例可和 1 例差（平均随访时间 18.7 个月）。失败的跗管综合征组的结果分别为 2 例优、6 例良、13 例可和 4 例差（平均随访时间 13.9 个月）。创伤亚组的结果最好：9 例优、4 例良、1 例可和 0 例差（平均随访时间 13.4 个月）。
无论病因如何，如果发现位于比目鱼肌吊带下方的近端胫神经受压，神经松解术可能会改善疼痛和感觉及运动功能。
临床问题/证据水平：治疗性，IV。
