Université de Technologie de Compiègne UMR CNRS 7338 Biomécanique et Bioingénierie, 60319 60203, Compiègne cedex, France.
Acta Neurochir (Wien). 2013 Sep;155(9):1731-43. doi: 10.1007/s00701-013-1770-5. Epub 2013 May 29.
The neuromechanical consequences of tibial neurotomy have not been extensively studied.
Fifteen patients were evaluated before and after selective tibial neurotomy (after 2 months and after 15 months) by means of clinical, neurophysiological [tendon (T) reflexes, Hoffmann (H) reflexes and maximum motor response, Mmax] and mechanical parameters (passive stiffness of plantar flexors at the ankle). The neurotomy concerned the soleus (100 % of cases), gastrocnemius (20 % of cases), posterior tibial (60 % of cases) and flexor digitorum longus (47 % of cases) nerves.
Neurotomy provided more than 90 % improvement of clinical spasticity scores, 20 % improvement of walking scores and the angle of passive dorsiflexion (APDF) of the ankle (mean angle: 7°), temporary reduction of the soleus Mmax (18 % at 2 months with return to the preoperative value at 15 months), and lasting reduction of the soleus Hmax/Mmax (68 % at 2 months, 78 % at 15 months) and T/Mmax (84 % at 2 months, 80 % at 15 months). M and H responses of the gastrocnemius (whether or not they were included in the neurotomy) were not modified, while T/Mmax decreased to the same degree as for soleus. Passive stiffness was lastingly decreased from 64.0 Nm/rad to 49.0 Nm/rad (2 months) and 49.5 Nm/rad (15 months).
Selective tibial neurotomy of the soleus nerve induces long-term reduction of reflex hyperexcitability and passive stiffness of plantar flexors in spastic patients, with no lasting impairment of motor efferents. In parallel, it modifies the tendon reflexes of synergistic muscles (gastrocnemius) not concerned by the neurotomy.
胫骨神经切断术的神经力学后果尚未得到广泛研究。
通过临床、神经生理[肌腱（T）反射、Hoffmann（H）反射和最大运动反应，Mmax]和机械参数（踝关节跖屈肌的被动僵硬），对 15 例患者在选择性胫骨神经切断术（术后 2 个月和 15 个月后）前后进行评估。神经切断术涉及比目鱼肌（100%的病例）、腓肠肌（20%的病例）、胫后神经（60%的病例）和趾长屈肌（47%的病例）神经。
神经切断术使临床痉挛评分提高超过 90%，步行评分提高 20%，踝关节的被动背屈角度（APDF）提高（平均角度：7°），暂时降低比目鱼肌 Mmax（术后 2 个月时降低 18%，术后 15 个月时恢复术前值），并持续降低比目鱼肌 Hmax/Mmax（术后 2 个月时降低 68%，术后 15 个月时降低 78%）和 T/Mmax（术后 2 个月时降低 84%，术后 15 个月时降低 80%）。腓肠肌（无论是否包括在神经切断术中）的 M 和 H 反应均未改变，而 T/Mmax 降低的程度与比目鱼肌相同。被动僵硬从 64.0 Nm/rad 持续降低至 49.0 Nm/rad（术后 2 个月）和 49.5 Nm/rad（术后 15 个月）。
选择性比目鱼肌神经切断术可长期降低痉挛患者的反射兴奋性和跖屈肌的被动僵硬，而不会对运动传出神经造成持久损害。同时，它还会改变非神经切断术协同肌肉（腓肠肌）的肌腱反射。
