Gkotsoulias Efthymios N, Simonson Devin C, Roukis Thomas S
Department of Medical Education, Gundersen Medical Foundation (ENG, DCS), La Crosse, Wisconsin.
Foot Ankle Spec. 2014 Feb;7(1):57-60. doi: 10.1177/1938640013514267. Epub 2013 Dec 10.
Open surgical decompression of the tarsal tunnel is the standard surgical approach for compression of the tibial nerve within the tarsal tunnel. Complications associated with this approach can be significant and periods of non-weight bearing are required. An alternative approach allowing for minimal soft tissue trauma and reduced time to ambulation is therefore desirable. Endoscopic tarsal tunnel decompression may provide such an alternative. The authors performed a systematic review of electronic databases and other relevant sources to identify material regarding the safety of endoscopic tarsal tunnel decompression. Only articles that included clear information concerning the safety of endoscopic tarsal tunnel decompression with a follow-up of at least 12 months were included. Three studies were identified involving 37 feet, with a weighted mean follow-up of 27 months. There were no permanent complications relating to iatrogenic nerve injury, deep infection, or prolonged wound healing problems documented despite initiating ambulation within one week of surgery. Two patients (5.6%) developed recurrence more than 2 years postoperative and one (2.7%) showed no improvement. Endoscopic tarsal tunnel decompression is a safe procedure with a low rate of recurrence or failure and allows for near-immediate ambulation. However, additional prospective investigations comparing open and endoscopic approaches to tarsal tunnel decompression are warranted.
跗骨管开放手术减压是治疗跗骨管内胫神经受压的标准手术方法。该方法相关的并发症可能较为严重，且需要一段时间的非负重期。因此，需要一种能使软组织创伤最小化并缩短下地行走时间的替代方法。内镜下跗骨管减压术可能提供这样一种选择。作者对电子数据库和其他相关来源进行了系统综述，以确定有关内镜下跗骨管减压术安全性的资料。仅纳入了那些包含内镜下跗骨管减压术安全性明确信息且随访至少12个月的文章。共确定了3项研究，涉及37只足，加权平均随访时间为27个月。尽管在术后1周内就开始行走，但未记录到与医源性神经损伤、深部感染或伤口愈合延迟相关的永久性并发症。2例患者（5.6%）在术后2年以上出现复发，1例（2.7%）无改善。内镜下跗骨管减压术是一种安全的手术，复发率或失败率较低，且允许患者近乎立即行走。然而，有必要进行更多前瞻性研究，比较开放手术和内镜手术治疗跗骨管减压的效果。
