Le Bocq Charlotte, Rousseaux Marc, Buisset Nadia, Daveluy Walter, Blond Serge, Allart Etienne
Neurorehabilitation Unit, Swynghedauw Hospital, Lille University Medical Center, F-59037 Lille, France; Neurorehabilitation Unit, Clinique Saint Martin, F-13396 Marseille, France.
Neurorehabilitation Unit, Swynghedauw Hospital, Lille University Medical Center, F-59037 Lille, France.
J Neurol Sci. 2016 Jul 15;366:158-163. doi: 10.1016/j.jns.2016.04.055. Epub 2016 May 7.
To evaluate the objective and subjective functional effectiveness of tibial nerve neurotomy (TNN) in post-stroke spastic equinovarus foot (SEF).
In an open study, 23 hemiplegic patients were assessed immediately before TNN and then 5months after TNN. The main outcome measure was the Lower Limb Function Assessment Scale (LL-FAS), which provided an ecologic assessment of impairments in standing and walking (i.e. kinematic abnormalities) and their impacts on activities of daily living. Patients were also assessed for global clinical impression of change, fear of falling, neuromotor impairments, spatiotemporal and video gait parameters and walking capacities.
TNN had a very marked effect on the level of spasticity and the range of motion in dorsiflexion (p<10(-3)). These changes resulted in better foot positioning when standing and walking (particularly in stance), which was perceived very favorably by the patients. There was a clear, patient-perceived improvement in activities performed when standing and walking (LL-FAS (p<0.01)), the global clinical impression of change (p<10(-3)) and the fear of falling (p=0.022) that was not revealed by conventional, objective measurements (New Functional Ambulation Classification, Rivermead Mobility Index).
TNN is an effective treatment for post-stroke SEF; it is associated with a patient-reported improvement in standing and walking abilities during activities of daily living. Further research must now assess the long-term subjective efficacy of TNN.
评估胫神经切断术（TNN）治疗脑卒中后痉挛性马蹄内翻足（SEF）的客观和主观功能疗效。
在一项开放性研究中，对23例偏瘫患者在TNN术前及术后5个月进行评估。主要结局指标是下肢功能评估量表（LL-FAS），该量表对站立和行走时的功能障碍（即运动学异常）及其对日常生活活动的影响进行生态学评估。还对患者的整体临床变化印象、跌倒恐惧、神经运动功能障碍、时空和视频步态参数以及行走能力进行了评估。
TNN对痉挛程度和背屈活动范围有非常显著的影响（p<10⁻³）。这些变化使站立和行走时（尤其是站立期）足部位置更佳，患者对此评价很高。站立和行走时进行的活动（LL-FAS，p<0.01）、整体临床变化印象（p<10⁻³）和跌倒恐惧（p=0.022）有明显的、患者可感知的改善，而传统的客观测量方法（新功能步行分类、Rivermead运动指数）未显示出这些改善。
TNN是治疗脑卒中后SEF的有效方法；它与患者报告的日常生活活动中站立和行走能力的改善有关。现在必须进行进一步研究以评估TNN的长期主观疗效。
