Yao D, Jakubowitz E, Ettinger S, Plaass C, Stukenborg-Colsman C, Daniilidis K
Department für Fuß- und Sprunggelenkschirurgie, Diakovere Annastift, Medizinische Hochschule Hannover, Anna-von-Borries-Straße 1-7, 30625, Hannover, Deutschland.
Labor für Biomechanik und Biomaterialien der Orthopädischen Klinik, Medizinische Hochschule Hannover, Hannover, Deutschland.
Oper Orthop Traumatol. 2017 Jun;29(3):266-278. doi: 10.1007/s00064-017-0494-8. Epub 2017 May 4.
Gait improvement by restoring dorsiflexion using a neuroprosthesis implant.
Foot drop with damage to the 1st motor neuron; passive mobility in ankle is possible; adult patients.
Foot drop with peripheral damage and injury to the peroneal nerve; already implanted stimulators (e.g., defibrillator, pacemaker, or pain stimulator); severe anesthesia risks in multimorbid patients.
Surgery in lateral position. Searching for the peroneal nerve after dorsal incision in the popliteal fossa, using the medial edge of the biceps femoris as anatomic landmark. After identification of the motor branch of the peroneal nerve by positive dorsiflexion after using electrostimulation apply the electrode cuff on the nerve. Epifascial implantation of stimulation body lateral at the middle third of the thigh over the tractus iliotibialis.
Pain-adapted full weight bearing, no knee flexion more than 90° for 4-6 weeks, activation of neuroprosthesis 3 weeks after surgery, physiotherapy with gait training is required.
Between 2013 and 2015, implantation of the neuroprosthesis was performed in 21 patients (13 men/8 women) with chronic foot drop due to a central lesion. Significant improvement in walking speed measured with the 10 meter walk test (11.8 ± 5.4 s to 7.9 s ± 3.4; p = 0.007), in gait endurance with 6 min walk test (212.2 ± 75.5 m to 306.4 ± 96.4 m; p ≤ 0.001), and in gait performance using the Emory Functional Ambulation Profile (105.9 ± 49.7 s to 63.2 ± 31. 3 s; p ≤ 0.001). No patient required surgical revision. Postoperative bleeding was recorded in one case (4%). Patient satisfaction and improvement in mobility and quality of life could be achieved (95% and 90%, respectively).
通过植入神经假体恢复背屈功能来改善步态。
第一运动神经元受损导致的足下垂；踝关节有被动活动度；成年患者。
周围神经损伤及腓总神经损伤导致的足下垂；已植入刺激器（如除颤器、起搏器或疼痛刺激器）；患有多种疾病的患者存在严重麻醉风险。
侧卧位手术。在腘窝处做背侧切口后寻找腓总神经，以股二头肌内侧缘作为解剖标志。在使用电刺激后通过背屈阳性反应识别腓总神经的运动分支，然后将电极套应用于神经。刺激器体在大腿中三分之一处沿髂胫束进行筋膜外植入。
根据疼痛情况进行全负重，4 - 6周内膝关节屈曲不超过90°，术后3周激活神经假体，需要进行步态训练的物理治疗。
2013年至2015年期间，对21例（13例男性/8例女性）因中枢性病变导致慢性足下垂的患者进行了神经假体植入。10米步行测试测得的步行速度有显著改善（从11.8±5.4秒提高到7.9秒±3.4秒；p = 0.007），6分钟步行测试的步态耐力有显著改善（从212.2±75.5米提高到306.4±96.4米；p≤0.001），使用埃默里功能步行量表测得的步态表现有显著改善（从105.9±49.7秒提高到63.2±31.3秒；p≤0.001）。没有患者需要进行手术翻修。有1例（4%）记录到术后出血。患者满意度以及活动能力和生活质量得到改善（分别为95%和90%）。
