Cho Byung-Ki, Park Kyoung-Jin, Choi Seung-Myung, Im Se-Hyuk, SooHoo Nelson F
1 Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea.
2 Department of Orthopaedic Surgery, National Police Hospital, Seoul, Korea.
Foot Ankle Int. 2017 Jun;38(6):627-633. doi: 10.1177/1071100717695508. Epub 2017 Feb 1.
This retrospective comparative study reports the practical function in daily and sports activities after tibialis posterior tendon transfer for foot drop secondary to peroneal nerve palsy.
Seventeen patients were followed for a minimum of 3 years after tibialis posterior tendon transfer for foot drop secondary to peroneal nerve palsy. Matched controls were used to evaluate the level of functional restoration. Functional evaluations included American Orthopaedic Foot & Ankle Society (AOFAS) scores, Foot and Ankle Outcome Score (FAOS), Foot and Ankle Ability Measure (FAAM) scores, and isokinetic muscle strength test. Radiographic evaluation for the changes of postoperative foot alignment included Meary angle, calcaneal pitch angle, hindfoot alignment angle, and navicular height.
Mean AOFAS, FAOS, and FAAM scores significantly improved from 65.1 to 86.2, 55.6 to 87.8, and 45.7 to 84.4 points at final follow-up, respectively. However, all functional evaluation scores were significantly lower as compared to the control group ( P < .001). Mean peak torque (60 degrees/sec) of ankle dorsiflexors, plantarflexors, invertors, and evertors at final follow-up were 7.1 (deficit ratio of 65.4%), 39.2, 9.8, and 7.3 Nm, respectively. These muscle strengths were significantly lower compared to the control group ( P < .001). No significant differences in radiographic measurements were found, and no patients presented with a postoperative flat foot deformity. One patient (5.9%) needed an ankle-foot orthosis for occupational activity.
Anterior transfer of the tibialis posterior tendon appears to be an effective surgical option for paralytic foot drop secondary to peroneal nerve palsy. Although restoration of dorsiflexion strength postoperatively was about 33% of the normal ankle, function in daily activities and gait ability were satisfactorily improved. In addition, tibialis posterior tendon transfer demonstrated no definitive radiographic or clinical progression to postoperative flat foot deformity at intermediate-term follow-up.
Level IV, retrospective case series.
本回顾性比较研究报告了胫后肌腱转位治疗腓总神经麻痹继发足下垂后在日常活动和体育活动中的实际功能。
17例因腓总神经麻痹继发足下垂而行胫后肌腱转位的患者，术后至少随访3年。采用配对对照评估功能恢复水平。功能评估包括美国矫形足踝协会（AOFAS）评分、足踝结果评分（FAOS）、足踝能力测量（FAAM）评分以及等速肌力测试。对术后足部对线变化的影像学评估包括Meary角、跟骨倾斜角、后足对线角和舟骨高度。
末次随访时，平均AOFAS、FAOS和FAAM评分分别从65.1分显著提高至86.2分、从55.6分提高至87.8分、从45.7分提高至84.4分。然而，与对照组相比，所有功能评估评分均显著更低（P <.001）。末次随访时，踝背屈肌、跖屈肌、内翻肌和外翻肌的平均峰值扭矩（60度/秒）分别为7.1 Nm（ deficit ratio of 65.4%）、39.2 Nm、9.8 Nm和7.3 Nm。与对照组相比，这些肌肉力量显著更低（P <.001）。影像学测量未发现显著差异，且无患者出现术后扁平足畸形。1例患者（5.9%）在职业活动中需要使用踝足矫形器。
胫后肌腱前移似乎是治疗腓总神经麻痹继发麻痹性足下垂的一种有效手术选择。尽管术后背屈力量恢复至正常踝关节的约33%，但日常活动功能和步态能力得到了满意改善。此外，在中期随访中，胫后肌腱转位未显示出明确的影像学或临床进展至术后扁平足畸形。
IV级，回顾性病例系列。
