Yoshida Aya, Okutsu Ichiro, Hamanaka Ikki
Okutsu Minimally Invasive Orthopaedic Clinic, Minato-ku, Tokyo, Japan.
Department of Orthopaedic Surgery, Toride-Kitasouma Medical Association Hospital, Ibaraki, Japan.
Asia Pac J Sports Med Arthrosc Rehabil Technol. 2015 Nov 2;3:1-5. doi: 10.1016/j.asmart.2015.09.001. eCollection 2016 Jan.
BACKGROUND/OBJECTIVE: Tarsal tunnel syndrome is a relatively rare entrapment neuropathy with the lateral and medial plantar nerves entrapped inside of the tarsal tunnel. When conservative treatment fails, standard open decompression of the nerve can be achieved by releasing the flexor retinaculum of the foot through a several-centimetre-long skin incision made along the tarsal tunnel. By contrast, we made a 1-cm portal incision at the proximal part of the medial ankle, and endoscopic tarsal tunnel release of the flexor retinaculum of the foot and part of the abductor hallucis muscle was achieved using the Universal Subcutaneous Endoscope (USE) system.
Our procedure was performed under local anaesthesia without a pneumatic tourniquet on an outpatient basis. The USE system was inserted into the tarsal tunnel at the proximal part of the medial ankle; the nerves, vessels, flexor retinaculum, tendons of the foot, and the abductor hallucis muscle were then endoscopically identified. Decompression of the lateral and medial plantar nerves entrapped inside of the tarsal tunnel was then achieved by releasing the flexor retinaculum of the foot and part of the abductor hallucis muscle with a push knife under complete endoscopic observation.
Results from eight feet of five patients were compiled and analyzed. All showed improved clinical signs compared with their preoperative condition.
Our less invasive endoscopic management for tarsal tunnel syndrome using the USE system produces sufficient results.
背景/目的：跗管综合征是一种相对罕见的卡压性神经病变，胫神经的足底内侧和外侧神经在跗管内受到卡压。当保守治疗失败时，可通过沿跗管做一个几厘米长的皮肤切口，松解足部的屈肌支持带，对神经进行标准的开放减压。相比之下，我们在内踝近端做一个1厘米的入口切口，使用通用皮下内窥镜（USE）系统，在内窥镜下松解足部的屈肌支持带和部分拇展肌。
我们的手术在局部麻醉下、不使用气压止血带的情况下在门诊进行。将USE系统插入内踝近端的跗管；然后在内窥镜下识别神经、血管、屈肌支持带、足部肌腱和拇展肌。然后在完全内窥镜观察下用推刀松解足部的屈肌支持带和部分拇展肌，对跗管内受压的足底内侧和外侧神经进行减压。
汇总并分析了5例患者8只足的结果。与术前相比，所有患者的临床症状均有改善。
我们使用USE系统对跗管综合征进行的微创内窥镜治疗取得了满意的效果。
