Faculty of Medicine, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.
Acta Neurochir (Wien). 2018 Sep;160(9):1847-1856. doi: 10.1007/s00701-018-3614-9. Epub 2018 Jul 1.
Peroneal nerve entrapment is the most common peripheral mononeuropathy of the lower limbs. Foot drop, a common presentation, leads to an impaired eversion and dorsiflexion of the foot. An intriguing observation is the occurrence of foot drop secondary to weight loss.
A retrospective study of patients surgically treated for peroneal nerve entrapment was performed between January 1, 1995 and December 31, 2016, at the Department of Neurosurgery, Genk, Belgium. Out of a total of 421 patients, 200 patients with foot drop secondary to weight loss were included. For each subject, motor and sensory outcomes after external neurolysis were investigated. As a primary objective, we examined the postoperative outcomes of external neurolysis as a treatment for foot drop in patients with peroneal nerve entrapment at the fibular head secondary to weight loss. As a secondary objective, we analyzed the correlation between patient characteristics and the success rate of external neurolysis.
When defining success as a postoperative MRC score of 4 or 5, external neurolysis has a success rate of 85% in patients with foot drop secondary to weight loss. A significant difference (P = < 0.0001) between postoperative and preoperative MRC scores indicates that external neurolysis leads to significant improvement of motor function in patients with foot drop secondary to weight loss. A multiple logistic regression model showed that "preoperative MRC scores" and "duration of symptoms" were the only variables with an impact on postoperative MRC scores. Other variables such as "age," "gender," and "side of entrapment" had no significant impact on postoperative results.
Statistical analysis emphasizes the important role of external neurolysis in the treatment of peripheral peroneal nerve entrapment. Therefore, external neurolysis at the fibular head should be regarded as a very effective and safe procedure in patients with foot drop secondary to weight loss.
腓总神经卡压是下肢最常见的单一外周神经病变。足下垂是常见的表现，导致足的外翻和背屈功能受损。一个有趣的观察结果是体重减轻导致的足下垂。
对 1995 年 1 月 1 日至 2016 年 12 月 31 日期间在比利时根特神经外科系接受腓总神经卡压手术治疗的患者进行了回顾性研究。在总共 421 例患者中，纳入了 200 例因体重减轻导致的足下垂患者。对每个患者，研究了腓骨小头处腓总神经外松解术后的运动和感觉结果。作为主要目标，我们研究了外松解术作为治疗因体重减轻导致的腓总神经卡压的患者足下垂的术后结果。作为次要目标，我们分析了患者特征与外松解术成功率之间的相关性。
当将术后 MRC 评分为 4 或 5 定义为成功时，因体重减轻导致的足下垂患者的外松解术成功率为 85%。术后 MRC 评分与术前 MRC 评分之间存在显著差异（P<0.0001），表明外松解术可显著改善因体重减轻导致的足下垂患者的运动功能。多元逻辑回归模型显示，“术前 MRC 评分”和“症状持续时间”是对术后 MRC 评分有影响的唯一变量。其他变量，如“年龄”、“性别”和“卡压侧”，对外科手术结果没有显著影响。
统计分析强调了外松解术在治疗周围性腓总神经卡压中的重要作用。因此，在外因体重减轻导致的足下垂患者中，腓骨小头处的外松解术应被视为一种非常有效和安全的手术方法。
