开放性楔形高位胫骨截骨术后腓深神经麻痹：一例报告。
Deep peroneal nerve palsy after opening wedge high tibial osteotomy: A case report.
作者信息
Jeong Jin Hwa, Chang Moon Chong, Lee Seung Ah
机构信息
Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center.
Department of Physical Medicine & Rehabilitation, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
出版信息
Medicine (Baltimore). 2019 Jul;98(27):e16253. doi: 10.1097/MD.0000000000016253.
RATIONALE
Peroneal nerve injury is one of the major complications that may occur after closing wedge high tibial osteotomy (CWHTO). In contrast, the reduced risk of the peroneal nerve injury has been considered as one of the advantages of opening wedge HTO (OWHTO).
PATIENT CONCERNS
A 61-year-old male who underwent OWHTO showed a dropped big toe immediately after surgery.
DIAGNOSIS
Injury of deep peroneal nerve was confirmed by electrodiagnostic study. It was probably caused by a posterolaterally protruded screw.
INTERVENTIONS
The protruded screw was replaced with a shorter one 3 weeks after OWHTO.
OUTCOMES
The motor weakness and sensory reduction were completely recovered at 9 months after surgery.
LESSONS
OWHTO has been known to be safe from peroneal nerve injury. However, considering the anatomical course of deep peroneal nerve, great care should be taken to avoid damage to the deep peroneal nerve while drilling holes and inserting distal screws toward the posterolateral aspect of the proximal tibia.
理论依据
腓总神经损伤是闭合楔形高位胫骨截骨术（CWHTO）后可能发生的主要并发症之一。相比之下，腓总神经损伤风险降低被认为是开放楔形高位胫骨截骨术（OWHTO）的优点之一。
患者情况
一名61岁男性接受OWHTO手术后立即出现拇趾下垂。
诊断
电诊断研究证实为腓深神经损伤。可能是由一枚向外侧后方突出的螺钉所致。
干预措施
OWHTO术后3周将突出的螺钉更换为较短的螺钉。
结果
术后9个月运动无力和感觉减退完全恢复。
经验教训
OWHTO一直被认为可避免腓总神经损伤。然而，考虑到腓深神经的解剖走行，在向胫骨近端后外侧钻孔和插入远端螺钉时，应格外小心以避免损伤腓深神经。
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