Mukohara Shintaro, Inui Atsuyuki, Mifune Yutaka, Nishimoto Hanako, Kataoka Takeshi, Kurosawa Takashi, Yamaura Kohei, Kuroda Ryosuke
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Kobe J Med Sci. 2020 Jan 20;65(3):E110-E113.
Common peroneal nerve (CPN) injury following a knee dislocation is a serious problem, and an optimal treatment is yet to be established. We report a case of complete CPN palsy following a knee dislocation treated with sural nerve grafting.
A 19-year-old man suffered a knee injury during a hurdle race. Diagnosis in a previous hospital revealed a complex ligament injury with CPN palsy. Ten weeks following injury, he was admitted to our institution because of a lack of neurological improvement. Considering the grade 0 results obtained in the manual muscle test (MMT) of tibialis anterior (TA) and extensor hallucis longus (EHL), the patient was diagnosed with complete neurotmesis of CPN, and surgery was performed. Operative findings revealed CPN discontinuity and an extended nerve defect length of 15 cm; therefore, sural nerve grafting was performed to repair the CPN injury. One year postoperatively, a grade 1 result from MMT of TA and EHL indicated a gradual neurological recovery. Three years postoperatively, MMT of TA and EHL showed significant improvement to grade 4+ and grade 4, respectively, and he could walk and jog without a knee brace.
Nerve graft length of >6 cm has shown limited success, and their efficacy for the treatment of CPN palsy following knee dislocations is controversial. However, young patients with complete CPN lesion are more likely to recover regardless of the length of nerve injury. Therefore, in such cases, nerve grafting can be considered as one of the treatments for complete CPN lesion following knee dislocations.
膝关节脱位后腓总神经（CPN）损伤是一个严重问题，目前尚未确立最佳治疗方法。我们报告一例膝关节脱位后出现完全性CPN麻痹并接受腓肠神经移植治疗的病例。
一名19岁男性在跨栏比赛中膝关节受伤。先前医院的诊断显示为复杂韧带损伤合并CPN麻痹。受伤10周后，因神经功能未改善而入住我院。考虑到胫骨前肌（TA）和拇长伸肌（EHL）的徒手肌力测试（MMT）结果为0级，该患者被诊断为CPN完全性神经断裂，并接受了手术。手术发现CPN连续性中断，神经缺损长度延长至15 cm；因此，进行了腓肠神经移植以修复CPN损伤。术后1年，TA和EHL的MMT结果为1级，表明神经功能逐渐恢复。术后3年，TA和EHL的MMT分别显著改善至4+级和4级，且他无需佩戴膝关节支具即可行走和慢跑。
神经移植长度>6 cm的成功率有限，其对膝关节脱位后CPN麻痹的治疗效果存在争议。然而，年轻的CPN完全性损伤患者无论神经损伤长度如何，更有可能恢复。因此，在这种情况下，神经移植可被视为膝关节脱位后CPN完全性损伤的治疗方法之一。
