Johnston Stephen, Kraus Jonathan, Tutton Sean, Symanski John
Department of Radiology, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA.
Department of Orthopedic Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA.
Skeletal Radiol. 2020 Aug;49(8):1313-1321. doi: 10.1007/s00256-020-03443-7. Epub 2020 Apr 15.
To describe our technical and preliminary clinical experience with ultrasound-guided diagnostic deep peroneal nerve (DPN) blocks for patients considering deep peroneal neurectomy.
Retrospective analysis of ultrasound-guided diagnostic DPN blocks performed in the anterior lower leg in patients pursuing deep peroneal neurectomy for foot pain not directly attributable to the DPN. Patient age, sex, foot laterality, diagnosis, nerve block complications, location of the DPN with respect to vascular landmarks in the lower leg, pain relief from nerve block, and pain relief from neurectomy (if performed) were recorded.
Twenty-six DPN blocks were performed for 25 feet, of which a majority had pain attributable to midfoot osteoarthritis (22/25). Variable DPN locations with respect to vascular landmarks in the lower leg were observed, including lateral to the anterior tibial artery (12/25), anterior to the artery (5/25), medial to the artery (3/25), lateral to the lateral paired vein (4/25), and 1-cm lateral to the artery (1/25). After DPN blocks, patients reported pain relief in 22/25 feet. Of the eleven patients who proceeded to have a deep peroneal neurectomy, ten reported improved foot pain.
Diagnostic deep peroneal nerve blocks for patients considering deep peroneal neurectomy for denervation therapy should be performed in the anterior lower leg where the anterior tibial vessels serve as anatomic landmarks. Those who perform DPN blocks with ultrasound guidance should be aware of variable DPN position with respect to the vascular landmarks.
描述我们对考虑行腓深神经切除术的患者进行超声引导下诊断性腓深神经（DPN）阻滞的技术及初步临床经验。
对因足部疼痛（并非直接由DPN引起）而行腓深神经切除术的患者在小腿前侧进行的超声引导下诊断性DPN阻滞进行回顾性分析。记录患者的年龄、性别、患侧足部、诊断、神经阻滞并发症、DPN在小腿中相对于血管标志的位置、神经阻滞带来的疼痛缓解情况以及（若进行了）腓深神经切除术后的疼痛缓解情况。
对25只足进行了26次DPN阻滞，其中大多数患者的疼痛归因于中足骨关节炎（22/25）。观察到DPN在小腿中相对于血管标志的位置各不相同，包括位于胫前动脉外侧（12/25）、动脉前方（5/25）、动脉内侧（3/25）、外侧成对静脉外侧（4/25）以及动脉外侧1厘米处（1/25）。DPN阻滞术后，22/25只足的患者报告疼痛缓解。在接受腓深神经切除术的11名患者中，10名报告足部疼痛有所改善。
对于考虑行腓深神经切除术进行去神经治疗的患者，诊断性腓深神经阻滞应在小腿前侧进行，以胫前血管作为解剖标志。使用超声引导进行DPN阻滞的人员应了解DPN相对于血管标志的可变位置。
