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胫神经比目鱼肌支转位至腓深神经修复腓总神经损伤后足下垂:一项回顾性研究

Transfer of Soleus Muscular Branch of Tibial Nerve to Deep Fibular Nerve to Repair Foot Drop After Common Peroneal Nerve Injury: A Retrospective Study.

作者信息

Bao Bingbo, Wei Haifeng, Zhu Hongyi, Zheng Xianyou

机构信息

Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.

出版信息

Front Neurol. 2022 Feb 11;13:745746. doi: 10.3389/fneur.2022.745746. eCollection 2022.


DOI:10.3389/fneur.2022.745746
PMID:35222238
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8873085/
Abstract

OBJECTIVE: Common peroneal nerve (CPN) injury that leads to foot drop is difficult to manage and treat. We present a new strategy for management of foot drop after CPN injury. The soleus muscular branch of the tibial nerve is directly transferred to the deep fibular nerve, providing partial restoration of motor function. METHODS: We retrospectively reviewed eight patients treated for CPN injury between 2017 and 2019. The soleus muscular branch of the tibial nerve was transferred to the deep fibular nerve to repair foot drop. Electrophysiology was conducted, and motor function was assessed. Motor function was evaluated by measuring leg muscle strength during ankle dorsiflexion using the British Medical Research Council (BMRC) grading system and electromyography (EMG). RESULTS: In 10-15 months postoperatively, EMG revealed newly appearing electrical potentials in the tibialis anterior, extensor hallucis longus, and extensor toe longus muscle ( = 7). Two patients achieved BMRC grade of M4 for ankle dorsiflexion, 2 patients achieved M3, 1 patient achieved M2, and 2 patients achieved M1. Four patients showed good functional recovery after surgery and could walk and participate in activities without ankle-foot orthotics. CONCLUSION: Surgical transfer of the soleus muscular branch of the tibial nerve to the deep fibular nerve after CPN injury provides variable improvements in ankle dorsiflexion strength. Despite variable strength gains, 50% of patients achieved BMRC M3 or greater motor recovery, which enabled them to walk without assistive devices.

摘要

目的:腓总神经(CPN)损伤导致足下垂,其管理和治疗颇具难度。我们提出一种针对CPN损伤后足下垂的新管理策略。将胫神经的比目鱼肌支直接转移至腓深神经,可部分恢复运动功能。 方法:我们回顾性分析了2017年至2019年间接受CPN损伤治疗的8例患者。将胫神经的比目鱼肌支转移至腓深神经以修复足下垂。进行了电生理检查并评估了运动功能。使用英国医学研究委员会(BMRC)分级系统和肌电图(EMG),通过测量踝关节背屈时的腿部肌肉力量来评估运动功能。 结果:术后10 - 15个月,肌电图显示胫骨前肌、拇长伸肌和趾长伸肌出现新的电位( = 7)。2例患者踝关节背屈达到BMRC M4级,2例达到M3级,1例达到M2级,2例达到M1级。4例患者术后功能恢复良好,无需踝足矫形器即可行走并参与活动。 结论:CPN损伤后将胫神经的比目鱼肌支手术转移至腓深神经可使踝关节背屈力量有不同程度的改善。尽管力量增加程度各异,但50%的患者实现了BMRC M3或更高的运动恢复,使其能够无需辅助装置行走。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f1d4/8873085/19b62fd8b51a/fneur-13-745746-g0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f1d4/8873085/6883533038b7/fneur-13-745746-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f1d4/8873085/80b3ac202e1c/fneur-13-745746-g0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f1d4/8873085/19b62fd8b51a/fneur-13-745746-g0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f1d4/8873085/6883533038b7/fneur-13-745746-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f1d4/8873085/80b3ac202e1c/fneur-13-745746-g0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f1d4/8873085/19b62fd8b51a/fneur-13-745746-g0003.jpg

相似文献

[1]
Transfer of Soleus Muscular Branch of Tibial Nerve to Deep Fibular Nerve to Repair Foot Drop After Common Peroneal Nerve Injury: A Retrospective Study.

Front Neurol. 2022-2-11

[2]
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Clin Orthop Relat Res. 2012-3

[3]
Gait Improvements After Peroneal or Tibial Nerve Transfer in Patients with Foot Drop: A Retrospective Study.

Eplasty. 2017-9-29

[4]
Translocation of the soleus muscular branch of the tibial nerve to repair high common peroneal nerve injury.

Acta Neurochir (Wien). 2019-1-8

[5]
Foot Reanimation Using Double Nerve Transfer to Deep Peroneal Nerve: A Novel Technique for Treatment of Neurologic Foot Drop.

Foot Ankle Int. 2021-8

[6]
Soleus nerve transfer to deep peroneal nerve for treatment of foot drop.

J Clin Neurosci. 2020-8

[7]
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Microsurgery. 2023-7

[8]
Clinical results of transferring a motor branch of the tibial nerve to the deep peroneal nerve for treatment of foot drop.

Neurosurgery. 2013-10

[9]
Surgical Treatment of Complete Foot Drop: Partial Tibial Nerve Transfer to the Motor Branch of the Tibialis Anterior: 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown). 2020-11-16

[10]
Partial tibial nerve transfer for foot drop from deep peroneal palsy: Lessons from three pediatric cases.

Microsurgery. 2022-1

引用本文的文献

[1]
Intraneural Topography and Branching Patterns of the Common Peroneal Nerve: Studying the Feasibility of Distal Nerve Transfers.

Plast Reconstr Surg Glob Open. 2024-10-17

[2]
Functional outcomes of different surgical treatments for common peroneal nerve injuries: a retrospective comparative study.

BMC Surg. 2024-2-17

[3]
Distal Nerve Transfers in High Peroneal Nerve Lesions: An Anatomical Feasibility Study.

J Pers Med. 2023-2-16

本文引用的文献

[1]
Cortical plasticity and nerve regeneration after peripheral nerve injury.

Neural Regen Res. 2021-8

[2]
Evaluation and Treatment of Foot Drop Using Nerve Transfer Techniques.

Clin Podiatr Med Surg. 2021-1

[3]
Posterior Tibial Tendon Transfer for Common Peroneal Nerve Injury.

Clin Sports Med. 2020-8-14

[4]
Nerve transfers in the upper extremity: A review.

Injury. 2020-12

[5]
STROCSS 2019 Guideline: Strengthening the reporting of cohort studies in surgery.

Int J Surg. 2019-11-6

[6]
Tendon Transfers in Foot Drop.

Indian J Plast Surg. 2019-1

[7]
The Interdisciplinary Management of Foot Drop.

Dtsch Arztebl Int. 2019-5-17

[8]
Translocation of the soleus muscular branch of the tibial nerve to repair high common peroneal nerve injury.

Acta Neurochir (Wien). 2019-1-8

[9]
Results of Phrenic Nerve Transfer to the Musculocutaneous Nerve Using Video-Assisted Thoracoscopy in Patients with Traumatic Brachial Plexus Injury: Series of 28 Cases.

Oper Neurosurg (Hagerstown). 2019-9-1

[10]
Clinical Outcomes of Nerve Transfers in Peroneal Nerve Palsy: A Systematic Review and Meta-Analysis.

J Reconstr Microsurg. 2019-1

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