Bao Bingbo, Wei Haifeng, Zhu Hongyi, Zheng Xianyou
Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Front Neurol. 2022 Feb 11;13:745746. doi: 10.3389/fneur.2022.745746. eCollection 2022.
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.
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。
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