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腓总神经损伤手术治疗后的有效功能恢复及生活质量

Useful functional recovery and quality of life after surgical treatment of peroneal nerve injuries.

作者信息

Rasulić Lukas, Nikolić Živan, Lepić Milan, Savić Andrija, Vitošević Filip, Novaković Nenad, Radojević Stefan, Mićić Aleksa, Lepić Sanja, Mandić-Rajčević Stefan

机构信息

Faculty of Medicine, University of Belgrade, Belgrade, Serbia.

Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia.

出版信息

Front Surg. 2022 Nov 14;9:1005483. doi: 10.3389/fsurg.2022.1005483. eCollection 2022.

Abstract

Closed injuries to the peroneal nerve recover spontaneously in about a third of patients, but surgery may be needed in the remaining 2/3. The recovery after surgery is not always satisfactory and the patients may need an orthosis or a walking aid to cope with regular daily activities. This study aimed to evaluate the useful functional recovery and quality of life (QoL) in surgically treated patients with peroneal nerve (PN) injuries. The study involved 51 patients who have undergone surgical treatment due to PN injury in our department, within a 15-year period (2006-2020). Thirty patients (59%) were treated with neurolysis, 12 (23%) with nerve repair techniques, and 9 (18%) with tendon transfer (TT). Neurolysis is employed in the least extensive nerve injuries when nerve continuity is preserved and yields a motor recovery ratio of almost 80%. Nerve repairs were followed by 58.33% of patients achieving M3+ recovery, while 41.66% recovered to the useful functional state (M4 or M5) With the use of TTs, all patients recovered to the M3+, while 66.7% recovered to M4. All our results correspond to the results of previous studies. No statistically significant differences were found regarding the QoL of the groups. There is an apparent advantage of neurolysis, over nerve repair, over TT procedure, both in terms of useful functional recovery, and foot-drop-related QoL. However, when involving all aspects of QoL, these advantages diminish. The individual approach leads to optimal results in all groups of patients.

摘要

腓总神经闭合性损伤约三分之一的患者可自发恢复,但其余三分之二的患者可能需要手术治疗。手术后的恢复情况并不总是令人满意,患者可能需要矫形器或助行器来应对日常活动。本研究旨在评估手术治疗的腓总神经(PN)损伤患者的有效功能恢复和生活质量(QoL)。该研究纳入了15年间(2006 - 2020年)在我科因PN损伤接受手术治疗的51例患者。30例患者(59%)接受了神经松解术,12例(23%)接受了神经修复技术治疗,9例(18%)接受了肌腱转移术(TT)。神经松解术用于神经连续性保留的最轻微神经损伤,运动恢复率近80%。神经修复术后,58.33%的患者恢复到M3 +,而41.66%恢复到有效功能状态(M4或M5)。使用TTs后,所有患者恢复到M3 +,66.7%恢复到M4。我们所有的结果与先前研究的结果一致。各组在生活质量方面未发现统计学上的显著差异。无论是在有效功能恢复还是与足下垂相关的生活质量方面,神经松解术相对于神经修复术和TT手术都具有明显优势。然而,当涉及生活质量的所有方面时,这些优势就会减弱。个体化治疗方法能使所有患者组都取得最佳结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/952f/9702062/8c404b229947/fsurg-09-1005483-g001.jpg

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