Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan.
Medicina (Kaunas). 2023 Feb 27;59(3):466. doi: 10.3390/medicina59030466.
Muscle herniation of the lower extremity, such as tibialis anterior muscle herniation (TAMH), is not a rare cause of leg pain in athletes. However, a few studies have reported surgical treatment for TAMH, and the optimal surgical procedure remains controversial. Fasciotomy was reported to be effective for patients with TAMH. However, this procedure would be associated with a risk of intraoperative injury to the superficial peroneal nerve (SPN), although no previous literature has reported this complication. This case report aimed to report a case of bilateral TAMHs in which a traumatic neuroma of the SPN developed after fasciotomy. A 16-year-old baseball player presented with painful swelling lesions of the bilateral lower extremities (1 lesion on the right, 3 lesions on the left) after sports activities. An ultrasonographic evaluation showed swelling lesions of the anterolateral parts of the bilateral lower extremities in the standing position after dashing, while these lesions were not detected in the supine position. A fasciotomy of the crural fascia was performed after conservative treatment failed. Several days after surgery, the patient presented with weakened touch sensation over the dorsal area of the left foot. At the three-month follow-up examination, a swelling lesion with hard elasticity was identified. The palpation of this lesion caused a radiating sensation in the area supplied by the SPN. He was able to return to playing baseball six months after surgery. The patient was asymptomatic without palpation of the traumatic neuroma of the SPN at the latest follow-up examination. In conclusion, the present case report suggests that orthopedic surgeons need to consider the risk of iatrogenic injury to the SPN during fasciotomy for the treatment of TAMHs. However, there may be a risk of injuring the SPN because of the many variants of the course of the SPN within the compartment of the lower extremities.
下肢肌肉疝出，如胫骨前肌疝出（TAMH），在运动员中并不是引起腿部疼痛的罕见原因。然而，仅有少数研究报道了 TAMH 的手术治疗，且最佳手术方式仍存在争议。筋膜切开术被报道对 TAMH 患者有效。然而，该手术可能会导致术中腓浅神经（SPN）损伤，尽管之前的文献并未报道过这种并发症。本病例报告旨在报道一例双侧 TAMH 患者，其在筋膜切开术后发生 SPN 外伤性神经瘤。一名 16 岁棒球运动员在运动后出现双侧下肢（右侧 1 处，左侧 3 处）疼痛性肿胀病变。超声评估显示，在冲刺后站立位时双侧下肢前外侧出现肿胀病变，而在仰卧位时则未检测到这些病变。在保守治疗失败后，对小腿筋膜进行了筋膜切开术。手术后几天，患者出现左侧足部背侧感觉减弱。在三个月的随访检查中，发现一个肿胀病变，具有坚硬的弹性。触诊该病变会引起 SPN 支配区的放射感。手术后 6 个月，他能够重返棒球运动。在最近的随访检查中，患者无症状，且未触诊到 SPN 的外伤性神经瘤。总之，本病例报告提示，矫形外科医生在进行筋膜切开术治疗 TAMH 时，需要考虑到对 SPN 造成医源性损伤的风险。然而，由于 SPN 在下肢筋膜内的走行存在多种变异，因此可能会有损伤 SPN 的风险。
