iULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, 06000 Nice, France; Unité de Recherche Clinique Côte d'Azur (UR2CA), CHU de Nice, Université Côte d'Azur (UCA), Nice, France.
iULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, 06000 Nice, France; Unité de Recherche Clinique Côte d'Azur (UR2CA), CHU de Nice, Université Côte d'Azur (UCA), Nice, France; Department of Radiology, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, 06000 Nice, France.
Orthop Traumatol Surg Res. 2023 Dec;109(8):103708. doi: 10.1016/j.otsr.2023.103708. Epub 2023 Oct 13.
The Flexor Hallucis Longus (FHL) is a muscle that can be subject to multiple impingements caused by exaggerated plantar flexion in athletes. The most common impingement is due to inflammation of the tendon at the retrotalar pulley. The constraints exerted on the FHL are responsible for a pathology called functional Hallux Limitus. Surgical treatment consists of tenolysis of the FHL arthroscopically or via open surgery, by opening the pulley. The objective of this study was to evaluate the risk of lesions of the neurovascular pedicle and the posterior tibial tendon after tenolysis of the Flexor Hallucis Longus under ultrasound guidance.
The hypothesis of this study is that tenolysis of the Flexor Hallucis Longus could proceed under ultrasound guidance without associated tendon lesions or neurovascular lesions.
Thirteen cadaveric specimens were studied, resulting in an analysis of 26 feet. Following identification of the Flexor Hallucis Longus, tenolysis with a 19-gauge needle under ultrasound guidance was performed by an orthopedic specialist after hydrodissection to push back the posterior tibial pedicle. The dissection of the cadavers made it possible to verify the positioning of the posterior tibial pedicle, the FHL tendon and the opening of the retrotalar pulley.
Five cadaveric subjects, 10 cases, underwent a complete opening of the retrotalar pulley under ultrasound guidance. In 16 cases, the opening was partial, with a section of the pulley of 65.87±18%. The cases of partial openings showed no neurovascular or tendinous lesions. The 10 cases of complete opening resulted in 5 lesions of the tibial nerve, 4 vascular lesions: 1 venous and 3 arterial, and 6 lesions of the FHL tendon.
Tenolysis of the Flexor Hallucis Longus under ultrasound guidance at the level of its retrotalar pulley was systematically associated with neurovascular lesions in the event of complete release of the pulley by the method studied, unlike a partial release where no lesion was found.
III; case-control study.
屈肌踇长肌（FHL）是一种肌肉，在运动员中，由于过度跖屈，可发生多种撞击。最常见的撞击是由于跟骨后滑车处的肌腱炎症引起的。对 FHL 施加的约束是导致一种称为功能性踇趾受限的病理学的原因。手术治疗包括 FHL 的关节内或开放性松解术，通过切开滑车。本研究的目的是评估在超声引导下进行 FHL 松解时，对神经血管蒂和后胫肌腱的损伤风险。
本研究的假设是，在超声引导下进行 FHL 松解可以在不伴相关肌腱损伤或神经血管损伤的情况下进行。
对 13 个尸体标本进行了研究，共分析了 26 只脚。在识别出屈肌踇长肌后，由一名矫形专家在水分离后用 19 号针在超声引导下进行松解，以将后胫神经推向后方。对尸体的解剖使我们能够验证后胫神经、FHL 肌腱和跟骨后滑车的开口的位置。
在超声引导下，有 5 个尸体标本，即 10 例，可完全打开跟骨后滑车。在 16 例中，开口是部分的，滑车的部分为 65.87±18%。部分开口的病例没有神经血管或肌腱损伤。10 例完全开口导致 5 例胫骨神经损伤、4 例血管损伤：1 例静脉和 3 例动脉，6 例 FHL 肌腱损伤。
在超声引导下，在跟骨后滑车水平进行 FHL 松解，如果采用研究中描述的方法完全释放滑车，系统地伴有神经血管损伤，而在部分释放滑车的情况下，没有发现损伤。
III；病例对照研究。
