Skalley T C, Schon L C, Hinton R Y, Myerson M S
Union Memorial Hospital, Baltimore, Maryland.
Foot Ankle Int. 1994 Jul;15(7):360-7. doi: 10.1177/107110079401500703.
The results following revision tarsal tunnel release in 12 patients (13 feet), including three men and nine women aged 28 to 66 years, are presented. The indication for surgery was incapacitating focal pain, associated with paresthesias and hyperesthesias, refractory to nonoperative treatment modalities. Electrodiagnostic studies were abnormal in nine and normal in four cases. Revision surgery was performed a mean 3.5 years (range 1-10 years) after the initial tarsal tunnel release. Epineurolysis was performed in nine of the 13 cases where the nerve was encased in a scar. An insufficient previous distal release was identified in nine of the 13 cases. Wound infection occurred in two patients, one of whom ultimately underwent a below the knee amputation. With the exception of this patient, all patients were evaluated a mean 31 months (range 12-59 months) after the revision surgery. Three groups of patients were identified based on similarities in presentation, intraoperative findings, and clinical outcome. The first group (four feet), characterized by encasement of the tibial nerve in scar and an adequate distal release at the previous tarsal tunnel surgery, did poorly. The second group (five feet), with both scarring of the tibial nerve and an inadequate prior distal release, had somewhat mixed results, but overall were improved. The final group (four feet), who had no significant tibial nerve scarring but had had an inadequate prior distal release, did well. Clinical history and physical examination were more helpful than electrodiagnostic studies in determining the extent and location of the tibial nerve irritation following previous tarsal tunnel release surgery.
本文报告了12例患者（13足）行跗管松解翻修术后的结果，其中男性3例，女性9例，年龄在28至66岁之间。手术指征为非手术治疗无效的、伴有感觉异常和感觉过敏的致残性局部疼痛。9例患者的电诊断检查结果异常，4例正常。翻修手术在初次跗管松解术后平均3.5年（范围1 - 10年）进行。13例中9例神经被瘢痕包裹的患者进行了神经外膜松解术。13例中有9例发现先前的远端松解不足。2例患者发生伤口感染，其中1例最终接受了膝下截肢术。除该患者外，所有患者在翻修手术后平均31个月（范围12至59个月）接受评估。根据临床表现、术中发现和临床结果的相似性，将患者分为三组。第一组（4足），其特征为胫神经被瘢痕包裹且先前跗管手术的远端松解充分，预后较差。第二组（5足），胫神经有瘢痕形成且先前远端松解不足，结果好坏参半，但总体有所改善。最后一组（4足），胫神经无明显瘢痕形成但先前远端松解不足，预后良好。在确定先前跗管松解术后胫神经刺激的程度和位置方面，临床病史和体格检查比电诊断检查更有帮助。
