Mont M A, Dellon A L, Chen F, Hungerford M W, Krackow K A, Hungerford D S
Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Good Samaritan Hospital, Baltimore, Maryland 21239, USA.
J Bone Joint Surg Am. 1996 Jun;78(6):863-9.
We retrospectively reviewed the results of operative decompression for peroneal nerve palsy in thirty-one patients who had been managed between 1980 and 1990. All patients had been managed non-operatively for at least two months after they had initially been seen. Intraoperatively, we found epineurial fibrosis and bands of fibrous tissue constricting the peroneal nerve at the level of the fibular head and at the proximal origin of the peroneus longus muscle. At a mean of thirty-six months (range, twelve to seventy-two months) postoperatively, thirty (97 per cent) of the thirty-one patients reported subjective and functional improvement and were able to discontinue the use of the ankle-foot orthosis. In contrast, only three of nine patients who had been managed non-operatively reported subjective and functional improvement (p < 0.01). Peroneal nerve palsy does not always resolve spontaneously; if it is left untreated, the loss of dorsiflexion of the ankle and persistent paresthesias can result in severe functional disability. Therefore, if non-operative measures do not lead to improvement within two months, we believe that operative decompression should be considered.
我们回顾性分析了1980年至1990年间接受手术减压治疗的31例腓总神经麻痹患者的手术结果。所有患者在初次就诊后至少接受了两个月的非手术治疗。术中，我们发现神经外膜纤维化以及纤维组织束在腓骨头水平和腓骨长肌近端起点处压迫腓总神经。术后平均36个月（范围为12至72个月）时，31例患者中有30例（97%）报告主观症状和功能有所改善，并且能够停用踝足矫形器。相比之下，9例接受非手术治疗的患者中只有3例报告主观症状和功能有所改善（p<0.01）。腓总神经麻痹并非总能自行缓解；如果不进行治疗，踝关节背屈丧失和持续感觉异常可导致严重的功能残疾。因此，如果非手术措施在两个月内未导致病情改善，我们认为应考虑进行手术减压。
