Prahinski J R, McHale K A, Temple H T, Jackson J P
Department of Surgery, Walter Reed Army Medical Center, Washington, DC 20307, USA.
Foot Ankle Int. 1996 Oct;17(10):615-9. doi: 10.1177/107110079601701005.
In the Riordan (bridle) transfer, the posterior tibialis muscle as motor is routed through the interosseous membrane and anastomosed into a "bridle" formed by the distal tibialis anterior and peroneus longus muscles. In theory, the bridle provides inversion/eversion balance even if the transfer effects only tenodesis. However, the procedure has been criticized because its insertion is not into bone. This review analyzes the use of bridle transfer in flaccid paresis involving musculature innervated by the peroneal nerve. Surgery was performed 1 to 3 years after injury for patients with traumatic etiology. Ten patients are reviewed at 61 months' mean follow-up. Eight patients had traumatic peroneal nerve loss. Two had neuromuscular etiology. Evaluation included review of records, telephone interviews, and physical examinations. Data on functional status included walking barefoot running, need for bracing, return to duty, and patient satisfaction. Physical examination recorded ankle position and motions, gait findings, and results of static electromyograms. All patients were able to walk barefoot, but 6 of 10 had a mild to moderate limp. Five patients returned to running initially; only two were able to keep running. Nine patients were brace-free initially (polio sequela required bracing initially), and four others returned to bracing. Of these, two experienced an acute "tearing" and dorsiflexion loss, one sustained a prolonged gradual loss of dorsiflexion, and one sustained a contralateral cerebrovascular accident. Only three of seven patients returned to active duty, and one is on jump status. All patients were satisfied with their initial result. Only two patients had no detectable swing phase problems (both returned to active duty). Five patients had peroneal nerve exploration with repair or neurolysis; two of them sustained complete transections. Postoperative electromyograms showed insignificant, if any, nerve return. The Riordan transfer works well for neuromuscular flaccid paresis and in patients with peroneal nerve injuries with low demands. It may stretch out over time to the point of acute failure in patients with high demands. Concurrent peroneal nerve exploration and repair did not seem to be beneficial in this small study.
在里奥丹（系带）转移术中，作为动力肌的胫后肌穿过骨间膜，与由胫前肌远端和腓骨长肌形成的“系带”进行吻合。理论上，即使该转移术仅起到肌腱固定作用，系带也能提供内翻/外翻平衡。然而，该手术受到批评，因为其肌腱并非附着于骨。本综述分析了系带转移术在腓总神经支配肌肉的弛缓性麻痹中的应用。对创伤性病因患者在受伤后1至3年进行手术。对10例患者进行了平均61个月的随访。8例患者为创伤性腓总神经损伤。2例为神经肌肉病因。评估包括病历回顾、电话访谈和体格检查。功能状态数据包括赤脚行走、跑步、是否需要支具、重返工作岗位以及患者满意度。体格检查记录了踝关节位置和活动度、步态表现以及静态肌电图结果。所有患者均能赤脚行走，但10例中有6例有轻度至中度跛行。5例患者最初能够跑步；只有2例能够持续跑步。9例患者最初无需支具（小儿麻痹后遗症患者最初需要支具），另外4例患者后来又重新使用支具。其中，2例经历了急性“撕裂”和背屈丧失，1例持续出现背屈逐渐丧失，1例发生了对侧脑血管意外。7例患者中只有3例重返现役，1例处于跳跃状态。所有患者对其初始结果均满意。只有2例患者没有可检测到的摆动期问题（均重返现役）。5例患者进行了腓总神经探查并修复或行神经松解术；其中2例为完全横断伤。术后肌电图显示神经恢复不明显（若有恢复的话）。里奥丹转移术对于神经肌肉弛缓性麻痹以及对功能要求较低的腓总神经损伤患者效果良好。对于功能要求较高的患者，随着时间推移，它可能会伸展到急性失效的程度。在这项小型研究中，同时进行腓总神经探查和修复似乎并无益处。
