Fabre T, Piton C, Andre D, Lasseur E, Durandeau A
Groupe Hospitalier Pellegrin, Bordeaux, France.
J Bone Joint Surg Am. 1998 Jan;80(1):47-53. doi: 10.2106/00004623-199801000-00009.
Sixty patients (sixty-two limbs) who had entrapment of the peroneal nerve were managed with operative decompression, and the results were evaluated after an average duration of follow-up of forty-two months (range, twenty-five to 162 months). The entrapment was postural in five patients, dynamic in two (one of whom had bilateral entrapment), and idiopathic in fifty-three (one of whom had bilateral entrapment). Fifty-eight patients (including the two who had bilateral entrapment) had a positive Tinel sign. Twenty-two patients (including the two who had bilateral entrapment) had sensory symptoms only, and thirty-eight had both sensory and motor symptoms. Electrophysiological studies were performed for all patients in order to confirm the diagnosis. Sensory deficits were confirmed on the basis of a marked decrease in the amplitude of sensory potentials, and motor deficits were confirmed on the basis of decreased nerve-conduction velocities. The common peroneal nerve was decompressed by division of both edges of the fibular fibrous arch. The average time from the onset of symptoms to the operation was fourteen months (range, one to 120 months), primarily because of delayed referrals. Twelve of the twenty-two patients who had had only sensory symptoms preoperatively had complete recovery by the time of the latest follow-up. The average delay from the onset of symptoms to the operation was thirty months (range, six to eighty-six months) for the ten patients (eleven limbs) who did not have full recovery compared with nine months (range, four to thirty-six months) for the twelve patients (thirteen limbs) who did. The postoperative recovery of motor function, as determined with use of the grading system of the Medical Research Council, was good for thirty-three (87 per cent) of the thirty-eight patients who had had both sensory and motor symptoms preoperatively. All seven patients who had peroneal nerve entrapment of known etiology had improvement postoperatively. We recommend operative decompression when symptoms persist or recovery remains incomplete for three to four months, provided that the diagnosis has been confirmed with electrophysiological studies.
60例（62条肢体）腓总神经卡压患者接受了手术减压治疗，平均随访42个月（范围25至162个月）后对结果进行评估。5例患者的卡压为姿势性，2例为动力性（其中1例双侧卡压），53例为特发性（其中1例双侧卡压）。58例患者（包括2例双侧卡压者）有阳性Tinel征。22例患者（包括2例双侧卡压者）仅有感觉症状，38例有感觉和运动症状。对所有患者均进行了电生理检查以确诊。感觉功能障碍根据感觉电位幅度明显降低得以证实，运动功能障碍根据神经传导速度降低得以证实。通过切开腓骨纤维弓的两边对腓总神经进行减压。从症状出现到手术的平均时间为14个月（范围1至120个月），主要原因是转诊延迟。术前仅有感觉症状的22例患者中，12例在最近一次随访时已完全恢复。未完全恢复的10例患者（11条肢体）从症状出现到手术的平均延迟时间为30个月（范围6至86个月），而完全恢复的12例患者（13条肢体）为9个月（范围4至36个月）。根据医学研究委员会的分级系统评估，术前有感觉和运动症状的38例患者中，33例（87%）术后运动功能恢复良好。所有7例已知病因的腓总神经卡压患者术后均有改善。我们建议，若症状持续或三到四个月仍未完全恢复，且已通过电生理检查确诊，则应进行手术减压。
