踝管综合征的显微手术治疗  

Microsurgical Treatment in Tarsal Tunnel Syndrome

作　　者：王换新[1] 吴学建[2] 李锦永[1] 程学锋[1] 

机构地区：[1]郑州市第二人民医院骨科,450006 [2]郑州大学第一附属医院骨科

出　　处：《医学研究杂志》2013年第3期137-139,共3页Journal of Medical Research

摘　　要：目的探讨踝管综合征的诊断及显微手术治疗。方法 2003年3月～2010年6月,采用显微外科技术治疗踝管综合征21例。男性15例,女性6例。患者年龄20～56岁,平均年龄35岁。病程最长2年,最短1个月。21例中14例有外伤史:11例踝关节扭伤;3例跟骨骨折。4例腱鞘囊肿;2例脂肪瘤,1例神经鞘瘤。手术方法:完全打开屈肌支持带,显露踝管,观察其内组织的病理变化情况。如腱鞘囊肿、骨赘形成予以切除,曲张静脉团予以结扎切断,跖筋膜增厚予以切开减压。病变段神经采用显微外科技术进行松解。结果本组病例均获随访,时间最长3.5年,最短1年,平均2年2个月。末次随访时,17例术后恢复良好,感觉运动基本正常;3例感觉恢复正常,足内肌力部分恢复;1例感觉大部分恢复,足内肌未见恢复。结论 踝管综合征保守治疗2～3个月无效时,应抓紧时机手术治疗。采用显微外科技术可提高手术疗效。Objective To investigate the causes of tarsal tunnel syndrome,and diagnosis and microsurgical treatment. Methods From March 2003 to June 2010,21 cases of tarsal tunnel syndrome were treated, including 15 maizes and 6 females,in which the age range was from 20 to 56 years old, and treating time was durating from 2 years to the shortest 1 month. 21 patients had a history of trauma in 14cases： 11 cases of ankle sprain, 3 fractures, 3 cases of ganglion cyst, 2 case of neurilemoma, and 2 lipoma, flexor support was fully open to expose the tarsal tunnel, and the pathological changes within the organization were observed. For example, the ganglion cyst, osteo- phyte formation were removed, and varicose vein ligation group was cut off, thickening of the plantar fascia was open for decompression. Nerve in lesions was reteased under the operating microscope. Results The patients were followed up,with the longest time of 3.5 years, the shortest time of 1 year,and an average of 2 years and 2 months. 17 patients recovered well, with normal sensory - motor; 3 cases feel back to normal and foot muscle partially restorated; 1 patient feels most of the recovery, and the foot muscle did not recover. Conclusion Tarsal tunnel syndrome is relatively rare, has not yet attracted the attention of clinicians, and is often misdiagnosed. Once it being diag- nosed, when conservative treatment fails,dot tors should seize the opportunity to line neurolysis treatment.

关 键 词：踝管 胫神经 神经嵌压显微外科技术 神经松解 

分 类 号：R681.8[医药卫生—骨科学]