胫后肌腱转位治疗腓总神经损伤源性足下垂畸形  

Effectiveness of tibialis posterior tendon transfer for foot drop secondary to peroneal nerve palsy

作　　者：温晓东 赵宏谋[1] 鹿军 李毅[1] 张言[1] 梁景棋 常鑫 梁晓军[1] WEN Xiaodong;ZHAO Hongmou;LU Jun;LI Yi;ZHANG Yan;LIANG Jingqi;CHANG Xin;LIANG Xiaojun(Department of Foot and Ankle Surgery,Honghui Hospital,Xi’an Jiaotong University,Xi’an Shaanxi,710054,P.R.China)

机构地区：[1]西安交通大学附属红会医院足踝外科,西安710054

出　　处：《中国修复重建外科杂志》2020年第5期591-595,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(81301604)。

摘　　要：目的探讨胫后肌腱转位治疗腓总神经损伤源性足下垂畸形的疗效。方法2009年10月—2016年9月,采用胫后肌腱转位治疗21例单侧腓总神经损伤源性足下垂畸形。男12例,女9例;年龄23~47岁,平均32.1岁。致伤原因:医源性腓总神经损伤7例,胫腓骨近端骨折合并骨筋膜室综合征5例,刺伤或割伤行神经探查术3例,直接打击暴力4例,腓骨头骨折2例。受伤至手术时间2~8年,平均5.6年。合并家族遗传性踇外翻畸形1例、柔韧性足趾屈曲挛缩5例。采用美国矫形外科足踝协会(AOFAS)踝-后足评分及踝足功能(FAAM)评分评价踝关节功能,测量踝关节背伸、跖屈活动度以及背伸肌力。摄X线片并测量Meary角、跟骨倾斜角以及后足力线角。结果术后切口均Ⅰ期愈合。患者均获随访,随访时间18~42个月,平均30.2个月。患者踝关节背伸肌力由术前0级恢复至3~4级。随访期间未出现平足畸形、爪形趾。末次随访时,Meary角、跟骨倾斜角以及后足力线角与术前比较,差异均无统计学意义(P>0.05)。末次随访时,患侧AOFAS评分、FAAM评分、踝关节背伸活动度均较术前显著提高(P<0.05),跖屈活动度与术前差异无统计学意义(t=4.239,P=0.158)。健、患侧踝关节背伸活动度及AOFAS评分、FAAM评分差异均有统计学意义(P<0.05),跖屈活动度差异无统计学意义(t=2.319,P=0.538)。结论胫后肌腱转位治疗腓总神经损伤源性足下垂畸形有效,患者踝关节功能改善明显,术后早期未出现继发性平足畸形。Objective To investigate the effectiveness of tibialis posterior tendon transfer for foot drop secondary to peroneal nerve palsy.Methods The clinical data of 21 patients with unilateral foot drop secondary to peroneal nerve palsy between October 2009 and September 2016 was retrospectively analyzed.There were 12 males and 9 females with an average age of 32.1 years(range,23-47 years).The causes of peroneal nerve injury were iatrogenic injury in 7 cases,tibiofibular fractures combined with compartment syndrome in 5 cases,nerve exploration surgery after stab or cut injury in 3 cases,direct violence in 4 cases,and the fibular head fracture in 2 cases.The average time from injury to operation was 5.6 years(range,2-8 years).There was 1 case of hallux valgus and 5 cases of toe flexion contracture.The American Orthopaedic Foot and Ankle Society(AOFAS)ankle and hindfoot scores,Foot and Ankle Ability Measure(FAAM)scores,range of motion(ROM),and dorsiflexion strength of ankle joint were used to evaluated the ankle function.Radiographic evaluation for the changes of postoperative foot alignment included Meary angle,calcaneal pitch angle,and hindfoot alignment angle.Results All incisions healed by first intention.All patients were followed up 18-42 months(mean,30.2 months).The dorsiflexion strength of ankle joint recovered from grade 0 to grade 3-4 after operation.There was no patient with a postoperative flat foot deformity and claw toe during follow-up.There was no significant difference in Meary angle,calcaneal pitch angle,and hindfoot alignment angle between pre-and post-operation(P>0.05).The AOFAS score,FAAM score,and ROM of dorsiflexion significantly improved at last follow-up when compared with preoperative values(P<0.05);while there was no significant difference in ROM of plantar-flexion between pre-and postoperation(t=4.239,P=0.158).There were significant differences in AOFAS score,FAAM score,and ROM of dorsiflexion between affected and healthy sides(P<0.05);but no significant difference in ROM of plantar-flexion was

关 键 词：足下垂 胫后肌腱 肌腱转位 腓总神经损伤 踝关节 

分 类 号：R687.3[医药卫生—骨科学]