改良胫后肌移位术治疗腓总神经损伤后足下垂及内翻畸形  

Modified posterior tibialis muscle transfer for treatment of foot drop and varus deformity after common peroneal nerve injury

作　　者：杨勇[1] 李忠哲[1] 陶莉[2] 李莹[3] 黄行健[1] 李斌[1] 李峰[1] 孙丽颖[1] 武竞衡[1] Yang Yong;Li Zhongzhe;Tao Li;Li Ying;Huang Xingjian;Li Bin;Li Feng;Sun Liying;Wu Jingheng(Department of Hand Surgery,Beijing Jishuitan Hospital、Beijing 100035,China;Department ofRehabilitation,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Foot and AnkleSurgery,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院手外科,100035 [2]北京积水潭医院康复科,100035 [3]北京积水潭医院足踝外科,100035

出　　处：《中华创伤杂志》2021年第1期44-49,共6页Chinese Journal of Trauma

基　　金：北京市卫生系统高层次卫生技术人才培养计划(2015-3-036)。

摘　　要：目的探讨改良胫后肌移位术治疗腓总神经损伤所致足下垂及内翻畸形的早期疗效。方法采用回顾性病例系列研究分析2017年12月至2019年10月北京积水潭医院收治的6例腓总神经麻痹性足下垂及内翻患者的临床资料,其中男4例,女2例;年龄33~48岁[(39.5±6.0)岁]。左侧4例,右侧2例。患者均行胫后肌移位术,通过异体肌腱移植,将胫后肌止点重建于第四跖骨,纠正足下垂及内翻畸形。比较术前和末次随访时踝关节主动背屈和跖屈的活动度、足内翻和外翻的活动度;60°/s角速度时,踝关节背屈和跖屈的等速力矩峰值、足部冠状面内翻和外翻的等速力矩峰值。末次随访时观察足部的影像学Meary角、跟骨投照角及第四跖骨直径。术前和末次随访时采用美国足踝外科协会(AOFAS)踝-后足评分评价踝关节功能。结果患者均获随访6~17个月[10(6,15)个月]。末次随访时,踝关节主动背屈为6(0,10)°,足外翻为3(0,5)°,较术前[-31(-33,-28)°、-10(-12,-8)°]均显著改善(P<0.05);60°/s角速度的等速力矩峰值,踝关节背屈力矩[(7.7±0.8)Nm]、足外翻力矩[(7.2±0.7)Nm]较术前[(0.0±0.0)Nm、(2.1±0.6)Nm]均显著提高(P<0.01)。影像学检查未见获得性扁平足畸形和第四跖骨止点处形变。AOFAS踝-后足评分由术前的50~73分[(61.3±8.4)分]提高至末次随访时的75~97分[(86.8±7.2)分](P<0.01)。结论改良胫后肌移位术治疗腓总神经损伤后足下垂及内翻畸形,能够增加踝关节背屈和外翻的力矩,改善踝关节活动度,促进踝关节功能恢复。Objective To investigate the early effect of modified posterior tibialis muscle transferin treating foot drop and varus deformity caused by common peroneal nerve injury.Methods Aretrospective case series study was conducted to analyze the clinical data of 6 patients with fool drop ofcommon peroneal nerve palsy and varus deformity admitted to Beijing Jishuitan Hospital from December2017 to October 2019,including 4 males and 2 females,agedl 33.48 years[(39.5±6.0)years].Theleft side was involved in 4 patients and the right side in 2 patients.All patients underwent posterior tibialmuscle transer.The insertion of posterior tibial muscle was reconstructed in the fourth melaltarsal with thetendon allograft to correct foot drop and varus deformity.The range of motion of active ankle dorsiflexionand plantar flexion and range of motion of varus and valgus of foot were measured before operation and at the last follow-up.The isokinetic torque peak value of ankle dorsiflexion and plantar flexion at 60/sangular velocity and peak isokinetic torque of foot varus and valgus at 60°/s angular velocity weremeasured before operation and at the last follow-up.The postoperative foot imaging evaluation wasperformed at the last follow-up,including Meary angle,calcaneal projection and diameter of the fourthmetatarsal.The American Orthopaedic Foot&Ankle Association(AOFAS)ankle-hindfoot score wasused to evaluate the ankle function.Results All patients were followed up for 6-17 months[10(6,15)months].At the last follow-up,the range of motion of dorsiflexion of the ankle[6(0,10)°]and footvalgus[3(0,5)°]were significantly improved compared with the preoperative level[-31(-33,-28)°,-10(-12,-8)°](P<0.05);the ankle dorsiflexion torque[(7.7±0.8)Nm]and footvalgus torque[(7.2±0.7)Nm]were significantly improved compared with the preoperative level[(0.0±0.0)Nm,(2.1±0.6)Nm]at 60/s angular velocity(P<0.0l).lmaging examination showed noacquired flat foot deformity and deformation of the fourth metatarsal insertion.The AOF AS ankle-hindfootscore

关 键 词：腓神经 移植 异种 足下垂 

分 类 号：R658.3[医药卫生—外科学]