跗管综合征的MR成象

跗管是一从踝至足中段的纤维骨性管道,其中通过内侧肌腱及胫后神经血管束。当外伤、肿瘤或炎性病变压迫胫后神经或其分支时则产生跗管综合征。压迫常发生在胫后神经或其分支在小腿深筋膜、屈肌支持带及(足母)展肌下方通过跗管的行程中。与腕管综合征不同,跗管有由屈肌支持带下面发出的几个深在的纤维隔伸至跟骨内侧,走行于肌腱及神经血管束之间,将其包绕形成分隔管道。有些间隔与神经血管束相连使之较为固定,易受牵拉或占位性病变的损伤。所以,轻度压迫也能引起跗管综合征症状。作者报道了27例33双足跗管综合征及2     

踝管综合征7例治疗体会

我院1986年4月～1992年7月共收治踝管综合征12例,采取胫后神经松解、骨桥切除、环钻法跟距关节融合治疗,效果较好。现将得到随访的7例报告如下:1　临床资料1.1　一般情况　本组男5例,女2例;年龄18～32岁。病史3个月～2年。右踝5例,左踝3例(含双侧1例)。1.2　治疗方法　手术在气囊止血带下进行。切口选在内踝后下方,以骨突为中心长7～10cm。分离出屈肌支持带并纵行切开,在趾长屈肌与长屈肌间找出胫后神经及其伴行的动静脉束。可见跟距骨桥挤压胫后神经向下移位,胫后神经局部瘀血、水肿,踝关节屈伸活动时胫后肌腱、血管神经束在骨桥上来回摩…     

糖尿病下肢周围神经痛的外科治疗

 目的 探讨下肢多神经减压手术治疗糖尿病周围神经病变引起的下肢疼痛和麻木的方法及疗效.方法 采用Dellon三切口手术对具有神经卡压体征的糖尿病周围神经病变患者进行下肢神经减压手术.结果 患者下肢疼痛麻木症状明显缓解.其中明显缓解率在70％以上,麻木缓解率在80％以上.结论 神经减压手术为糖尿病周围神经病变的治疗提供了一条有效的新途径.     

关节镜技术在关节外手术的临床应用

应用关节镜技术镜技术行关节外手术45例，其中关节镜下双侧臂肌挛缩射频汽化松解14例，关节镜监视下腕横韧带松解治疗腕管综合征15例，肱骨大结节骨折关节镜下经皮复位内固定3例，股骨干钢板取出5例，Guo窝囊肿关节镜下射频汽化8例，肱骨大结节骨折关节镜下经皮复位空心钉内固定3例均达解剖复位，骨折愈合，肩关节功能恢复良好，关节镜监视下腕横韧带切开减压治疗腕管综合征，术后15例神经压迫症状解除，感觉运动功能恢复恢复正常，双臀肌挛缩关节镜下射频汽化松解14例，术后髋关节弹响消失，下肢交腿试验阴性，双膝并拢下蹲功能恢复正常，Guo窝囊肿关节镜射频汽化术后无复发，无血管神经损伤和感染等并发症，说明关节镜下手术为微创操作，安全可靠，不仅适用于关节内关节，而且可选择性地用于关节外手术。     

微创掌侧锁定钢板治疗桡骨远端骨折

目的 探讨微创掌侧插入锁定钢板治疗桡骨远端骨折的临床效果、可行性、注意点和并发症.方法 选择2009年8-2010年8月收治的22例桡骨远端骨折患者,应用微创掌侧锁定钢板治疗.按AO分型:A2型5例,A3型3例,B1型4例,B3型7例,C1型2例,C2型1例.采用掌侧2条垂直或平行的切口,切口均长2 cm,其中远端横切口即沿腕近纹切开,两端纵切口紧贴桡侧腕屈肌桡侧切开,经旋前方肌深部插入锁定钢板固定.结果 术后随访10～18个月,平均12个月.按Dienst功能评估标准:优13例,良6例,可3例,差0例,优良率为86％.手术并发症:腕近纹处横切口延迟愈合1例;大鱼际部麻木1例,术后3个月症状消失;残留腕关节尺侧痛2例;腕关节功能受限2例.结论 微创掌侧锁定钢板治疗桡骨远端骨折安全、创伤小、固定可靠,利于早期功能锻炼,切口外形美观,符合微创理念,值得推广.     

招飞体检发现腕管综合征及尺侧腕管综合征各一例

一、临床资料例 1:患者男性 ,19岁 ,无明显原因感左手麻木疼痛两年余 ,清晨较明显 ,活动手腕后可缓解。查体 :左手皮肤正常 ,正中神经分布区感觉迟钝 ,叩击腕掌侧有过电感 ,压迫腕横韧带处症状加重。Phalea试验阳性即极度屈腕并用力握拳1～ 2 min手部麻木感加重。大鱼际肌无萎缩瘫痪 ,左拇指对掌力较健侧稍弱 ,动作灵活性稍差 ,左拇外展、对掌功能无受限。左手腕部正侧位拍片未见异常 ,诊断左腕管综合征。　　例 2 :患者男性 ,19岁 ,右腕扭伤后疼痛并向环指、小指放射近 1年。查体 :右手皮肤正常 ,尺侧一个半手指掌侧感觉稍迟钝 ,叩击尺侧…     

肘关节畸形致肘管综合征肌电图特征分析

目的 对肘关节畸形致肘管综合征（CTS）患者肌电图特征进行分析,并与颈椎病、胸出口综合征等疾病相鉴别.方法 对82例肘关节一侧或双侧畸形患者,分别采用运动神经传导速度（MCV）、感觉神经传导速度（SCV）、针电极肌电图方法,对双侧尺神经、正中神经、桡神经进行检测.对仅有尺神经的MCV、SCV异常,并有肘管传导速度减慢,且有明显神经传导阻滞点,而正中神经、桡神经不受累患者,确诊为CTS.结果 在测定的82例164条尺神经中,腕-肘下3 cm处MCV减慢的共56条（34.3%）,腕部测定SCV减慢45条（27.4%）、未引出41条（25%）;36例双侧、46例单侧共118条尺神经肘管传导速度均不同程度减慢,并伴有波幅降低,卡压部位均位于肘正中或上、下1 cm左右处.82例正中神经MCV与SCV均正常;针电极肌电图检测第一背侧骨间肌、小指展肌及尺侧屈腕肌异常48例（58%）,拇短展肌及桡侧屈腕肌均未见异常.82例中,最后明确诊断为CTS单侧46例、双侧36例,均可见确定的肘管内卡压点.结论 对有肘关节畸形的患者均应作神经肌电图检测,尽早明确CTS诊断,以便及时治疗.     

脊膜瘤完全骨化1例

患者 女,65岁.因右下肢疼痛5年,加重伴双下肢麻木、跛行2月入院.查体:T1～T3椎间隙压痛阳性,平T4平面以下皮肤感觉减弱,右侧髂腰肌、股四头肌、胫前肌肌力Ⅱ级,拇长伸肌、趾总伸肌肌力Ⅰ级,腓骨长短肌肌力Ⅰ级,胫后肌、拇长屈肌、趾长屈肌肌力Ⅰ级,小腿三头肌肌力Ⅰ级,左侧髂腰肌、股四头肌肌力Ⅰ级,左侧胫前肌、拇长伸肌、趾总伸肌、腓骨长短肌、胫后肌及拇长屈肌、小腿三头肌肌力Ⅱ级.     

腕尺管综合征1例神经电生理检查分析

1 病例报告 患者女，42岁。无明显诱因出现左手环指及小指麻木1年，症状逐渐加重，左手乏力、疼痛、肌肉萎缩、精细动作受限。查体：左手爪形手，骨间肌及外展小指肌萎缩（＋＋）、肌力2级，手指外展及内收均明显受限，外展拇短肌、尺侧腕屈肌、掌长肌、桡侧腕屈肌等肌力均正常，屈腕正常。左手环指及小指尺侧半掌面皮肤刺痛觉减退，尺神经背支支配区感觉正常。     

前跗管综合征14例诊治体会

前跗管综合征是踝关节前远侧“十”字韧带与其深面的跗骨构成的骨 纤维管内的腓深神经受到卡压所致 ,多发生在部队训练中。此综合征临床报道较少 ,常常出现误诊。 1991～ 1998年 ,我们诊治前跗管综合征 14例 ,报告如下。1　临床资料1 1　一般情况　本组男 13例 ,女 1例 ;年龄 19～4 2岁 ,平均 2 3 5岁。均为单侧发病 :左足 9例 ,右足 5例。发病诱因 :踝关节扭伤 5例 ,跑、跳等训练伤 5例 ,鞋太紧 2例 ,无明显诱因 2例。症状与体征 :足背酸胀痛 ,足背内侧及第 1、2趾皮肤麻木 ,前跗管部位压痛 ,第 1、2跗趾蹼及第 1趾背侧和第 2趾背内侧皮肤…     

MR imaging of the tarsal tunnel and related spaces: normal and abnormal findings with anatomic correlation

The tarsal tunnel syndrome may be caused by extrinsic or intrinsic pressure on the posterior tibial nerve or its terminal branches. The specific symptoms depend on the extent of nerve involvement, and compression distal or proximal to the tarsal tunnel may result in variants of the syndrome. To define better the capability of MR imaging for evaluating this entity, we performed MR imaging on three normal subjects and correlated the images with cryomicrotome sections. Six patients with symptoms suggestive of tarsal tunnel syndrome also were studied with MR. In all normal subjects, MR images showed the flexor retinaculum and the structures passing deep to the retinaculum: the tibialis posterior tendon, flexor digitorum longus tendon, flexor hallucis longus tendon, and the posterior tibial neurovascular bundle. The medial calcaneal sensory branch(es) and the medial and lateral plantar nerves also were delineated. Mechanical causes of compression were shown in all six symptomatic patients. The pathologic entities included two neurilemomas, tenosynovitis involving all three tendons, a ganglion cyst arising from the flexor hallucis longus tendon sheath, posttraumatic fibrosis, and post-traumatic fibrosis with associated posttraumatic neuroma. The MR findings were confirmed surgically in five cases. MR imaging can accurately depict the contents of the tarsal tunnel and the courses of the terminal branches of the posterior tibial nerve. In our small series, MR imaging accurately showed the lesions responsible for tarsal tunnel syndrome.     

Posterior tibial nerve entrapment at the ankle

Compression of the posterior tibial nerve of the ankle, also known as tarsal tunnel syndrome (TTS), is being seen withincreasing frequency in athletes, particularly runners. For this reason, it behooves the sports medicine professional to be well informed about this condition. TTS is caused by either extrinsic or intrinsic pressure on the posterior tibial nerve or its terminal branches. The syndrome, although analogous to carpal tunnel syndrome, is much less common. The most common symptoms of TTS are numbness and burning pain in the medial heel and foot. The condition is often difficult to differentiate from plantar fasciitis. Electrodiagnostic studies, including nerve conduction studies and electromyography, help confirm the diagnosis. Conservative measures are usually unsuccessful, and surgical decompression of the tarsal tunnel is generally regarded as the treatment of choice.     

MR imaging in tarsal tunnel syndrome.

Magnetic resonance imaging was used to demonstrate the normal anatomy of the tarsal tunnel in two volunteers and to evaluate 33 feet in 27 patients with tarsal tunnel syndrome. The tarsal tunnel is a fibroosseous channel extending from the ankle to the midfoot, through which the medial tendons and the posterior tibial neurovascular bundle pass. Tarsal tunnel syndrome is a compression neuropathy of the posterior tibial nerve or one of its branches and may be caused by a variety of pathologic lesions. Magnetic resonance imaging demonstrated a mass lesion in five feet, dilated veins or varicosities in eight feet, fracture or soft tissue injury in five feet, fibrous scar in two feet, flexor hallucis longus tenosynovitis in six feet, and abductor hallucis muscle hypertrophy in one foot. Six feet were normal on MR imaging. The findings of MR imaging were confirmed in 17 of 19 patients that went to surgery. Magnetic resonance is useful for localizing lesions within the tarsal tunnel and for determining the lesion extent and relationship to the posterior tibial nerve and its branches.     

Anatomical variations within the deep posterior compartment of the leg and important clinical consequences.

The management of musculoskeletal conditions makes up a large part of a sports medicine practitioner's practice. A thorough knowledge of anatomy is an essential component of the armament necessary to decipher the large number of potential conditions that may confront these practitioners. To cloud the issue further, anatomical variations may be present, such as supernumerary muscles, thickened fascial bands or variant courses of nerves and blood vessels, which can themselves manifest as acute or chronic conditions that lead to significant morbidity or limitation of activity. There are a number of contentious areas within the literature surrounding the anatomy of the leg, particularly involving the deep posterior compartment. Conditions such as chronic exertional compartment syndrome, tibial periostitis (shin splints), peripheral nerve entrapment and tarsal tunnel syndrome may all be affected by subtle anatomical variations. This paper primarily focuses on the deep posterior compartment of the leg and uses the gross dissection of cadaveric specimens to describe definitively the anatomy of the deep posterior compartment. Variant fascial attachments of flexor digitorum longus are documented and potential clinical sequelae such as chronic exertional compartment syndrome and tarsal tunnel syndrome are discussed.     

Tarsal tunnel syndrome in runners.

Tarsal tunnel syndrome has only recently been noted to be a cause of foot and ankle pain in runners. The tarsal tunnel is located just posterior to the medial malleolus and may compress the posterior tibial nerve as it passes through it, producing numbness and paraesthesia in the foot. While the aetiology of this condition is frequently multifactorial, abnormal foot and ankle mechanics and excessive training tend to be the most commonly cited aetiological factors. Successful treatment of tarsal tunnel syndrome requires an accurate diagnosis by differentiating it from plantar fasciitis and Achilles tendinitis and then making proper biomechanical and training changes in the runner. Conservative treatment is generally successful, but occasionally surgical treatment is required to decompress the nerve.     

MR imaging of flexor digitorum accessorius longus

Objective The flexor digitorum accessorius longus muscle (FDAL), an anomalous muscle about the ankle, has recently been implicated in tarsal tunnel syndrome. The purpose of this study is to document the prevalence of the FDAL, its MR appearance and its relation to the neurovascular bundle in the tarsal tunnel. Design and patients The prevalence of the FDAL was determined from 100 ankle MR examinations in asymptomatic individuals. The appearance of the FDAL was summarized from 20 examples of FDAL: six gathered from the asymptomatic group and 14 acquired from a group of randomly collected cases of patients with ankle complaints. Results The prevalence of the FDAL was 6%, calculated from the group of 100 asymptomatic individuals. Possessing a dominant fleshy component in the tarsal tunnel, the FDAL accompanies the posterior neurovascular bundle as it descends the ankle. Conclusion The FDAL is encountered in 6% of asymptomatic individuals. Its prominent fleshy component in the tarsal tunnel and its close proximity to the posterior tibial neurovascular bundle readily differentiate the FDAL from other medial anomalous muscles on MR imaging. Received: 29 September 1998 Revision requested: 6 November 1998 Revision received: 30 November 1998 Accepted: 30 November 1998     

Ultrasound of the tarsal tunnel: Normal and pathological imaging features

Tarsal tunnel syndrome is a condition that is caused by compression of the tibial nerve or its associated branches. Diagnosis is based on clinical findings but imaging is performed to exclude a cause of compression, identified in 60 to 80% of cases. Ultrasound is a useful examination because of its high spatial resolution and ability to rapidly perform an axial survey of the nerves. The ultrasound imaging features of the tarsal tunnel are described. The etiologies and different types are illustrated through a review of clinical cases.     

Nerve entrapment of the foot and ankle in runners

In the 10 years 1972 through 1982, the senior author performed 21 operations on 15 runners with persistent foot and ankle pain. The operative procedures involved decompression of peripheral nerves in the foot and ankle, consisting of release of soft tissues in the tarsal tunnel and foot or removal of abnormal bony excrescences that were irritating these nerves. All 15 runners had good to excellent results and all returned to their preinjury running status, including the competitive athletes. Foot and ankle pain is best treated conservatively, but when signs and symptoms culled from a careful history and physical examination reflect a nerve entrapment syndrome, surgical intervention has its place in the armamentarium of the surgeon.     

Entrapment neuropathies III: lower limb

Clinicians frequently encounter compressive neuropathies of the lower extremity. The clinical history and physical examination, along with electrodiagnostic testing and imaging studies, lead to the correct diagnosis. The imaging characteristics of the compression neuropathies can include acute and chronic changes in the nerves and the muscles they innervate. We provide a detailed review of compression neuropathies of the lower extremity with an emphasis on magnetic resonance (MR) imaging characteristics. We discuss the clinical presentation, etiology, anatomical location, and MR imaging appearance of these neuropathies, including the piriformis syndrome, iliacus syndrome, saphenous neuropathy, obturator neuropathy, lateral femoral cutaneous neuropathy (meralgia paresthetica), proximal tibial neuropathy, common peroneal neuropathy, deep peroneal neuropathy, superficial peroneal neuropathy, tarsal tunnel syndrome, Baxter's neuropathy, jogger's foot, sural neuropathy, and Morton's neuroma.