腓浅神经的行程与腓骨骨折的手术入路

目的：体表定位腓浅神经,为腓骨骨折提供安全合适的手术入路。方法：经4%甲醛溶液固定的成人尸体下肢标本66例,男42例,女24例;年龄37～88岁,平均69岁;左侧35例,右侧31例。对下肢的腓浅神经进行解剖,观察测量腓浅神经在小腿各部位的行走、分支情况及与体表标志的关系。结果：腓浅神经于腓骨颈的前外侧离开腓总神经,旁开腓骨头与外踝连线稍前方,下行于肌内、深筋膜下和浅筋膜内;主干12例在小腿以单支向下至足背,50例在穿出深筋膜于浅筋膜内分为2支,4例穿出肌肉后即分为2支。结论：为了避免损伤腓浅神经,腓骨中上段骨折宜从腓侧后肌间隙入路,腓骨下段骨折宜从腓侧前肌间隙入路。目的：体表定位腓浅神经,为腓骨骨折提供安全合适的手术入路。方法：经4%甲醛溶液固定的成人尸体下肢标本66例,男42例,女24例;年龄37～88岁,平均69岁;左侧35例,右侧31例。对下肢的腓浅神经进行解剖,观察测量腓浅神经在小腿各部位的行走、分支情况及与体表标志的关系。结果：腓浅神经于腓骨颈的前外侧离开腓总神经,旁开腓骨头与外踝连线稍前方,下行于肌内、深筋膜下和浅筋膜内;主干12例在小腿以单支向下至足背,50例在穿出深筋膜于浅筋膜内分为2支,4例穿出肌肉后即分为2支。结论：为了避免损伤腓浅神经,腓骨中上段骨折宜从腓侧后肌间隙入路,腓骨下段骨折宜从腓侧前肌间隙入路。     

带腓浅动脉远端蒂筋膜皮瓣的临床应用

1998年 2月～ 2 0 0 2年 3月 ,采用带腓浅动脉远端蒂的筋膜皮瓣转移修复小腿中下段、踝部及跟部软组织缺损 11例 ,皮瓣全部成活 ,效果良好 ,报道如下。1　应用解剖　　腓浅动脉在腓骨小头下约 4 7ｃｍ处起自胫前动脉[1] ,向前外走行 ,行经小腿前外侧肌间隔 ,趾长伸肌与腓骨长肌之间 ,动脉起始处外径 1 0ｍｍ ,伴行静脉 2条 ,行程中有腓浅神经伴行 ,在小腿中下部与腓浅神经一起穿出深筋膜进入皮下 ,由起始到穿出深筋膜的长度为 2 6 9ｃｍ[2 ] ,腓浅动脉较粗且恒定存在 ,它在下降的过程中 ,尚得到 3～ 4条胫前动脉下段肌间隙穿血管的加强 ,…     

腓浅神经营养血管远端蒂皮瓣感觉重建的解剖学基础

目的 为腓浅神经营养血管远端蒂皮瓣感觉功能重建提供解剖学依据. 方法 在40侧常规防腐的成人下肢标本上,解剖观测小腿外侧部感觉神经的来源、走行及分布规律.1例标本摹拟手术设计. 结果 ①腓肠外侧皮神经在腓骨头尖平面上方约7 cm处自腓总神经发出,向下随腓总神经行一短程后穿出胭筋膜至小腿外面,沿途发出1～3个终支,分布于小腿后外侧Ⅰ、Ⅱ区的皮肤.②腓浅神经在腓骨头下1.9 cm处起于腓总神经,先于腓骨长肌与腓骨之间向下向前行,继降于腓骨长肌与腓骨短肌之间并分支供应两肌,其主干(纯感觉支)径直下行于腓骨短肌与小腿前肌间隔之间,在小腿外侧Ⅱ、Ⅲ区交界处穿出深筋膜至皮下组织中分为足背内侧、中间皮神经,分布于小腿外侧Ⅲ区和足背的皮肤.结论 通过腓肠外侧皮神经主干与受区感觉神经分支吻合,可重建腓浅神经营养血管远端蒂皮瓣的感觉功能.     

踝关节外伤性腓总神经卡压综合征的治疗

目的探讨踝关节外伤性腓总神经卡压综合征的发生机制及治疗效果。方法对16例踝关节外伤性腓总神经卡压综合征进行综合治疗,其中11例保守治疗,5例进行手术治疗,术中发现腓总神经有不同程度的水肿、黏连,色泽苍白或暗淡,外膜增厚。结果本组均获随访,随访时间8个月～6年,平均4年。观察双下肢胫骨前肌、腓骨长短肌、伸足母长肌及伸趾长肌等肌力及小腿外侧、足背皮肤感觉恢复情况。16例患者腓总神经损伤的功能有不同程度恢复,其中优10例,良4例,可1例,差1例。结论对于踝关节损伤引起腓总神经卡压综合征予以保守治疗为主,但对于诊断完全性神经损伤保守治疗无效的患者及早行神经松解术,疗效比较满意。     

外伤性腓总神经卡压征的手术疗效

目的 探讨外伤性腓总神经卡压征的手术时机、方法与疗效的关系。方法 对16例外伤性腓总神经卡压征进行手术，术中发现腓总神经有不同程度的水肿、粘连，色泽苍白或暗淡，神经外膜血管网模糊不清或消失。术后随访3个月至2年，观察双下肢胫骨前肌、腓骨长短肌、躅长伸肌、趾长伸肌等肌力及小腿外侧、足背皮肤感觉恢复情况。结果 按顾玉东单根神经功能评定标准评定，16例中疗效优1：2例，良2例，差2例。结论 创伤引起的腓总神经卡压征因伤情不同，卡压程度亦各不相同，早期进行彻底的神经松解术，疗效比较满意。     

保守疗法治疗腓总神经卡压综合征7例

腓总神经卡压综合征是指腓总神经在腓骨颈的骨—筋膜和内受压而产生的征候群。自 1988年～ 1994年 ,我们采用保守疗法对在门诊所遇的 7名患者进行了治疗 ,取得了良好的效果。临床资料一、一般资料　本组病例男 5例 ,女 2例 ,年龄 16～ 37岁。其中长时间屈膝下蹲所致者 4例 ,踝关节急剧内翻损伤所致者 3例。从出现症状到就诊时间为 36小时～ 3天。二、症状及诊断　腓总神经卡压综合征主要表现为 :小腿及足外侧疼痛或感觉障碍 ,疼痛于行走加快时及足内翻时加剧 ,踝背伸和伸趾无力或受限 ,足外翻力差或消失。腓骨颈处 Tinel征阳性。本组病例均…     

腓总神经损伤修复一例

男 ,30岁。因左膝外侧刀砍伤后下肢感觉、运动障碍 1个月 ,于 1996年 5月 16日入院。自觉左小腿外侧及足背麻木 ,左侧踝关节及趾背伸障碍。检查 :左膝外侧长 8cm瘢痕 ,左小腿外侧及足背感觉消失 ,左胫骨前肌、口止母长伸肌、趾长、短伸肌及腓骨长、短肌肌力 0级 ,神经干叩击试验阳性。手术自左侧股后、腓骨小头上约 8cm处 ,沿股二头肌内缘向下外经腓骨小头后方 ,转向腓骨颈前下 ,长约 15 cm呈S形切口 ,解剖腓总神经。在距腓骨小头下 3cm处 ,见腓深、浅神经完全断裂 ,松解远近神经断端 ,屈膝 90°位用 9/ 0针线吻合腓深浅神经外膜。术后长腿…     

腓总神经嵌压综合征

报告腓总神经嵌压综合征９例，用保守疗法治疗３例，手术治疗６例，获满意疗效。该症的发生与腓总神经在窝至腓骨颈的解剖特点密切相关。主要病因为膝关节急剧屈曲下蹲位劳动使腓总神经反复损伤和局部赘生物压迫。临床表现为胫前肌、腓骨长肌、长伸肌、趾长伸肌等肌力减退或麻痹，小腿外侧及足背皮肤麻木或感觉缺失。电生理检查对诊断有一定价值。早期可保守治疗，３个月无效者，即应手术探查。局部赘生物嵌压者，应将其切除，进行彻底的神经松解术。     

前跗管综合征

踝部伸肌支持带下方的腓深神经受累综合征报告很少。作者报告4例,称之为前跗管综合征,并认为该病值得重视。病人男性66岁。主诉右足背持续疼痛、感觉异常并放散到(足母)趾,症状严重,夜间可痛醒。穿高筒靴、系紧靴带时症状加重。检查发现右足第一蹠骨间区感觉过敏,1,2趾间皮肤感觉消失。伸趾肌力无减弱,但伸趾短肌摸不到收缩。在右跗管前按压腓深神经处,第一趾间区感觉异常。肌电图显示伸趾短肌呈去神经状态且自主活动性降低。腓深神经远段运动潜伏期为8.2毫秒。胫前肌无损害,腓骨小头至踝关节段腓深神经传导速度正常。右跗管前处类固醇封闭治疗,每周2次,疼痛和感觉异常消失,但4周后感觉缺失仍     

腓总神经医原性损伤二例

1　病历介绍　例1,女性,50岁。车祸致伤左下肢2ｈ入院。入院诊断:左股骨髁上及左胫腓骨上端开放性粉碎性骨折、失血性休克。即刻抗休克治疗,同时行手术内固定。术中处理胫骨上端骨折时,取髂骨及同侧上段腓骨植骨。术后次日查房,查见左足背伸肌力0级,左腓骨长、短肌肌力Ⅰ级。左足背及左小腿外侧面感觉迟钝。考虑为左腓总神经损伤,给予神经营养药物治疗无明显改善,半个月后,切口甲级愈合。在硬膜外麻醉下行神经探查术,术中见左腓总神经被首次手术取腓骨植骨时未取出之腓骨小头骨断端卡压,神经梭形肿胀,将腓骨头取出,神经予以松解。术后辅以神…     

Superficial peroneal nerve syndrome: an unusual nerve entrapment. Case report

Lower-extremity pain and paresthesia have multiple origins. Early recognition of the symptoms of peripheral nerve entrapment leads to timely treatment and avoids the cost of unnecessary studies. The authors report on a case of superficial peroneal nerve syndrome resulting from nerve herniation through a fascial defect, which was responsive to surgical treatment. This 22-year-old man presented with pain and paresthesias over the lateral aspect of the right calf and the dorsum of the foot without motor weakness. Exercise led to the formation of a tender bulge approximately 12 cm above the lateral malleolus. Percussion of this site worsened his symptoms. Radiography and electromyography studies were nondiagnostic. The patient underwent surgical decompression that involved division of the fascia overlying the nerve and neurolysis of the superficial peroneal nerve. The operation resulted in symptom-free relief. Superficial peroneal nerve syndrome is an entrapment neuropathy that results from mechanical compression of the nerve at or near the point where the nerve pierces the fascia to travel within the subcutaneous tissue. Surgical decompression of the mechanical entrapment usually provides relief from pain and paresthesia.     

Potential Entrapment of an Accessory Superficial Peroneal Sensory Nerve at the Lateral Malleolus: A Cadaveric Case Report and Review of the Literature

The superficial peroneal nerve presents great anatomic variability regarding its emergence from the crural fascia, course, branching pattern, and distribution area. Entrapment neuropathy of the superficial peroneal nerve has been documented in the published data, resulting in pain and paresthesia over the dorsum of the foot. We report a case of a female cadaver in which an accessory superficial peroneal sensory nerve was encountered. The nerve originated from the main superficial peroneal nerve trunk, proximal to the superficial peroneal nerve emergence from the crural fascia, and followed a subfascial course. After fascial penetration, the supernumerary nerve was distributed to the skin of the proximal dorsum of the foot and lateral malleolar area. A potential entrapment site of the nerve was observed at the lateral malleolar area, because the accessory nerve traveled through a fascial tunnel while perforating the crural fascia, and presented with distinct post-stenotic enlargement at its exit point. The likely presence of such a very rare variant and its potential entrapment is essential for the physician and surgeon to establish a correct diagnosis and avoid complications during procedures to the foot and ankle region.     

Less Invasive Combined Micro- and Endoscopic Neurolysis of Superficial Peroneal Nerve Entrapment: Technical Note

As superficial peroneal nerve (S-PN) entrapment neuropathy is relatively rare, it may be an elusive clinical entity. For decompression surgery addressing idiopathic S-PN entrapment, narrow- area decompression may be insufficient and long-area decompression along the S-PN from the peroneus longus muscle (PLM) to the peroneal nerve exit site may be required. To render it is less invasive, we performed S-PN neurolysis in a combined microscope/endoscope procedure. We report our surgical procedure and clinical outcomes. We microsurgically decompressed the affected S-PN under local anesthesia without a proximal tourniquet. We made a small linear skin incision at the distal portion of the S-PN, performed distal decompression of the S-PN where it penetrated the deep fascia, and then performed proximal decompression under an endoscope. At the site where the S-PN exited the PLM, we placed additional small incisions and proceeded to microscopic decompression. We surgically treated three patients with S-PN entrapment. They were two men and one woman ranging in age from 66 to 85 years. The mean postoperative follow-up was 22 months. Their symptoms before treatment and at the latest follow-up visit were recorded on the numerical rating scale (NRS). The mean incision length was 5.5 cm and 17.3 cm of the S-PN was decompressed. All three patients reported postoperative symptom improvement. There were no complications. In patients with idiopathic S-PN entrapment, long-site neurolysis under local anesthesia using a microscope/endoscope combination is useful.     

Ultrasound-guided surgical treatment for ulnar nerve entrapment: A cadaver study

Several open and endoscopic techniques for the surgical treatment of ulnar nerve entrapment at the elbow (cubital tunnel syndrome) have been described that provide decompression with or without anterior transposition. Based on our experience with US-guided decompression for carpal tunnel syndrome in our department, we developed a similar surgical technique for the decompression of the ulnar nerve at the elbow. Using sixteen cadaver upper limbs, we performed decompression of all the structures possibly responsible for ulnar nerve compression at the elbow. The structures involved were Struthers’ arcade, the cubital tunnel retinaculum, Osborne's fascia and Amadio-Beckenbaugh's arcade. The procedure was followed by anatomical dissection to confirm complete sectioning of the compressive structures, absence of iatrogenic vascular or nervous injuries and absence of nerve dislocation or instability. There were no remaining compressive structures after the release procedure. There was no iatrogenic damage to the nerves and no nerve dislocation was observed during elbow flexion or extension. In 3.4% cases, a thin superficial layer of one or more of the identified structures remained but these did not appear to compress the nerve based on US imaging. Using ultrasonographic visualization of the nerve and compressive structures is easy. Each procedure can be tailored according to the nerve compression sites. Our cadaveric study shows the feasibility of an US-guided percutaneous surgical release for ulnar nerve entrapment.     

Endoscopic Anterior Tarsal Tunnel Release: A Case Report

Anterior tarsal tunnel syndrome is a rare entrapment neuropathy of the deep peroneal nerve beneath the inferior extensor retinaculum of the ankle. We report a patient with anterior tarsal tunnel syndrome who was successfully treated with endoscopic anterior tarsal tunnel release. Our endoscopic technique, because it preserves the inferior extensor retinaculum, is potentially less traumatic than traditional surgical techniques for repairing this entrapment neuropathy.     

Operative Dekompression des Nervus peroneus superficialis

OBJECTIVE: Relief of chronic pain over the lateral aspect of the leg through decompression of the superficial peroneal nerve where it emerges from the deep fascia of the leg. INDICATIONS: Chronic pain over the lateral side (lower quarter) of the leg and the dorsum of the ankle exaggerated by activities of daily living and sports; sometimes sensory abnormality or decreased sensibility in the distribution of the nerve over the dorsum of the foot. Presence of a positive Tinel-Hoffmann sign at the site of compression. CONTRAINDICATIONS: Occasional pain or absence of chronic pain. SURGICAL TECHNIQUE: Before starting spinal anesthesia, the site of nerve compression has to be identified (Tinel-Hoffmann sign) and marked. Supine position, internal rotation of the affected leg. Thigh tourniquet. Longitudinal skin incision over the lateral aspect of the leg 1 cm posterior to the site of compression. The nerve is released by local fasciotomy where it emerges through the deep fascia. Release of the tourniquet and careful hemostasis. No suture of the fascia. Subcutaneous and skin suture. Sterile compressive dressing. RESULTS: Between November 1998 and April 2003, a decompression of the superficial peroneal nerve was performed in twelve legs of twelve patients (seven men and five women, average age 40 years [18-50 years]). Follow-up after an average of 48 months (12-84 months) based on subjective and clinical evaluation. The clinical examination consisted of the search for Tinel-Hoffmann sign and subjective assessment on a questionnaire. Postoperatively, at clinical examination no entrapment sign was found in any patient. The subjective rating was excellent in eight patients and good in four. It had always improved when compared with the preoperative situation. All patients would accept the surgery again for an identical condition.     

Entrapment of the lateral antebrachial cutaneous nerve exiting through the forearm fascia

Isolated lateral antebrachial cutaneous nerve entrapment syndromes are uncommon. This report describes the compression of the lateral antebrachial cutaneous nerve of the forearm at the level of its passage through the superficial antebrachial fascia, distal to the elbow crease. Numbness and a painful dysesthesia over the radial aspect of the volar forearm were documented. Failure of conservative treatment necessitated surgical decompression.     

Bilateral Common Peroneal Nerve Entrapment After Excessive Weight Loss: Case Report and Review of the Literature

We report a case of excessive weight loss causing bilateral common peroneal nerve entrapment in a 60-year-old patient. The bilateral peroneal involvement suggested a systemic cause. Excessive weight loss during a relatively short period can cause changes in the tissues surrounding the common peroneal nerve and lead to its entrapment in the peroneal tunnel. Our patient underwent successful surgical decompression with significant improvement.     

铍针治疗颈肩部皮神经卡压综合征

目的：探讨皮神经卡压综合征的发病机制和铍针的治疗机制。方法：采用铍针治疗78例颈肩部皮神经卡压综合征的患者，枕大皮神经卡压综合征18例，枕小皮神经卡压综合征5例，肩胛上皮神经卡压综合征27例，颈横皮神经卡压综合征4例．锁骨上皮神经卡压综合征24例。其中男35例，女43例；年龄19～63岁，平均39．8岁。根据治疗前后患者颈肩部疼痛的改变判定疗效。结果：临床痊愈54例；显效16例；有效8例。结论：通过铍针对皮下组织、筋膜和肌肉的切割，使筋膜表面张力降低，松解粘连，消除瘢痕，消除感觉神经末梢所受的刺激和压迫，缓解疼痛。