胫神经缩窄术治疗下肢痉挛性瘫痪

目的探讨胫神经缩窄术治疗下肢痉挛性瘫痪、矫正内翻马蹄足的手术适应证、手术方法。方法25例患者,其中脑瘫患者15例,其他患者10例。术前明确诊断病因,详细分析挛缩肌肉及神经支配,在显微镜下行胫神经缩窄术。术中神经电刺激定位运动神经和诱发肌电图监测。结果行胫神经缩窄术37例次,术后功能改善36肢。踝关节增加10°～45°背屈,改善率97%。内翻足26例,22足改善,改善率85%。37足中术后足底位置正常(足底完全着地)9例(24%),尚不正常4例(11%)。25例患者中,术后随意运动功能改善21例(84%),其中显著改善5例(20%)。4例无效均为脑瘫患者。结论胫神经缩窄术是治疗下肢痉挛性瘫痪、矫正内翻马蹄足,改善下肢运动的有效方法。

Neurotomy of the tibial nerve for treatment of the talipes equinovarus

Objective To explore indication and approaches of neurotomy of tibial nerve for the treatment of the talipes equinovarus and spastic paralysis. Method A total of 25 patients including 15 patients with cerebral paralysis and other 10 patients were diagnosed with clear etiology, spastic muscles with supplied nerves were analyzed in detail, neurotomy of the tibial nerve was performed under microscope, during operation, motor nerve was lovated with electronic stimuli and monitored with induced electromyocardiogram. The surgical results were analyzed. Results A total of 36 of 37(97%) neurotomy of the tibial nerve were improved with dorsum flex of ankle at 10-45 degree, and 22 of 24(85%) talipes aquinovarus improved clinically. Of 37 feet with surgery, 24 feet (65%) were in normal position and could touch ground completely, 9 feet (24%) had 10 degree with ground or could contact ground with external one third of the feet, 4 feet (11%) were abnormal. Of 25 patents, 21(84%) had improvement of motor activity at discretion, 5 patients (20%)improved dramatically. All the 4 patients failed after the operation were cerebral paralysis, and were presumably related to disorders of spinal function, abnormal reflex and the disappearance of inhibitory reflex. Conclusion Neurotomy is an effective method to treat talipes equinovarus, and can improve the motor activity of low extremity.