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

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...

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

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 months10(6,15)months].At the last follow-up,the range of motion of dorsiflexion of the ankle6(0,10)°]and footvalgus3(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 increased from 50-73 points(61.3±8.4)points]before operation to 75-97 points(86.8±7.2)points]at the last follow-up(P<0.01).Conclusion For foot drop and varus caused by commonperoneal nerve injury,modlified posterior tibialis muscle transfer can increase the torque of ankledorsiflexion and valgus,improve the ankle range of motion,and accelerate the ankle function recovery.