Operative Orthopadie und Traumatologie · 2020
[Surgical decompression of the peroneal nerve at the level of the fibular head].
СтатьяОбзорНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Heinrich K, Pumberger P, Schwaiger K, Schaffler G, Hladik M, Wechselberger G
Аннотация
OBJECTIVE: Functional and sensible regeneration of deficits related to common peroneal nerve palsy.
INDICATIONS: Functional deficits like foot drop, malfunctioning pronation, foot in supination and sensible deficits located at the anterior and lateral lower leg, the dorsum of the foot, the extension side of toes 1-4 and the interdigital space between toe 1 and 2, for positive Hoffmann-Tinel sign located at the fibular head and steppage gait.
CONTRAINDICATIONS: Infection, spinal cord damage and spinal cord tumors with related sensitivity disorders and paralysis, advanced multiple sclerosis, amyotrophic lateral sclerosis, pAVK IV, reinnervation refractory muscles with denervation >15-18 months, polyneuropathy, previous nerve lesions by direct trauma.
SURGICAL TECHNIQUE: Surgery in lateral position and thigh tourniquet. L‑Shaped incision made in accordance with the marking. Nerve release by fasciotomy first proximal, then distal up to the branching. Opening of the thigh tourniquet, careful coagulation. Insertion of a Mini Redovac Drainage, subcutaneous and skin sutures. Compression bandage.
POSTOPERATIVE MANAGEMENT: Full mobilization on postoperative day 1. An electric stimulation therapy can be considered after drainage removal. After suture removal physio- and ergotherapy indicated. Check ups should be performed every 3 months with clinical exams, photo and video documentation. Four months after surgery an electroneurographic exam should be done. Follow-up should be performed for 24 months.
RESULTS: From 2010-2018 15 patients received decompression of the common peroneal nerve. Sensibility, functionality and subjective feeling were evaluated. In 12 patients (80%) a full recovery, in one case (6.67%) a partial recovery and in 2 cases (13.33%) no recovery was observed.
INDICATIONS: Functional deficits like foot drop, malfunctioning pronation, foot in supination and sensible deficits located at the anterior and lateral lower leg, the dorsum of the foot, the extension side of toes 1-4 and the interdigital space between toe 1 and 2, for positive Hoffmann-Tinel sign located at the fibular head and steppage gait.
CONTRAINDICATIONS: Infection, spinal cord damage and spinal cord tumors with related sensitivity disorders and paralysis, advanced multiple sclerosis, amyotrophic lateral sclerosis, pAVK IV, reinnervation refractory muscles with denervation >15-18 months, polyneuropathy, previous nerve lesions by direct trauma.
SURGICAL TECHNIQUE: Surgery in lateral position and thigh tourniquet. L‑Shaped incision made in accordance with the marking. Nerve release by fasciotomy first proximal, then distal up to the branching. Opening of the thigh tourniquet, careful coagulation. Insertion of a Mini Redovac Drainage, subcutaneous and skin sutures. Compression bandage.
POSTOPERATIVE MANAGEMENT: Full mobilization on postoperative day 1. An electric stimulation therapy can be considered after drainage removal. After suture removal physio- and ergotherapy indicated. Check ups should be performed every 3 months with clinical exams, photo and video documentation. Four months after surgery an electroneurographic exam should be done. Follow-up should be performed for 24 months.
RESULTS: From 2010-2018 15 patients received decompression of the common peroneal nerve. Sensibility, functionality and subjective feeling were evaluated. In 12 patients (80%) a full recovery, in one case (6.67%) a partial recovery and in 2 cases (13.33%) no recovery was observed.