前跗管综合征发病机制、诊断及治疗研究

The diagnosis and treatment of anterior tarsal tunnel syndrome with an investigation of its pathogenesis

目的 探讨前跗管综合征发病机制中的解剖学因素及其与临床表现和治疗的关系。方法对１３例前附管综合征患者进行手术治疗，并解剖观察１３例成人尸体下肢踝部标本。结果（１）路■长伸肌肌腹进入中间管者，尸体解剖组４例（４／１３）；临床组３例（３／１３）。（２）静脉骑跨腓深神经者，尸体解剖组５例（５／１３）；临床组５例（５／１３）。（３）踝部伸肌下支持带上支深层构成前跗管前壁，系由致密结缔组织构成。结论腓深神经在前跑管内受压为发病的主要因素，其前置变异解剖因素值得重视，临床诊断及鉴别诊断要注意是否存在双卡压综合征的可能性，手术治疗效果良好。

To study the anatomical factor which involved in the anterior tarsal tunnel syndrome and its clinical manifestations as well as the relations with treatment. Methods 13 cases of anterior tarsal tunnel syndrome were operated upon and 13 adult cadaveric feet specimens were observed in dissection. Results in cadaveric specimens, the extensor hallucis longus muscle fibers and tendon extended into the intermediate tunnel were found in 4. In clinical cases the extensor hallucis longus muscle fibers and tendon extended into the intermediate tunnel were seen in 3. Overriding veniplex on the deep peroneal nerve were found in 5 in both cadaveric specimens and clinical cases. The anterior tarsal tunnel consisted of connective tissue and the anterior wall of anterior tarsal tunnel consisted of the inferior extensor retinaculum. Conclusion The compression of the deep peroneal nerve in the anterior tarsal tunnel is considered as a main cause of this syndrome; and the anatomical factor and anatomical variatons should not be overlooked. The 'existece of the double crush － compression syndrome' should not be neglected in the diagnosis. The surgical explorations has proved to be an effective management for this condition.