改良胫后神经松解术治疗跗管综合征的疗效观察

Efficacy of modified posterior tibial neurolysis on tarsal tunnel syndrome

目的评价改良胫后神经松解术治疗跗管综合征的疗效。方法选取2019年1月-2022年4月符合手术适应证的跗管综合征(TTS)患者23例(25足),采用局部麻醉下屈肌韧带切开、胫后神经血管周围松解,在不过度剥离的情况下进行跗管减压手术的方法进行治疗。分别在术前、术后第1天、术后1周、2周、术后3个月,采用视觉模拟评分法(VAS)评估记录患者疼痛程度;采用Kelly评定法以麻木症状缓解程度来评价疗效;两点辨别评价触觉功能;监测术前及术后3个月肌电图感觉神经及运动神经传导速度。结果术后第1天、术后1周、2周及术后3个月患者疼痛评分(VAS),麻木感(Kelly分级)优良率及两点辨别觉较术前改善,差异有统计学意义(P<0.001)。术前与术后运动神经传导速度(MCV)及感觉神经传导速度(SCV)差异有统计学意义(P<0.05)。结论对于严格符合手术适应证的跗管综合征,应用改良胫后神经松解术可以迅速且显著地减轻患者的疼痛及麻木症状,有效改善两点辨别觉。合并糖尿病患者通过改良胫后神经松解术也可以明显改善症状。

Objective To evaluate the efficacy of modified posterior tibial neurolysis in the treatment of tarsal tunnel syndrome(TTS).Methods From January 2019 to April 2022,23 patients(with 25 feet)with tarsal tunnel syndrome(TTS)were eligible for surgery.They underwent flexor ligament incision and posterior tibial nerve and perivascular release under local anesthesia without excessive stripping.Before surgery,on the 1st day after surgery,1 week after surgery,2 weeks after surgery,and 3 months after surgery,the visual analogue scale(VAS)was used to evaluate and record the patient's pain level;the Kelly assessment method was used to evaluate the degree of numbness symptom relief;to evaluate the efficacy;two-point discrimination to evaluate tactile function;and monitor electromyography sensory nerve and motor nerve conduction velocity before surgery and 3 months after surgery.Results In this group of patients,the patient's pain score(VAS),numbness(Kelly classification),excellent and good rate,and two-point discrimination 1 day after surgery,1 week after surgery,2 weeks after surgery,and 3 months after surgery were statistically significant compared with those before surgery(P<0.001).There was no significant difference in motor nerve conduction velocity(MCV)and sensory nerve conduction velocity(SCV)between preoperative and postoperative periods(P<0.05).Conclusion For tarsal tunnel syndrome that strictly meets the indications,the application of modified posterior tibial neurolysis can quickly and significantly reduce the patient's pain and numbness symptoms,and effectively improve two-point discrimination.Patients with diabetes can also significantly improve their symptoms through modified posterior tibial nerve release.