Predictive Reliability of the Phoenix Sign for the Outcome of Common Fibular (Peroneal) Nerve Decompression Surgery

A positive Phoenix sign occurs when a patient, with a suspected focal nerve entrapment of the Common Fibular (Peroneal) Nerve (CFN) at the level of the fibular neck, demonstrates an improvement in dorsifexion after an ultrasound guided infiltration of a sub-anesthetic dose of lidocaine. Less than 5 cc’s of 1% or 2% lidocaine is utilized and the effect is seen within minutes after the infiltration, but usually lasts only 10 minutes. This effect may be due to the vasodilatory action of lidocaine on the microcirculation in the area of infiltration. This nerve block has significant diagnostic utility as it is highly specific in the confirmation of true focal entrapment of the CFN, has high predictive value for a patient who may undergo surgical nerve decompression if they have demonstrated a positive Phoenix Sign, and may help in the surgical decision-making process in patients who have had a drop foot for many years but still may regain some motor function after decompression. In this retrospective review, 26 patients were tested, and 25 of this cohort demonstrated a Positive Phoenix Sign (an increase in dorsiflexion strength of the Extensor Hallucis Longus muscle (EHL)). One patient had no response to the peripheral nerve block. Of the 25 patients who demonstrated a positive “Phoenix Sign” and underwent nerve decompression of the CFN, and 25 (100%) showed an increase in dorsiflexion strength of the EHL after nerve decompression surgery of the CFN. The one patient in this cohort who did not demonstrate any improvement in dorsiflexion of the EHL after the nerve block did not have any improvement after surgery.

腓总神经继发性卡压的治疗

目的 探讨坐骨神经损伤后腓总神经继发性卡压的发生机制、诊断及治疗。方法 对 5例坐骨神经损伤后患者的临床表现、腓管 Tinel征及治疗情况等进行综合分析 ,发现 5例患者均存在腓总神经继发性卡压 ,均行腓管切开减压松解。结果 术后随访 13～ 37个月 ,平均 2 5个月 ,4例足背伸肌力由术前 0～ 级恢复至 ～ 级 ,1例未恢复。结论 坐骨神经损伤后腓管处产生腓总神经继发性卡压 ,一旦诊断明确 ,须尽早行腓管切开减压 ,亦可在早期修复坐骨神经时行腓管松解术 。

股骨骨折石膏固定术后腓总神经损伤的原因及处理

目的:总结股骨骨折石膏固定术后的腓总神经损伤的经验和教训。方法:回顾调查股骨骨折127例,对其中5例出现骨折石膏固定术后的腓总神经损伤的病例,分析损伤的原因及处理的临床疗效。效果:股骨骨折石膏固定术后腓总神经损伤常常产生于石膏固定后对腓总神经的牵拉、压迫。及时处理疗效尚为理想。结论:正确把握石膏固定方法,及时观察处理是解决股骨骨折石膏固定术后的腓总神经损伤的有效途径。

外伤性腓总神经卡压征的手术疗效

目的 探讨外伤性腓总神经卡压征的手术时机、方法与疗效的关系。方法 对16例外伤性腓总神经卡压征进行手术,术中发现腓总神经有不同程度的水肿、粘连,色泽苍白或暗淡,神经外膜血管网模糊不清或消失。术后随访3个月至2年,观察双下肢胫骨前肌、腓骨长短肌、长伸肌、趾长伸肌等肌力及小腿外侧、足背皮肤感觉恢复情况。结果 按顾玉东单根神经功能评定标准评定,16例中疗效优12例,良2例,差2例。结论 创伤引起的腓总神经卡压征因伤情不同,卡压程度亦各不相同,早期进行彻底的神经松解术,疗效比较满意。

胫神经肌支移位修复腓深神经的显微解剖

目的探讨胫神经肌支移位修复腓深神经的可行性。方法选取12具（23侧）福尔马林固定的成人下肢标本．解剖并测量胫神经各肌支的长度、直径、发出点至腓骨小头水平截面的距离（位置）和腓深神经近端的直径：模拟神经移位并测量各肌支的发出点至腓骨颈的距离。结果胫神经趾长屈肌支、躅长屈肌支和比目鱼肌浅支的平均长度分别为（95．70±13．40）mm、（96．90±13．60）mm和（73．60±12．00）mm，平均直径分别为（0．63±0．16）mm、（0．65±0．20）mm和（1．56±0．26）mm；腓深神经近端的平均直径为（2．54±0．26）mm。所有标本的胫神经趾长屈肌支和躅长屈肌支以及22侧（95．7％）标本的比目鱼肌浅支在长度上能够直接移位至腓骨颈处的腓深神经。胫神经的其他肌支均没有足够的长度直接移位至腓骨颈水平。结论实验证实胫神经肌支移位修复腓深神经在解剖学上可行。综合考虑神经的长度、直径以及手术操作难易度，比目鱼肌浅支是移位的最佳供体神经。