Peripheral nerve injury is a serious disease and its repair is challenging. A cable-style autologous graft is the gold standard for repairing long peripheral nerve defects; however, ensuring that the minimum number of...Peripheral nerve injury is a serious disease and its repair is challenging. A cable-style autologous graft is the gold standard for repairing long peripheral nerve defects; however, ensuring that the minimum number of transplanted nerve attains maximum therapeutic effect remains poorly understood. In this study, a rat model of common peroneal nerve defect was established by resecting a 10-mm long right common peroneal nerve. Rats receiving transplantation of the common peroneal nerve in situ were designated as the in situ graft group. Ipsilateral sural nerves（10–30 mm long） were resected to establish the one sural nerve graft group, two sural nerves cable-style nerve graft group and three sural nerves cable-style nerve graft group. Each bundle of the peroneal nerve was 10 mm long. To reduce the barrier effect due to invasion by surrounding tissue and connective-tissue overgrowth between neural stumps, small gap sleeve suture was used in both proximal and distal terminals to allow repair of the injured common peroneal nerve. At three months postoperatively, recovery of nerve function and morphology was observed using osmium tetroxide staining and functional detection. The results showed that the number of regenerated nerve fibers, common peroneal nerve function index, motor nerve conduction velocity, recovery of myodynamia, and wet weight ratios of tibialis anterior muscle were not significantly different among the one sural nerve graft group, two sural nerves cable-style nerve graft group, and three sural nerves cable-style nerve graft group. These data suggest that the repair effect achieved using one sural nerve graft with a lower number of nerve fibers is the same as that achieved using the two sural nerves cable-style nerve graft and three sural nerves cable-style nerve graft. This indicates that according to the ‘multiple amplification＇ phenomenon, one small nerve graft can provide a good therapeutic effect for a large peripheral nerve defect.展开更多
Background Sural neurofasciocutaneous flap has been popularly used as an excellent option for the coverage of soft tissue defects in the lower third of leg, ankle and foot, but its free transplantation has been rarely...Background Sural neurofasciocutaneous flap has been popularly used as an excellent option for the coverage of soft tissue defects in the lower third of leg, ankle and foot, but its free transplantation has been rarely reported. The objective of our work was to investigate the operative technique and clinical results of repairing the soft tissue defects of hand and forearm with free peroneal perforator-based sural neurofasciocutaneous flap. Methods Between May 2006 and March 2007, 10 patients including 7 men and 3 women were treated. Their ages ranged from 22 to 51 years. They presented to emergency with large soft tissue defects of 16 cm × 7 cm to 24 cm × 10 cm in size in hand and forearm after injured by motor vehicle accidents （2 cases） or crushed by machine （8 cases）. Thorough debridements and primary treatments to associated tendon ruptures or bone fractures were performed on emergency. And free peroneal perforator-based sural neurofasciocutaneous flaps were transplanted when the wound areas were stable at 5 to 7 days after emergency treatment. The flaps were designed along the axis of the sural nerve according to the shape and size of the soft tissue defects, with the peroneal perforator above the lateral malleolus as the pedicle and along with a part of the peroneal artery for vascular anastomosis. Then the flaps were harvested to repair the recipient sites with the peroneal artery anastomosed to the radial （or ulnar） artery and the peroneal veins to one of the radial （or ulnar） veins and the cephalic vein respectively. The flap sizes ranged from 18 cm × 8 cm to 25 cm × 12 cm. The donor areas were closed by skin grafts. Results All of the 10 flaps survived after surgeries. Marginal necrosis occurred in only 2 cases. The skin grafts survived entirely in the donor sites, and no obvious influence on the donor legs was observed. All of the transplanted flaps presented favourable contours and good functions at 9 to 12 months＇ follow-up. Conclusions Peroneal perforator-based sural neurofasci展开更多
Introduction: There has been a surge in the use of tendoscopic surgery for treating peroneal tendons instability. The novelty of this approach demanded a literature review of its indications, limitations, and clinical...Introduction: There has been a surge in the use of tendoscopic surgery for treating peroneal tendons instability. The novelty of this approach demanded a literature review of its indications, limitations, and clinical outcomes. Aim: a literature review of the clinical studies reporting on tendoscopic peroneal tendon stabilisation surgery along with its outcomes and complications. Methods: We carried out a comprehensive review of the literature up until September 2022 with an extensive search of the MEDLINE, Embase and Cochrane library databases. Results: Initial search resulted in 66 articles. Four duplicate articles were removed. Further 30 articles were excluded after title and abstract screening. Eight studies satisfied the inclusion criteria and were included in this review. Articles were analysed for outcomes and complications. Conclusion: The tendoscopic technique for peroneal tendon instability is an effective and safe surgical technique with very low failure rate. Levels of Evidence: Level IV.展开更多
Suture and autologous nerve transplantation are the primary therapeutic measures for completely severed nerves. However, imbalances in the microenvironment and adhesion of surrounding tissues can affect the quality of...Suture and autologous nerve transplantation are the primary therapeutic measures for completely severed nerves. However, imbalances in the microenvironment and adhesion of surrounding tissues can affect the quality of nerve regeneration and repair. Previous studies have shown that human amniotic membrane can promote the healing of a variety of tissues. In this study, the right common peroneal nerve underwent a 5-mm transection in rats. Epineural nerve repair was performed using 10/0 non-absorbable surgical suture. The repair site was wrapped with a two-layer amniotic membrane with α-cyanoacrylate rapid medical adhesive after suture. Hindlimb motor function was assessed using footprint analysis. Conduction velocity of the common peroneal nerve was calculated by neural electrical stimulation. The retrograde axoplasmic transport of the common peroneal nerve was observed using fast blue BB salt retrograde fluorescent staining. Hematoxylin- eosin staining was used to detect the pathological changes of the common peroneal nerve sputum. The mRNA expression of axon regeneration-related neurotrophic factors and inhibitors was measured using real-time polymerase chain reaction. The results showed that the amniotic membrane significantly improved the function of the injured nerve;the toe spread function rapidly recovered, the nerve conduction velocity was restored, and the number of fast blue BB salt particles were increased in the spinal cord. The amniotic membrane also increased the recovery rate of the tibialis anterior muscle and improved the tissue structure of the muscle. Meanwhile, mRNA expression of nerve growth factor, growth associated protein-43, collapsin response mediator protein-2, and brain-derived neurotrophic factor recovered to near-normal levels, while Lingo-1 mRNA expression decreased significantly in spinal cord tissues. mRNA expression of glial-derived neurotrophic factor did not change significantly. Changes in mRNA levels were more significant in amniotic-membrane-wrapping-treated rats compared with展开更多
Introduction: Hereditary multiple exostosis (HME) is a hereditary disorder characterized by multiple osteochondromas. Clinical symptoms can result from compression of adjacent structures such as peripheral nerves. In ...Introduction: Hereditary multiple exostosis (HME) is a hereditary disorder characterized by multiple osteochondromas. Clinical symptoms can result from compression of adjacent structures such as peripheral nerves. In Indonesia, HME with nerve compression cases have rarely reported. Presentation of Case: An eleven-year-old female with complaining of left knee joint pain and progressive masses in left lower leg since 6 years ago. This complains followed by numbness and difficulty to dorso flexion motion on left ankle joint since four months ago. Physical examination showed of the bony masses was detected at the left lateral upper third lower leg with measuring about six into eight centimeters. Range of motion of left ankle joint patient had difficult to dorso flexion. X-ray imaging viewed demonstrates multiple exostosis appearance involving distal femoral, proximal fibula, proximal tibia and distal fibula bone. MR Imaging revealed cartilage cap of head fibula is thin less 1.5 cm and the axially specimen showed peroneal nerve compression. The patient underwent left head fibula wide resection. Intraoperative findings peripheral nerve peroneal compression and was decompression. Medical rehabilitation for physiotherapy was advised. The results of the follow-up after 2 years, no pain feels and the patient was able to dorso flexion of left ankle joint and no additional bumps in other areas of the body. These lesions may arise from any bone which was pre-formed in the cartilage. Nerve compression syndromes are the neurological complex symptom caused by the mechanical or dynamic compression of a specific single segment. MRI was excellent demonstration of blood vessels compromise and represents choices with peripheral nerves structures and to measuring cartilage cap thickness for criterion of osteochondromas differentiation and exostotic grade. Complete resection was importance of the cartilaginous cap to prevent recurrence. The decompressing the peroneal nerve that pressured by the masses and vascular problems occured. Con展开更多
Wallerian degeneration and nerve regeneration after injury are complex processes involving many genes, proteins and cytokines. After different peripheral nerve injuries the regeneration rate can differ. Whether this i...Wallerian degeneration and nerve regeneration after injury are complex processes involving many genes, proteins and cytokines. After different peripheral nerve injuries the regeneration rate can differ. Whether this is caused by differential expression of genes and proteins during Wallerian degeneration remains unclear. The right tibial nerve and the common peroneal nerve of the same rat were exposed and completely cut through and then sutured in the same horizontal plane. On days 1, 7, 14, and 21 after surgery, 1–2 cm of nerve tissue distal to the suture site was dissected out from the tibial and common peroneal nerves. The differences in gene and protein expression during Wallerian degeneration of the injured nerves were then studied by RNA sequencing and proteomic techniques. In the tibial and common peroneal nerves, there were 1718, 1374, 1187, and 2195 differentially expressed genes, and 477, 447, 619, and 495 differentially expressed proteins on days 1, 7, 14, and 21 after surgery, respectively. Forty-seven pathways were activated during Wallerian degeneration. Three genes showing significant differential expression by RNA sequencing (Hoxd4, Lpcat4 and Tbx1) were assayed by real-time quantitative polymerase chain reaction. RNA sequencing and real-time quantitative polymerase chain reaction results were consistent. Our findings showed that expression of genes and proteins in injured tibial and the common peroneal nerves were significantly different during Wallerian degeneration at different time points. This suggests that the biological processes during Wallerian degeneration are different in different peripheral nerves after injury. The procedure was approved by the Animal Experimental Ethics Committee of the Second Military Medical University, China (approval No. CZ20160218) on February 18, 2016.展开更多
Cutaneous nerve injury is the most common complication following foot and ankle surgery. However, clinical studies including long-term follow-up data after cutaneous nerve injury of the foot and ankle are lacking. In ...Cutaneous nerve injury is the most common complication following foot and ankle surgery. However, clinical studies including long-term follow-up data after cutaneous nerve injury of the foot and ankle are lacking. In the current retrospective study, we analyzed the clinical data of 279 patients who underwent foot and ankle surgery. Subjects who suffered from apparent paresthesia in the cutaneous sensory nerve area after surgery were included in the study. Pa- tients received oral vitamin B^2 and methylcobalamin. We examined final follow-up data of 17 patients, including seven with sural nerve injury, five with superficial peroneal nerve injury, and five with plantar medial cutaneous nerve injury. We assessed nerve sensory function using the Medical Research Council Scale. Follow-up immediately, at 6 weeks, 3, 6 and 9 months, and 1 year after surgery demonstrated that sensory function was gradually restored in most patients within 6 months. However, recovery was slow at 9 months. There was no significant difference in sensory function between 9 months and 1 year after surgery. Painful neuromas occurred in four patients at 9 months to 1 year. The results demonstrated that the recovery of sensory func- tion in patients with various cutaneous nerve injuries after foot and ankle surgery required at least 6 months.展开更多
BACKGROUND Neuropathy of the common peroneal nerve caused by compression by a fabella is an extremely rare form of compression neuropathy.Involving both the superficial and deep peroneal nerves,it usually manifests as...BACKGROUND Neuropathy of the common peroneal nerve caused by compression by a fabella is an extremely rare form of compression neuropathy.Involving both the superficial and deep peroneal nerves,it usually manifests as either impaired sensation from the lower lateral leg to the top of the foot or drop foot,or as a combination of both.CASE SUMMARY We report the case of a 58-year-old Asian female who presented with inversion of the right foot during the stance phase of gait without sensory complaints related to the lower leg.Electrodiagnostic testing revealed the neuropathy of the common peroneal nerve at the level of the knee,exclusively affecting the muscular branch of the superficial peroneal nerve.A neuromuscular ultrasound disclosed swelling of the right common peroneal nerve just before it crossed over a large fabella as well as atrophy and fatty infiltration of the right peroneus longus and peroneus brevis muscles.Surgical excision of the fabella and neurolysis were performed.Subsequently,the strength of the right foot evertors improved,but the unsteady gait with occasional falls persisted for nine months after the surgery.Therefore,another procedure was performed to transfer the split posterior tibialis tendon to the peroneus brevis in order to correct the gait.CONCLUSION This is the first case of neuropathy of the common peroneal nerve caused by compression by a fabella affecting exclusively the muscular branch of the superficial peroneal nerve.Clinicians should be aware of this unusual peripheral neuropathy while evaluating and treating patients with gait disturbance.展开更多
BACKGROUND Acute leg compartment syndrome is a well-known orthopedic emergency associated with potentially devastating consequences if not treated immediately.Multiple compartments are usually involved with a clear hi...BACKGROUND Acute leg compartment syndrome is a well-known orthopedic emergency associated with potentially devastating consequences if not treated immediately.Multiple compartments are usually involved with a clear history of trauma and classic symptoms and signs.However,isolated lateral leg compartment syndrome is relatively rare and is often misdiagnosed due to the atypical presentation of no trauma and the lack of pathognomonic signs.CASE SUMMARY A 31-year-old male patient presented to our emergency room with excruciating left calf pain and inability to mobilize one-day after participating in a football match despite no clear history of preceding trauma.The patient went to another hospital before presenting to us where he was diagnosed to have a soft tissue injury and was discharged home on simple analgesics.On clinical examination,the left leg showed a tense lateral compartment with severe tenderness.The pain was aggravated by dorsiflexion and ankle inversion.Neurovascular examination of the limb was normal.We suspected a compartment syndrome but as the presentation was atypical and an magnetic resonance imaging(MRI)was readily available in our institution,we immediately performed an MRI and this confirmed a large hematoma in the lateral compartment with a possible partial proximal peroneus longus muscle tear.The patient was taken immediately for an emergency open fasciotomy.The patient is now 18 mo postoperatively having recovered completely and engages fully in sports with no restrictions.CONCLUSION Atypical presentation due to the lack of pathognomonic signs makes the diagnosis of isolated lateral leg compartment syndrome difficult.Pain on passive inversion and dorsiflexion and weak active eversion may be suggested as sensitive signs.展开更多
Although ganglion cysts occur frequently, their presence in the lower extremities is rare and they seldom cause peripheral nerve compression. There are enumerable case reports of intraneural ganglion involvement with ...Although ganglion cysts occur frequently, their presence in the lower extremities is rare and they seldom cause peripheral nerve compression. There are enumerable case reports of intraneural ganglion involvement with the common peroneal nerve and its branches, the sural nerve, and the posterior tibial nerve but extraneural ganglion sciatic and common peroneal nerve palsy cases are quite rare. Our case, a 26 years old female patient presented with right leg tingling and radiating pain followed up gradually with progressive right sided foot drop. MRI diagnosed the lesion as a ganglion cyst and the EMG/NCV confirmed the level of compression at the right fibular head. The patient was electively operated with standard lateral approach and the ganglion cyst engulfing the common peroneal nerve was excised. The cyst was traced to the base of its articular origin, excised and stalk ligated to prevent recurrence. At 1 year, there were no signs of recurrence and the patient was symptomatically free with no residual weakness. We, thus, report to you a rare cause of common peroneal nerve palsy—a proximal tibio-fibular joint “ganglion cyst”;a cause of foot drop which can be completely reversible if treated appropriately, its implications and thus, making its early diagnosis significant.展开更多
It has been reported that stimulation of hypothalamic defence area (HDA) led to the increased release of central NA and other monoamine neurotransmitters,
BACKGROUND Peroneal tendinopathies are an under-diagnosed and potentially under-treated pathology. If left untreated it can be a cause of chronic lateral hindfoot pain. Its diagnosis is challenging owing to its low in...BACKGROUND Peroneal tendinopathies are an under-diagnosed and potentially under-treated pathology. If left untreated it can be a cause of chronic lateral hindfoot pain. Its diagnosis is challenging owing to its low incidence and vague clinical presentation.CASE SUMMARY We share a case of a patient who experienced a chronic lateral ankle pain exacerbated after alighting from a bus. This patient came to our attention only after failing conservative management on two separate occasions. Plain radiographs and magnetic resonance imaging revealed rupture of the peroneus longus tendon(PLT). Findings were confirmed intra-operatively and tenodesis of the PLT to the peroneus brevis was performed. Patient was kept non-weight-bear with his foot everted and in plantarflexion before being converted to an offloading boot at two weeks. Patient was started on a progressive rehabilitation programme at six weeks and was able to return to work shortly after with excellent outcomes.CONCLUSION We aim to share our experience in managing this patient and propose some pointers guided by available literature to avoid missing this commonly overlooked pathology.展开更多
It has been demonstrated that excitation of hypothalamic defence area (HDA) causes an increase in sympathetic activity of the cardiovascular system and changes of other functions, which may be related to the activitie...It has been demonstrated that excitation of hypothalamic defence area (HDA) causes an increase in sympathetic activity of the cardiovascular system and changes of other functions, which may be related to the activities of central monoamines; electroacupuncture applied to "Zusanli" or deep peroneal nerve stimulation (DPNS) can inhibit HDA stimulation-induced pressor, ventricular extrasystoles and other de-展开更多
BACKGROUND： Many diseases of the common peroneal nerve are a result of sciatic nerve injury. The present study addresses whether anatomical positioning of the sciatic nerve is responsible for these injuries. OBJECTIV...BACKGROUND： Many diseases of the common peroneal nerve are a result of sciatic nerve injury. The present study addresses whether anatomical positioning of the sciatic nerve is responsible for these injuries. OBJECTIVE： To analyze anatomical causes of sciatic nerve and common peroneal nerve injury by studying the relationship between the sciatic nerve and piriformis. DESIGN, TIME AND SETTING： Observe and measure repeatedly. The experiment was conducted in the Department of Anatomy, Tianjin Medical College between January and June 2005. MATERIALS： Fifty-two adult cadavers 33 males and 19 females, with a total of 104 hemispheres, and fixed with formaldehyde, were provided by Tianjin Medical College and Tianjin Medical University. METHODS： A posterior cut was made from the lumbosacral region to the upper leg, fully exposing the piriformis and path of the sciatic nerve. MAIN OUTCOME MEASURES： （1） Anatomical characteristics of the tibial nerve and common peroneal nerve. （2） According to different areas where the sciatic nerve crosses the piriformis, the study was divided into two types-normal and abnormal. Normal is considered to be when the sciatic nerve passes through the infrapiriform foramen. Remaining pathways are considered to be abnormal. （3） Observe the relationship between the suprapiriform foramen, infrapiriform foramen, as well as the superior and inferior space of piriformis. RESULTS： （1） The nerve tract inside the common peroneal nerve is smaller and thinner, with less connective tissue than the tibial nerve. When pathological changes or variations of the piriformis, or over-abduction of the hip joint, occur, injury to the common peroneal nerve often arises due to blockage and compression. （2） A total of 76 hemispheres （73.08%） were normal, 28 were abnormal （26.92%）. The piriformis can be injured, and the sciatic nerve can become compressed, when the hip joint undergoes intorsion, extorsion, or abduction. （3） The structures between the infrapiriform and suprapi展开更多
Purpose Common peroneal nerve palsy is quite disabling and every effort should be made to prevent its injury during the treatment.Methods We retrospectively reviewed the prospectively collected data of 7 cases of tibi...Purpose Common peroneal nerve palsy is quite disabling and every effort should be made to prevent its injury during the treatment.Methods We retrospectively reviewed the prospectively collected data of 7 cases of tibial plateau fractures in association with proximal fibula fracture from January 2019 to September 2019 who presented to emergency room of our hospital.Results In addition to fibular neck fracture,the first case had type 6 tibial plateau displaced fracture and the second case had displaced acetabular fracture with instability of knee with tibial tuberosity avulsion.common peroneal nerve palsy developed following application of distal tibial skeletal traction in both the cases.Other 6 such cases remained neurologically intact as traction was not applied to them.Conclusion Such iatrogenic complication could have been prevented if the injury pattern of"concomitant medial and lateral columns"of the proximal leg is kept in mind by the treating surgeon before applying skeletal traction.展开更多
Infantile peroneal nerve injury,also calledperoneal paralysis,is mostly caused by intraglutealinjection.Clinically,it is characterized by foot drop,strephenopodia,digital flexion,and high leg raisingwhile walking.The ...Infantile peroneal nerve injury,also calledperoneal paralysis,is mostly caused by intraglutealinjection.Clinically,it is characterized by foot drop,strephenopodia,digital flexion,and high leg raisingwhile walking.The authors have treated 12 cases ofperoneal nerve injury by electroacupuncture,withsatisfactory results reported as follows.展开更多
Objective： To assess the inhibitory modulation of blood pressure by stimulation of the deep peroneal nerve （DPN） and to determine the involvement of nociceptive fibers in the modulation. Methods： All the animals w...Objective： To assess the inhibitory modulation of blood pressure by stimulation of the deep peroneal nerve （DPN） and to determine the involvement of nociceptive fibers in the modulation. Methods： All the animals were divided into six groups （A-F）. The rats in groups A and B received no pretreatment. The rats in groups C and D received subcutaneous injection of capsaicin or control vehicle, respectively, near the DPN for 2 days. Those in groups E and F had the DPN exposed to capsaicin or control vehicle, respectively, for 20 min. Subsequently, pressor responses were induced by stimulation of paraventricular nucleus （PVN） either electrically （groups A and C-F） or chemically via injection of glutamate （group B）. After two stable pressor responses （baseline）, all groups were subject to 5-min DPN stimulation followed by PVN stimulation for 10 s. Arterial blood pressure, heart rate, and electrocardiogram were recorded. The pressor response was calculated as the difference in the mean arterial pressure （MAP） before and after PVN stimulation, and changes from baseline in pressor response after DPN stimulation were compared between the groups. Results： Increases of MAP of 22.88 ＋ 2.18 mm Hg and 20.32 ＋ 5.25 mm Hg were induced by electrical （group A） or chemical （group B） stimulation of the PVN, respectively. These pressor responses were inhibited by stimulation of the DPN, and the MAP was reduced to 12.00 _＋ 2.10 mm Hg in group A （n=6, P〈0.01） and 7.00 ＋ 2.85 mm Hg in group B （n=6, P〈0.01）. Subcutaneous injection of capsaicin （125 mg/kg） near the DPN in group C （n=7） had no effect on the inhibitory effect of DPN stimulation compared with the group D （n=9）, and neither did blockade of nociceptive fibers with capsaicin in group E （n=6） compared with group F （n=8）. Conclusion： Stimulation of the DPN mimicking acupuncture has an inhibitory effect on the pressor response, and the effect is mediated by capsaicin-insensitive afferent fibers in th展开更多
Schwannomas are benign, well-encapsulated and slow growing tumor arising from Schwann cells of the peripheral nerve sheath. They commonly saw in the head and neck, rarely from deep peroneal nerve in the lower limb. We...Schwannomas are benign, well-encapsulated and slow growing tumor arising from Schwann cells of the peripheral nerve sheath. They commonly saw in the head and neck, rarely from deep peroneal nerve in the lower limb. We present a case of 42-year-old active national hockey coach, who presented with mild pain and numbness over lateral aspect of left leg for 2 years. The pain was provoked by sporting activities, and was initially relieved by analgesics, until recently, hence his presentation. MRI was done and showed well-defined oval lesion within the deep intermuscular fascia between tibialis anterior and extensor halluces longus muscles. He had an open dissection, and the histology showed a diagnosis of schwannoma. Post-operative healing was uneventful, the pain and numbness improving after 12 months.展开更多
基金supported by the National Basic Research Program of China(973 Program),No.2014CB542200a grant from the Ministry of Education Innovation Team,No.IRT1201+2 种基金the National Natural Science Foundation of China,No.31271284,31171150,81171146,30971526,31100860,31040043,31640045,31671246a grant from the Educational Ministry New Century Excellent Talents Support Project in China,No.BMU20110270a grant from the National Key Research and Development Program in China,No.2016YFC1101604
文摘Peripheral nerve injury is a serious disease and its repair is challenging. A cable-style autologous graft is the gold standard for repairing long peripheral nerve defects; however, ensuring that the minimum number of transplanted nerve attains maximum therapeutic effect remains poorly understood. In this study, a rat model of common peroneal nerve defect was established by resecting a 10-mm long right common peroneal nerve. Rats receiving transplantation of the common peroneal nerve in situ were designated as the in situ graft group. Ipsilateral sural nerves（10–30 mm long） were resected to establish the one sural nerve graft group, two sural nerves cable-style nerve graft group and three sural nerves cable-style nerve graft group. Each bundle of the peroneal nerve was 10 mm long. To reduce the barrier effect due to invasion by surrounding tissue and connective-tissue overgrowth between neural stumps, small gap sleeve suture was used in both proximal and distal terminals to allow repair of the injured common peroneal nerve. At three months postoperatively, recovery of nerve function and morphology was observed using osmium tetroxide staining and functional detection. The results showed that the number of regenerated nerve fibers, common peroneal nerve function index, motor nerve conduction velocity, recovery of myodynamia, and wet weight ratios of tibialis anterior muscle were not significantly different among the one sural nerve graft group, two sural nerves cable-style nerve graft group, and three sural nerves cable-style nerve graft group. These data suggest that the repair effect achieved using one sural nerve graft with a lower number of nerve fibers is the same as that achieved using the two sural nerves cable-style nerve graft and three sural nerves cable-style nerve graft. This indicates that according to the ‘multiple amplification＇ phenomenon, one small nerve graft can provide a good therapeutic effect for a large peripheral nerve defect.
文摘Background Sural neurofasciocutaneous flap has been popularly used as an excellent option for the coverage of soft tissue defects in the lower third of leg, ankle and foot, but its free transplantation has been rarely reported. The objective of our work was to investigate the operative technique and clinical results of repairing the soft tissue defects of hand and forearm with free peroneal perforator-based sural neurofasciocutaneous flap. Methods Between May 2006 and March 2007, 10 patients including 7 men and 3 women were treated. Their ages ranged from 22 to 51 years. They presented to emergency with large soft tissue defects of 16 cm × 7 cm to 24 cm × 10 cm in size in hand and forearm after injured by motor vehicle accidents （2 cases） or crushed by machine （8 cases）. Thorough debridements and primary treatments to associated tendon ruptures or bone fractures were performed on emergency. And free peroneal perforator-based sural neurofasciocutaneous flaps were transplanted when the wound areas were stable at 5 to 7 days after emergency treatment. The flaps were designed along the axis of the sural nerve according to the shape and size of the soft tissue defects, with the peroneal perforator above the lateral malleolus as the pedicle and along with a part of the peroneal artery for vascular anastomosis. Then the flaps were harvested to repair the recipient sites with the peroneal artery anastomosed to the radial （or ulnar） artery and the peroneal veins to one of the radial （or ulnar） veins and the cephalic vein respectively. The flap sizes ranged from 18 cm × 8 cm to 25 cm × 12 cm. The donor areas were closed by skin grafts. Results All of the 10 flaps survived after surgeries. Marginal necrosis occurred in only 2 cases. The skin grafts survived entirely in the donor sites, and no obvious influence on the donor legs was observed. All of the transplanted flaps presented favourable contours and good functions at 9 to 12 months＇ follow-up. Conclusions Peroneal perforator-based sural neurofasci
文摘Introduction: There has been a surge in the use of tendoscopic surgery for treating peroneal tendons instability. The novelty of this approach demanded a literature review of its indications, limitations, and clinical outcomes. Aim: a literature review of the clinical studies reporting on tendoscopic peroneal tendon stabilisation surgery along with its outcomes and complications. Methods: We carried out a comprehensive review of the literature up until September 2022 with an extensive search of the MEDLINE, Embase and Cochrane library databases. Results: Initial search resulted in 66 articles. Four duplicate articles were removed. Further 30 articles were excluded after title and abstract screening. Eight studies satisfied the inclusion criteria and were included in this review. Articles were analysed for outcomes and complications. Conclusion: The tendoscopic technique for peroneal tendon instability is an effective and safe surgical technique with very low failure rate. Levels of Evidence: Level IV.
基金supported by Guizhou Province Major Special Projects in Science and Technology of China,No.Qin Ke He Zhong Da Zhuan Xiang Zi [2011]6002the Special Co-operation Funds of the Science and Technology Administration in Provinces and Cities of China,No.Sheng Shi He(2014)59(both to LMY)
文摘Suture and autologous nerve transplantation are the primary therapeutic measures for completely severed nerves. However, imbalances in the microenvironment and adhesion of surrounding tissues can affect the quality of nerve regeneration and repair. Previous studies have shown that human amniotic membrane can promote the healing of a variety of tissues. In this study, the right common peroneal nerve underwent a 5-mm transection in rats. Epineural nerve repair was performed using 10/0 non-absorbable surgical suture. The repair site was wrapped with a two-layer amniotic membrane with α-cyanoacrylate rapid medical adhesive after suture. Hindlimb motor function was assessed using footprint analysis. Conduction velocity of the common peroneal nerve was calculated by neural electrical stimulation. The retrograde axoplasmic transport of the common peroneal nerve was observed using fast blue BB salt retrograde fluorescent staining. Hematoxylin- eosin staining was used to detect the pathological changes of the common peroneal nerve sputum. The mRNA expression of axon regeneration-related neurotrophic factors and inhibitors was measured using real-time polymerase chain reaction. The results showed that the amniotic membrane significantly improved the function of the injured nerve;the toe spread function rapidly recovered, the nerve conduction velocity was restored, and the number of fast blue BB salt particles were increased in the spinal cord. The amniotic membrane also increased the recovery rate of the tibialis anterior muscle and improved the tissue structure of the muscle. Meanwhile, mRNA expression of nerve growth factor, growth associated protein-43, collapsin response mediator protein-2, and brain-derived neurotrophic factor recovered to near-normal levels, while Lingo-1 mRNA expression decreased significantly in spinal cord tissues. mRNA expression of glial-derived neurotrophic factor did not change significantly. Changes in mRNA levels were more significant in amniotic-membrane-wrapping-treated rats compared with
文摘Introduction: Hereditary multiple exostosis (HME) is a hereditary disorder characterized by multiple osteochondromas. Clinical symptoms can result from compression of adjacent structures such as peripheral nerves. In Indonesia, HME with nerve compression cases have rarely reported. Presentation of Case: An eleven-year-old female with complaining of left knee joint pain and progressive masses in left lower leg since 6 years ago. This complains followed by numbness and difficulty to dorso flexion motion on left ankle joint since four months ago. Physical examination showed of the bony masses was detected at the left lateral upper third lower leg with measuring about six into eight centimeters. Range of motion of left ankle joint patient had difficult to dorso flexion. X-ray imaging viewed demonstrates multiple exostosis appearance involving distal femoral, proximal fibula, proximal tibia and distal fibula bone. MR Imaging revealed cartilage cap of head fibula is thin less 1.5 cm and the axially specimen showed peroneal nerve compression. The patient underwent left head fibula wide resection. Intraoperative findings peripheral nerve peroneal compression and was decompression. Medical rehabilitation for physiotherapy was advised. The results of the follow-up after 2 years, no pain feels and the patient was able to dorso flexion of left ankle joint and no additional bumps in other areas of the body. These lesions may arise from any bone which was pre-formed in the cartilage. Nerve compression syndromes are the neurological complex symptom caused by the mechanical or dynamic compression of a specific single segment. MRI was excellent demonstration of blood vessels compromise and represents choices with peripheral nerves structures and to measuring cartilage cap thickness for criterion of osteochondromas differentiation and exostotic grade. Complete resection was importance of the cartilaginous cap to prevent recurrence. The decompressing the peroneal nerve that pressured by the masses and vascular problems occured. Con
基金funded by the National Natural Science Foundation of China,No.81572146(to HDL)the Program of Outstanding Medical Talent of Shanghai Municipal Health Bureau,China,No.2017BR034(to HDL)+1 种基金the Shuguang Program of Shanghai Education Development FoundationShanghai Municipal Education Commission,China,No.15SG34(to HDL)
文摘Wallerian degeneration and nerve regeneration after injury are complex processes involving many genes, proteins and cytokines. After different peripheral nerve injuries the regeneration rate can differ. Whether this is caused by differential expression of genes and proteins during Wallerian degeneration remains unclear. The right tibial nerve and the common peroneal nerve of the same rat were exposed and completely cut through and then sutured in the same horizontal plane. On days 1, 7, 14, and 21 after surgery, 1–2 cm of nerve tissue distal to the suture site was dissected out from the tibial and common peroneal nerves. The differences in gene and protein expression during Wallerian degeneration of the injured nerves were then studied by RNA sequencing and proteomic techniques. In the tibial and common peroneal nerves, there were 1718, 1374, 1187, and 2195 differentially expressed genes, and 477, 447, 619, and 495 differentially expressed proteins on days 1, 7, 14, and 21 after surgery, respectively. Forty-seven pathways were activated during Wallerian degeneration. Three genes showing significant differential expression by RNA sequencing (Hoxd4, Lpcat4 and Tbx1) were assayed by real-time quantitative polymerase chain reaction. RNA sequencing and real-time quantitative polymerase chain reaction results were consistent. Our findings showed that expression of genes and proteins in injured tibial and the common peroneal nerves were significantly different during Wallerian degeneration at different time points. This suggests that the biological processes during Wallerian degeneration are different in different peripheral nerves after injury. The procedure was approved by the Animal Experimental Ethics Committee of the Second Military Medical University, China (approval No. CZ20160218) on February 18, 2016.
文摘Cutaneous nerve injury is the most common complication following foot and ankle surgery. However, clinical studies including long-term follow-up data after cutaneous nerve injury of the foot and ankle are lacking. In the current retrospective study, we analyzed the clinical data of 279 patients who underwent foot and ankle surgery. Subjects who suffered from apparent paresthesia in the cutaneous sensory nerve area after surgery were included in the study. Pa- tients received oral vitamin B^2 and methylcobalamin. We examined final follow-up data of 17 patients, including seven with sural nerve injury, five with superficial peroneal nerve injury, and five with plantar medial cutaneous nerve injury. We assessed nerve sensory function using the Medical Research Council Scale. Follow-up immediately, at 6 weeks, 3, 6 and 9 months, and 1 year after surgery demonstrated that sensory function was gradually restored in most patients within 6 months. However, recovery was slow at 9 months. There was no significant difference in sensory function between 9 months and 1 year after surgery. Painful neuromas occurred in four patients at 9 months to 1 year. The results demonstrated that the recovery of sensory func- tion in patients with various cutaneous nerve injuries after foot and ankle surgery required at least 6 months.
基金Supported by the National Cheng Kung University Hospital,Taiwan,No.NCKUH-11210036.
文摘BACKGROUND Neuropathy of the common peroneal nerve caused by compression by a fabella is an extremely rare form of compression neuropathy.Involving both the superficial and deep peroneal nerves,it usually manifests as either impaired sensation from the lower lateral leg to the top of the foot or drop foot,or as a combination of both.CASE SUMMARY We report the case of a 58-year-old Asian female who presented with inversion of the right foot during the stance phase of gait without sensory complaints related to the lower leg.Electrodiagnostic testing revealed the neuropathy of the common peroneal nerve at the level of the knee,exclusively affecting the muscular branch of the superficial peroneal nerve.A neuromuscular ultrasound disclosed swelling of the right common peroneal nerve just before it crossed over a large fabella as well as atrophy and fatty infiltration of the right peroneus longus and peroneus brevis muscles.Surgical excision of the fabella and neurolysis were performed.Subsequently,the strength of the right foot evertors improved,but the unsteady gait with occasional falls persisted for nine months after the surgery.Therefore,another procedure was performed to transfer the split posterior tibialis tendon to the peroneus brevis in order to correct the gait.CONCLUSION This is the first case of neuropathy of the common peroneal nerve caused by compression by a fabella affecting exclusively the muscular branch of the superficial peroneal nerve.Clinicians should be aware of this unusual peripheral neuropathy while evaluating and treating patients with gait disturbance.
文摘BACKGROUND Acute leg compartment syndrome is a well-known orthopedic emergency associated with potentially devastating consequences if not treated immediately.Multiple compartments are usually involved with a clear history of trauma and classic symptoms and signs.However,isolated lateral leg compartment syndrome is relatively rare and is often misdiagnosed due to the atypical presentation of no trauma and the lack of pathognomonic signs.CASE SUMMARY A 31-year-old male patient presented to our emergency room with excruciating left calf pain and inability to mobilize one-day after participating in a football match despite no clear history of preceding trauma.The patient went to another hospital before presenting to us where he was diagnosed to have a soft tissue injury and was discharged home on simple analgesics.On clinical examination,the left leg showed a tense lateral compartment with severe tenderness.The pain was aggravated by dorsiflexion and ankle inversion.Neurovascular examination of the limb was normal.We suspected a compartment syndrome but as the presentation was atypical and an magnetic resonance imaging(MRI)was readily available in our institution,we immediately performed an MRI and this confirmed a large hematoma in the lateral compartment with a possible partial proximal peroneus longus muscle tear.The patient was taken immediately for an emergency open fasciotomy.The patient is now 18 mo postoperatively having recovered completely and engages fully in sports with no restrictions.CONCLUSION Atypical presentation due to the lack of pathognomonic signs makes the diagnosis of isolated lateral leg compartment syndrome difficult.Pain on passive inversion and dorsiflexion and weak active eversion may be suggested as sensitive signs.
文摘Although ganglion cysts occur frequently, their presence in the lower extremities is rare and they seldom cause peripheral nerve compression. There are enumerable case reports of intraneural ganglion involvement with the common peroneal nerve and its branches, the sural nerve, and the posterior tibial nerve but extraneural ganglion sciatic and common peroneal nerve palsy cases are quite rare. Our case, a 26 years old female patient presented with right leg tingling and radiating pain followed up gradually with progressive right sided foot drop. MRI diagnosed the lesion as a ganglion cyst and the EMG/NCV confirmed the level of compression at the right fibular head. The patient was electively operated with standard lateral approach and the ganglion cyst engulfing the common peroneal nerve was excised. The cyst was traced to the base of its articular origin, excised and stalk ligated to prevent recurrence. At 1 year, there were no signs of recurrence and the patient was symptomatically free with no residual weakness. We, thus, report to you a rare cause of common peroneal nerve palsy—a proximal tibio-fibular joint “ganglion cyst”;a cause of foot drop which can be completely reversible if treated appropriately, its implications and thus, making its early diagnosis significant.
文摘It has been reported that stimulation of hypothalamic defence area (HDA) led to the increased release of central NA and other monoamine neurotransmitters,
文摘BACKGROUND Peroneal tendinopathies are an under-diagnosed and potentially under-treated pathology. If left untreated it can be a cause of chronic lateral hindfoot pain. Its diagnosis is challenging owing to its low incidence and vague clinical presentation.CASE SUMMARY We share a case of a patient who experienced a chronic lateral ankle pain exacerbated after alighting from a bus. This patient came to our attention only after failing conservative management on two separate occasions. Plain radiographs and magnetic resonance imaging revealed rupture of the peroneus longus tendon(PLT). Findings were confirmed intra-operatively and tenodesis of the PLT to the peroneus brevis was performed. Patient was kept non-weight-bear with his foot everted and in plantarflexion before being converted to an offloading boot at two weeks. Patient was started on a progressive rehabilitation programme at six weeks and was able to return to work shortly after with excellent outcomes.CONCLUSION We aim to share our experience in managing this patient and propose some pointers guided by available literature to avoid missing this commonly overlooked pathology.
文摘It has been demonstrated that excitation of hypothalamic defence area (HDA) causes an increase in sympathetic activity of the cardiovascular system and changes of other functions, which may be related to the activities of central monoamines; electroacupuncture applied to "Zusanli" or deep peroneal nerve stimulation (DPNS) can inhibit HDA stimulation-induced pressor, ventricular extrasystoles and other de-
文摘BACKGROUND： Many diseases of the common peroneal nerve are a result of sciatic nerve injury. The present study addresses whether anatomical positioning of the sciatic nerve is responsible for these injuries. OBJECTIVE： To analyze anatomical causes of sciatic nerve and common peroneal nerve injury by studying the relationship between the sciatic nerve and piriformis. DESIGN, TIME AND SETTING： Observe and measure repeatedly. The experiment was conducted in the Department of Anatomy, Tianjin Medical College between January and June 2005. MATERIALS： Fifty-two adult cadavers 33 males and 19 females, with a total of 104 hemispheres, and fixed with formaldehyde, were provided by Tianjin Medical College and Tianjin Medical University. METHODS： A posterior cut was made from the lumbosacral region to the upper leg, fully exposing the piriformis and path of the sciatic nerve. MAIN OUTCOME MEASURES： （1） Anatomical characteristics of the tibial nerve and common peroneal nerve. （2） According to different areas where the sciatic nerve crosses the piriformis, the study was divided into two types-normal and abnormal. Normal is considered to be when the sciatic nerve passes through the infrapiriform foramen. Remaining pathways are considered to be abnormal. （3） Observe the relationship between the suprapiriform foramen, infrapiriform foramen, as well as the superior and inferior space of piriformis. RESULTS： （1） The nerve tract inside the common peroneal nerve is smaller and thinner, with less connective tissue than the tibial nerve. When pathological changes or variations of the piriformis, or over-abduction of the hip joint, occur, injury to the common peroneal nerve often arises due to blockage and compression. （2） A total of 76 hemispheres （73.08%） were normal, 28 were abnormal （26.92%）. The piriformis can be injured, and the sciatic nerve can become compressed, when the hip joint undergoes intorsion, extorsion, or abduction. （3） The structures between the infrapiriform and suprapi
文摘Purpose Common peroneal nerve palsy is quite disabling and every effort should be made to prevent its injury during the treatment.Methods We retrospectively reviewed the prospectively collected data of 7 cases of tibial plateau fractures in association with proximal fibula fracture from January 2019 to September 2019 who presented to emergency room of our hospital.Results In addition to fibular neck fracture,the first case had type 6 tibial plateau displaced fracture and the second case had displaced acetabular fracture with instability of knee with tibial tuberosity avulsion.common peroneal nerve palsy developed following application of distal tibial skeletal traction in both the cases.Other 6 such cases remained neurologically intact as traction was not applied to them.Conclusion Such iatrogenic complication could have been prevented if the injury pattern of"concomitant medial and lateral columns"of the proximal leg is kept in mind by the treating surgeon before applying skeletal traction.
文摘Infantile peroneal nerve injury,also calledperoneal paralysis,is mostly caused by intraglutealinjection.Clinically,it is characterized by foot drop,strephenopodia,digital flexion,and high leg raisingwhile walking.The authors have treated 12 cases ofperoneal nerve injury by electroacupuncture,withsatisfactory results reported as follows.
基金Supported by the National Natural Science Foundation of China (No.30870834)the Zhejiang Medical and Health Science Research Foundation(No.2008A042)the Zhejiang Provincial Natural Science Foundation of China(No.Y2110057 and No.Y2090820)
文摘Objective： To assess the inhibitory modulation of blood pressure by stimulation of the deep peroneal nerve （DPN） and to determine the involvement of nociceptive fibers in the modulation. Methods： All the animals were divided into six groups （A-F）. The rats in groups A and B received no pretreatment. The rats in groups C and D received subcutaneous injection of capsaicin or control vehicle, respectively, near the DPN for 2 days. Those in groups E and F had the DPN exposed to capsaicin or control vehicle, respectively, for 20 min. Subsequently, pressor responses were induced by stimulation of paraventricular nucleus （PVN） either electrically （groups A and C-F） or chemically via injection of glutamate （group B）. After two stable pressor responses （baseline）, all groups were subject to 5-min DPN stimulation followed by PVN stimulation for 10 s. Arterial blood pressure, heart rate, and electrocardiogram were recorded. The pressor response was calculated as the difference in the mean arterial pressure （MAP） before and after PVN stimulation, and changes from baseline in pressor response after DPN stimulation were compared between the groups. Results： Increases of MAP of 22.88 ＋ 2.18 mm Hg and 20.32 ＋ 5.25 mm Hg were induced by electrical （group A） or chemical （group B） stimulation of the PVN, respectively. These pressor responses were inhibited by stimulation of the DPN, and the MAP was reduced to 12.00 _＋ 2.10 mm Hg in group A （n=6, P〈0.01） and 7.00 ＋ 2.85 mm Hg in group B （n=6, P〈0.01）. Subcutaneous injection of capsaicin （125 mg/kg） near the DPN in group C （n=7） had no effect on the inhibitory effect of DPN stimulation compared with the group D （n=9）, and neither did blockade of nociceptive fibers with capsaicin in group E （n=6） compared with group F （n=8）. Conclusion： Stimulation of the DPN mimicking acupuncture has an inhibitory effect on the pressor response, and the effect is mediated by capsaicin-insensitive afferent fibers in th
文摘Schwannomas are benign, well-encapsulated and slow growing tumor arising from Schwann cells of the peripheral nerve sheath. They commonly saw in the head and neck, rarely from deep peroneal nerve in the lower limb. We present a case of 42-year-old active national hockey coach, who presented with mild pain and numbness over lateral aspect of left leg for 2 years. The pain was provoked by sporting activities, and was initially relieved by analgesics, until recently, hence his presentation. MRI was done and showed well-defined oval lesion within the deep intermuscular fascia between tibialis anterior and extensor halluces longus muscles. He had an open dissection, and the histology showed a diagnosis of schwannoma. Post-operative healing was uneventful, the pain and numbness improving after 12 months.
