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中华损伤与修复杂志(电子版) ›› 2024, Vol. 19 ›› Issue (03) : 262 -265. doi: 10.3877/cma.j.issn.1673-9450.2024.03.013

病例报告

闭合性跟腱断裂微创术后腓肠神经损伤异体神经移植治疗2例
魏绮珮1, 薛云皓2,(), 杨辰2, 刘畅2, 陈山林1   
  1. 1. 100035 北京大学第四临床医学院手外科
    2. 100035 首都医科大学附属北京积水潭医院手外科
  • 收稿日期:2023-12-25 出版日期:2024-06-01
  • 通信作者: 薛云皓
  • Received:2023-12-25 Published:2024-06-01
引用本文:

魏绮珮, 薛云皓, 杨辰, 刘畅, 陈山林. 闭合性跟腱断裂微创术后腓肠神经损伤异体神经移植治疗2例[J]. 中华损伤与修复杂志(电子版), 2024, 19(03): 262-265.

患者1,女,50岁。因运动致左足跟腱断裂,伤后行微创修复手术。自诉麻醉恢复后即出现左踝跟腱止点近端外侧皮肤切口区刺痛、左足背外侧感觉丧失,且在术后康复训练过程中,负重时出现足部疼痛。保守治疗观察7个月后,患者的局部神经刺激症状未缓解,步行时疼痛明显,自觉无法耐受,影响生活质量。查体结果显示,患者小腿远端后外侧原手术切口瘢痕处Tinel征阳性(图1A)。跟腱外侧皮肤麻木伴刺痛,疼痛程度中度,足背外侧痛温感觉丧失(图1B)。因疼痛无法完成单足提踵及下蹲动作,明显跛行负重行走时视觉模拟评估量表(visual analogue scale,VAS)评分为4分,美国足踝关节协会(the American orthopaedic foot and ankle society,AOFAS)踝与后足功能评分70分,足部功能指数(foot function index,FFI)评分49分。超声结果提示:腓肠神经于伤口水平局段显示不清,考虑医源性损伤。

图1 患者1,女,50岁。A示患者小腿后侧手术瘢痕位置;B示患者感觉减退区域(红色区域)及疼痛麻木区域(黑色区域);C示术中打开切口后:取小腿后外侧切口,显露腓肠神经,松解周围瘢痕,发现原切口平面处腓肠神经分为两束,周围可见小隐静脉伴行。两束腓肠神经及小隐静脉均断裂。1,2为腓肠神经,3为小隐静脉;D示修复完毕,清创损伤段神经,修整断端。手术显微镜下使用相应长度的两根去细胞的同种异体神经行神经外膜端-端吻合,桥接修复神经断端
图2 患者2,男,41岁。A示体表微创跟腱手术瘢痕位置;B示切开后可见腓肠外侧皮神经变细伴瘢痕化,腓肠内侧皮神经被缝线约束在跟腱旁;C示切除损伤瘢痕化神经;D示异体神经显微镜下移植修复
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