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題名 | Tarsal Tunnel Syndrome--Surgical Results and Prognostic Factors=跗骨隧道症候群--手術治療與預後因子的分析 |
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作者 | 蔡維軒; 陳理維; 楊國強; 徐圭璋; 林政達; 劉文忠; 何彥儀; Tsai, Wei-hsuan; Chen, Lee-wei; Yang, Kuo-chung; Hsu, Kuei-chang; Lin, Cheng-ta; Liu, Wen-chung; Ho, Yen-yi; |
期刊 | 臺灣整形外科醫學會雜誌 |
出版日期 | 20161200 |
卷期 | 25:4 2016.12[民105.12] |
頁次 | 頁306-313 |
分類號 | 416.293 |
語文 | eng |
關鍵詞 | 跗骨隧道症候群; 手術治療; 預後因子; Tarsal tunnel syndrome; Surgery; Prognostic factor; |
中文摘要 | 背 景:跗骨隧道症候群是足踝內側脛神經的壓迫性神經病變,常見症狀為足踝內側疼痛麻木並且延伸至腳掌面。當保守治療無效時候,往往需要手術介入治療。目的及目標:我們希望藉由此研究,討論手術介入的成效與分析預後因子。材料及方法:本篇為回朔性研究,收納22 位罹患跗骨隧道症候群並且接受手術治療的患者。文章內容就患者的基本資料、理學檢查結果、跗骨隧道症候群的成因、手術的細節與預後結果做討論與分析。結 果:因為外在直接壓迫神經而罹病的患者有統計學上較好的預後 ( p = 0.04),而慢性關節炎導致跗骨隧道症候群的患者其預後較差 ( p = 0.02)。理學檢查摸到足踝內側腫塊與Tinel's sign 陽性表現的患者,手術預後有比較好的趨勢(分別為p = 0.06 與 0.07)。施行神經鬆解術的脛神經與其分枝,數量與預後無關 ( p = 0.12)。足部同時接受其他手術也不影響結果 ( p = 0.30)。結 論:跗骨隧道症候群的致病機轉是影響手術預後最重要的因素。因為外在直接壓迫神經而罹病的患者有比較好的預後,而慢性關節炎的患者其預後較差。術前理學檢查對於預測術後結果也有幫助。沒有證據顯示慣例性將脛神經與其所有分枝行鬆解對於手術預後有幫忙。而同時進行跗骨隧道症候群手術與足部其他疾病手術也是安全的。 |
英文摘要 | Background: Tarsal tunnel syndrome is a compression neuropathy of the tibial nerve in the medial ankle. Common symptoms are tingling and numbness around the medial ankle with radiation to the plantar foot. Surgical intervention is usually required when conservative treatment failed. Aim and Objectives: We aim to find out prognostic factors of surgical intervention. Materials and Methods: A retrospective chart review was conducted with 22 patients receiving surgery for tarsal tunnel syndrome. Patient demographics, physical examination findings, etiology of tarsal tunnel syndrome, operation details and surgical outcomes were analyzed. Results: Patients from compression group had significantly better outcome ( p = 0.04), while arthritis group had significantly worse outcome ( p = 0.02). Patients with the presentations of mass lesion of the medial ankle and positive Tinel's sign had a trend toward better outcome ( p = 0.06 and 0.07 respectively). The number of released nerves was not related to outcome ( p = 0.12). Additional procedures in the foot other the tarsal tunnel release had no statistic influence on outcome ( p = 0.30). Conclusion: The etiology of tarsal tunnel syndrome is the most important prognostic factor. Patients with tibial nerve compression by space-occupying lesions have better surgical outcomes, whereas arthritis-induced tarsal tunnel syndrome is associated with poor surgical outcomes. Physical examination findings are helpful in predicting surgical outcomes. We found no evidence supporting that a routine release of all tibial nerve branches improves surgical outcomes. |
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