PDF(Pubmed)
Abstract：
The flexor digitorum accessorius longus muscle (ALM) can be overlooked as the eliciting factor in patients with tarsal tunnel syndrome (TTS), an entrapment neuropathy of the posterior tibial nerve that elicits sole numbness and pain. Most elicitations are idiopathic, however, mass lesions within the tarsal tunnel can be also implicated. We report an 80-year-old woman whose flexor digitorum ALM led to the onset of bilateral TTS. She had suffered numbness in both soles for 3 years. Magnetic resonance imaging (MRI) of the bilateral tarsal tunnel showed that the posterior tibial nerve was compressed by the arteriovenous complex and in contact with the flexor digitorum ALM. We diagnosed bilateral TTS based on her symptoms and imaging findings, and performed bilateral decompression surgery of the posterior tibial nerve under local anesthesia. The artery on both sides was dislocated for nerve decompression. Because the posterior tibial nerve on the right side was strongly compressed in ankle plantar flexion we excised a portion of the tendon compressing the nerve. Postoperatively her symptoms gradually improved and she reported surgical satisfaction 6 months after the operation. In patients with flexor digitorum ALM-related TTS, the effect of dynamic factors on MRI findings and on surgical treatment decisions must be considered. Intraoperatively, not only the flexor digitorum ALM, but also other potential etiologic factors eliciting TTS must be kept in mind.
摘要：
耻骨管综合征（TTS）患者的诱发因素可以忽略指屈肌（ALM），胫骨后神经的压迫性神经病，引起唯一的麻木和疼痛。大多数诱发是特发性的，然而,骨隧道内的肿块病变也可能涉及。我们报告了一名80岁的女性，其屈指ALM导致了双侧TTS的发作。她的两个鞋底都麻木了3年。双侧骨隧道的磁共振成像（MRI）显示，胫骨后神经被动静脉复合体压缩，并与屈指ALM接触。我们根据她的症状和影像学发现诊断双侧TTS，并在局麻下行双侧胫后神经减压术。两侧动脉脱位，进行神经减压。由于右侧胫骨后神经在踝关节足底屈曲中被强烈压缩，因此我们切除了一部分肌腱，压缩了神经。术后症状逐渐改善，术后6个月报告手术满意度。在屈指ALM相关的TTS患者中，必须考虑动态因素对MRI表现和手术治疗决策的影响.术中,不仅仅是指屈肌ALM，但也必须牢记引起TTS的其他潜在病因。
