UNASSIGNED: To observe the possibility of hyper selective neurectomy (HSN) of triceps branches combined with partial neurotomy of S 2 nerve root for relieving spastic equinus foot.
UNASSIGNED: Anatomical studies were performed on 12 adult cadaveric specimens. The S 2 nerve root and its branches were exposed through the posterior approach. Located the site where S 2 joined the sciatic nerve and measured the distance to the median line and the vertical distance to the posterior superior iliac spine plane, and the S 2 nerve root here was confirmed to have given off branches of the pelvic splanchnic nerve, the pudendal nerve, and the posterior femoral cutaneous nerve. Between February 2023 and November 2023, 4 patients with spastic equinus foot were treated with HSN of muscle branches of soleus, gastrocnemius medial head and lateral head, and cut the branch where S 2 joined the sciatic nerve. There were 3 males and 1 female, the age ranged from 5 to 46 years, with a median of 26 years. The causes included traumatic brain injury in 2 cases, cerebral hemorrhage in 1 case, and cerebral palsy in 1 case. The disease duration ranged from 15 to 84 months, with a median of 40 months. The triceps muscle tone measured by modified Ashworth scale (MAC) before operation was grade 3 in 2 cases and grade 4 in 2 cases. The muscle strength measured by Daniels-Worthingham manual muscle test (MMT) was grade 2 in 1 case, grade 3 in 1 case, and 2 cases could not be accurately measured due to grade 4 muscle tone. The Holden walking function grading was used to evaluate lower limb function and all 4 patients were grade 2. After operation, triceps muscle tone, muscle strength, and lower limb function were evaluated by the above grading.
UNASSIGNED: The distance between the location where S 2 joined the sciatic nerve and median line was (5.71±0.53) cm and the vertical distance between the location and posterior superior iliac spine plane was (6.66±0.86) cm. Before joining the sciatic nerve, the S 2 nerve root had given off branches of the pelvic splanchnic nerve, the pudendal nerve, and the posterior femoral cutaneous nerve. All the 4 patients successfully completed the operation, and the follow-up time was 4-13 months, with a median of 7.5 months. At last follow-up, the muscle tone of the patients decreased by 2-3 grades when compared with that before operation, and the muscle strength did not decrease when compared with that before operation. Holden walking function grading improved by 1-2 grades, and there was no postoperative hypoesthesia in the lower limbs.
UNASSIGNED: HSN of triceps branches combined with partial neurotomy of S 2 nerve root can relieve spastic equinus foot without damaging other sacral plexus nerves.
UNASSIGNED: 探讨小腿三头肌肌支超选择性神经切断术(hyper selective neurectomy,HSN)联合S 2神经根部分切断缓解痉挛性马蹄足的可行性。.
UNASSIGNED: 采用12具成人尸体标本进行解剖学研究,从后路显露S 2神经根及其分支,寻找S 2神经根汇入坐骨神经的部位,测量其到中线的距离以及到髂后上棘平面的垂直距离,并确认此处的S 2神经根是否已经发出盆内脏神经、阴部神经以及股后皮神经的分支。2023年2月—11月,对4例痉挛性马蹄足患者采用比目鱼肌及腓肠肌内、外侧头肌支HSN联合S 2神经根汇入坐骨神经分支切断进行治疗。男3例,女1例;年龄5~46岁,中位年龄26岁。病因包括脑外伤2例,脑出血1例,脑瘫1例。病程15~84个月,中位时间40个月。术前小腿三头肌跖屈肌张力改良Ashworth分级(MAC)为3级2例、4级2例;Daniels-Worthingham徒手肌力分级(MMT)评定肌力为2级1例、3级1例,2例因肌张力4级而无法准确测量术前肌力;Holden步行功能分级评价下肢功能,4例患者均为2级。术后采用上述分级评价小腿三头肌跖屈肌张力、肌力及下肢功能。.
UNASSIGNED: S 2神经根汇入坐骨神经位置至中线的距离为(5.71±0.53)cm,至髂后上棘平面的垂直距离为(6.66±0.86)cm。在汇入坐骨神经前S 2神经根已发出盆内脏神经、阴部神经以及股后皮神经的分支。4例患者均顺利完成手术,随访时间4~13个月,中位时间7.5个月。末次随访时,患者肌张力较术前下降2~3级,肌力较术前无下降,Holden步行功能分级提升1~2级,均无下肢感觉减退。.
UNASSIGNED: 小腿三头肌肌支HSN联合S 2神经根部分切断可缓解痉挛性马蹄足,且不损伤其余骶丛。.