Method for surgical treatment of foot-drop at fibular nerve paralysis

FIELD: medicine, orthopedics, traumatology.

SUBSTANCE: one should isolate and dissect the tendons of anterior tibial and long fibular muscles to dissect the tendon of posterior tibial muscle against the site of fixation and direct it towards plantar rear area in front of internal ankle through the tunnel in subcutaneous fiber, then one should subcutaneously direct dissected tendons of anterior tibial and long fibular muscles onto plantar rear area to suture them so to leave free the tendinous end of posterior tibial muscle which should be intraosseously fixed to median wedge bone that keeps the process of foot repulsion during walking.

EFFECT: higher efficiency of therapy.

5 dwg, 1 ex

The invention relates to medicine and relates to methods of surgical treatment of diseases of musculoskeletal system, in particular, paralytic protruding foot.

Known methods of treatment of paralytic protruding foot.

1. The Way Younousovich (1).

The method - separate transplant calf muscles on the rear foot. The disadvantage of this method is the most traumatic, the difficulty adjustment transplanted to the rear of the calf muscle on a new function - extension. During this surgery, the foot is held in a position of dorsiflexion, but range of motion is extremely small.

2. The Way Aperea (2).

Surgery is indicated in patients when all of the extensors of the foot is paralyzed and in reserve is only calf.

2. The Way Ceaselessly (3).

The peculiarity of the method is to transplant the basis of the first and fifth metatarsal bones ahead of the inner and outer ankle tendons of the back blueberries and long peroneal muscle.

The disadvantage of this method. When paralysis of the peroneal nerve become paralyzed long and short peroneal muscles and they are not suitable for transplant.

4. The Way Staneva (4).

The main features of the process - transplantation of the posterior tibial muscle to the long peroneal behind the external malleolus, transplant tendon of the long flexor of the first finger and the long flexor of the fingers, the EB to the tendon of the anterior tibial muscles.

The disadvantages of the method: transplantation of the long flexor of the first finger and the long flexors of the fingers on the rear of the foot leads to the loss of the functions of these muscles. These muscles are important when walking, in particular in the implementation process of the roll.

When the loss of function of the above muscles disrupted the process of repulsion of the foot from the floor.

The posterior tibial muscle is powerful enough to perform the function of an extension of the foot when transplanting it on the forefoot. The posterior tibial muscle innerviruetsya tibial nerve (n. Tibialis), and therefore retains its function in paralysis of the peroneal nerve, and it can be used for transplantation on the rear foot.

This method is used for the prototype.

The aim of the invention is to eliminate the disadvantages of the prototype function restoration and extension of the foot when her paralysis of extensor by transplanting the posterior tibial muscle on the rear foot.

Method perform the following: perform the initial skin incision on the inner surface of the tibia in the lower third of the length of 8-10 cm, allocate the tendon of the posterior tibial muscle and take on the taped (figure 1). The second skin incision are doing on the outer surface of the tibia. Isolated and cut the tendons of the anterior tibial and the long peroneal muscle (figure 2). The third incision of the skin do on the inside is it the surface of the foot length of 6 see Cut off from the place of attachment to the tendon of the posterior tibial muscle. The fourth skin incision is made on the outer surface of the foot length 5-6 see In the first operating wound deduce (by pulling) the tendon of the posterior tibial, in a third operating wound - anterior tibial; fourth operating wound - long peroneal muscle (figure 3). On the front surface of the foot make the fifth skin incision length 8-10 see Fifth surgical wound connect subcutaneous tunnel with the first, third, fourth operating wounds. In the fifth operative wound deduce tendon posterior tibial, anterior tibial, long peroneal muscle (figure 4). Stop deduce the position of the bending angle 90°. Tendon stitched together in such a way that the left free end of the tendon, the posterior tibial muscle length 5-6 see

In the middle of the sphenoid bone shape with an awl or drill a tunnel depth of 2.5 cm, the diameter of the tunnel and tendon of the posterior tibial muscle must match.

The end of the tendon extend into the bone tunnel, jam bone allograft, optionally fixed to the periosteum of the sutures (figure 5), the wound sutured in layers. Put a plaster bandage from the toes up to the knee for 6 weeks.

The invention is illustrated graphic material: made the s on the taped 2 tendon of the posterior tibial muscle 1 (1); selection and dissection of the tendon of the anterior tibial muscles 3 and the long peroneal muscle 4 (figure 2); the selection of the tendons of the muscles 3, 4 in the outer and inner operating of the wound (figure 3); the conduct of the tendons 1.3.4 in the fifth operative wound, forming a bone tunnel 5 in the middle of the sphenoid bone (figure 4); the suture of tendons 1.3.4 between themselves and the fixation of the tendon 1 in the bone tunnel 5 using bone allografts 6 (figure 5).

The fundamental difference between the proposed method against known is that to perform the function extension of the foot transplanted one of the rear tibial muscle, held on the rear foot in front of the inner ankle.

The advantage of the proposed method over the known is that the transplanted muscle has three points of fixation: intramedullary and two with the help of the tendons of the long peroneal and anterior tibial muscles. This ensures a high stability of the foot and is the prevention of deformation in the frontal plane in the postoperative period.

The proposed method with a positive effect was performed in one patient.

Patient K., 42 years old, was admitted to the orthopedic Department of the hospital of traumatology and orthopedics of the Samara state medical University on October 16, 2000 with complaints about the sagging of the right foot. In October 2000 the patient was proops arowana on the osteo-cartilaginous exostosis head of fibula large sizes. During surgery found that the common peroneal nerve was in the thickness of the tumor and was damaged during the removal of the tumor. Stitching nerve had failed. When examination revealed paralysis of the extensors of the foot and toes. Gait kind of like “cock” with a slap supported on a horizontal surface. Extension in the ankle joint is impossible. To walk the patient uses orthopedic shoes.

The posterior tibial muscle works well and has the power of 5 points. 17 October 2001 produced by the operation of the developed method. After 6 weeks removed plaster bandage, started post-operative rehabilitation. The transplanted muscle functioning, the patient walks with a stick, roll the feet restored. Patient operation very pleased.

The method can be recommended in practical medicine.

Sources of information

1. Iasconsole. Operative Orthopaedics. M., 1994, s-325.

2. Apicerno. A.S. 1449118 from 09.09.88,

3. Iasconsole. Operative Orthopaedics. M., 1994, S. 323.

4. Bboyce, Conforti, Kookana. Operative Orthopaedics and traumatology. Sofia. 1962, S. 704-705.

The method of surgical treatment of paralytic protruding foot in paralysis of the peroneal nerve, including transplantation of leg muscles to the foot, characterized in that the highlight on the outer surface of the tibia suhaili the anterior tibial and the length of the peroneal muscles, cut them, cut off from the attachment of the tendon of the posterior tibial muscle, hold the tendon of the posterior tibial muscle on the rear foot in front of the inner ankle through the tunnel in the subcutaneous tissue, subcutaneous spend severed tendons of the anterior tibial and the length of the peroneal muscles on the rear foot, sew the tendons of these muscles between them so that the left free end of the tendon, the posterior tibial muscle, which is fixed nutricote to the middle of the sphenoid bone.