| Objective:To summarize our experience of operative treatment in patients with tarsal tunnel syndrome, and explore the relation between surgical results and the involved tibial nerve bundle branches, onsets, surgical methods, and if we release epineurium and use dexamethasone intraoperatively or not. To summarize the experience of treatment about tarsal tunnel syndrome and provide references for clinical diagnosis and treatment. Methods:From Aprial of 2010 to August of 2014, we retrospectively analyzed the clinical characteristics, onsets, surgery methods, the operation intraoperatively and long-term curative effect of our hospital 55 cases(72 feet) with tarsal tunnel syndrome. We used the statistical principles to assess the relation between the surgical results and the involved tibial nerve bundle branches, onsets, surgical methods, and if we released epineurium and used dexamethasone or not. Results:This group had 55 cases(72 feet), including 23 male, 32 female. Among them, the ratio of male and female was 0.72 vs 1.The number of patients above 40 years old was 48, accounting for 87.27%.Therefore,tarsal tunnel syndrome occurred commonly in middle-aged and old-aged women.The number of left foot was 14, right foot was 24,bilateral was 17. Nerve involvement: simple medial plantar nerve was 17, simple calcaneal branch was 3, simple lateral plantar nerve was 0, two or above two nerve bundle branches involved were 52. In those 52 feet, the number of both lateral plantar nerve and calcaneal branch involved was 1, the number of both medial plantar nerve and calcaneal branch involved was 1, medial plantar nerve, lateral plantar nerve, calcaneal branch all involved was 2, both the medial plantar nerve and the lateral plantar nerve involved was 48. A total of 68 feet medial plantar nerves were involved, accounting for 94.44%.So the medial plantar nerve in tarsal tunnel syndrome was most easily affected. According to the postoperative evaluation criteria proposed by Takura, excellent was 17, good was 20, acceptable was 5, bad was 13. The excellent and good rate was 67.27%. According to the different causes of tarsal tunnel syndrome, we divided the cases into spaceoccupying, idiopathic and the others. Each group’s excellent and good rate was 90%(18/20), 45.45%(5/11), 58.33%(14/24) respectively. According to the never bundle branches involved,we divided the cases into the one branch involved and the above one branch group.Each group’s excellent and good rate was 86.68%(13/15), 60%(24/40). According to the operation methods, we divided the cases into Singh group and non Singh group. Each group’s excellent and good rate was 76.92%(10/13), 64.29%(27/42). According to whether release epineurium intraoperatively, these cases were divided into loose outer membrane group and non release membrane group, each group’s excellent and good rate was 75.00%(15/20), 62.86%(22/35). According to whether use dexamethasone introoperatively, the cases were divided into dexamethasone group and without dexamethasone group, each group’s excellent and good rate was 74.29%(26/35), 55%(11/20).Obtained through the statistical methods(spss21.0 software), we found the result of surgical treatment was related to the cause(P=0.012). Meanwhile we found no relationship between the result of surgical treatment and the involvement of bundle branch number(P=0.120), operation method(P=0.610), whether loosing the epineurium(P=0.356), or using dexamethasone(P=0.143) intraoperatively or not. The excellent and good rate of one nerve bundle branches involved group, Singh group, surgical treatment of neurolysis group, dexamethasone group was 86.67%, 76.92%, 75.00%, 74.29%, respectively higher than the controlled group, 60.00%, 64.29%, 62.86%, 55.00%. Conclusions:Tarsal tunnel syndrome occurs commonly in middle-aged and old-age women, the medial plantar nerve bundle branch was most easily affected. The result of surgical treatment was related to the onsets.We do not found relationship between surgical treatment and the involvement of bundle branch quantity, operation method, whether loosing the epineurium,or whether using dexamethasone intraoperatively. We recommend to use the Singh method for the neurolysis of tibial nerve and its branches.Therefore,we recommended nerve neurolysis and dexamethasone once occurring the fusiform swelling. |
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